Unprecedented Times: Jennifer Johnson

SPIA alumna Jennifer Johnson (MPA ’14) assesses public health risks for a living. The world of COVID-19 that we now all inhabit is a world that Johnson and other emergency preparedness experts have lived in for decades.

“Emergency preparedness work is going on all the time,” said Johnson, a Senior Preparedness Field Assignee at the Centers for Disease Control and Prevention (CDC) assigned to the Tennessee Department of Health (TDH). TDH gained early media attention for its exhaustive Novel Virus Pandemic Influenza Response Plan, a roadmap for the state’s preparedness officials and other decision-makers. This massive document, derived from CDC information and best practices in real-time as the pandemic evolved, pursued an all-hazards approach to pandemic planning. Johnson assisted with the update before the state had a single reported case.

“Since we had never seen this virus, we anticipated a doomsday scenario,” said Johnson. “So, as bad as it is, what we planned for was actually worse.” This plan guided the state’s response, from communications, to testing, to logistics, to mitigation strategies and promotion, like social distancing, alternate work schedules, and reorganization, to eventual vaccine distribution.

As the events on the ground grew unnervingly close to the document’s worst-case scenario, Johnson felt anxious but also validated. “When these things happened, it was like, wow, we live in the plan. It was empowering to a degree. Now these plan buzzwords are common vernacular.”

Before COVID-19, Johnson oversaw a pilot project with the Department of Health and Human Services to test a new risk assessment tool (the Risk Identification and Site Criticality (RISC) Toolkit) on 11 regional health offices. Based on these results, Johnson submitted ideas for improvements and now facilitates adoption statewide. This toolkit has been used to assess 109 TN public health offices, identifying and prioritizing threats and hazards, accounting for supply chain disruptions, examining critical dependencies, and estimating human, property, and economic consequences of hazards.

Johnson found her way to pandemic preparedness by way of an interest in health policy. At first, that interest was broadly cast but quickly became well-defined. She entered the federal service after graduation, through a two-year fellowship with the CDC Public Health Associate Program, and was first assigned to the Placer County, California health department. There, she addressed emergency preparedness, accreditation, risk, and community health assessments, and helped to develop a community health improvement plan.

“Since it was a small health department, I really touched a lot of program areas. It was a great way to sample around,” said Johnson. “I settled on emergency preparedness as the most exciting; it’s such a diverse field, even within public health, and really only emerged as a distinct profession after 9/11.”

Johnson planned to stay on board with the CDC, applying for and being assigned to a placement in her hometown of Nashville, TN through the Preparedness Field Assignee Program. Her job includes emergency planning across a whole spectrum of incidents and potentialities, directing training, exercises, and drills, and conducting a jurisdictional risk assessment across the state.

“There’s a notion called continuity of operations, the plan that says, all right, we work in this building. [In the event of a pandemic], what do we have to do? How do you continue the essential functions?” This calculation considers “dependencies,” or the extent to which a health department depends on outside resources for critical services like water, gas, light, transportation, and electricity. Her expertise is such that, in August, she presented on vulnerability assessment and mitigation at the National Association for City and County Health Officials, Preparedness Summit, the longest running national preparedness conference.

Johnson joined the ranks at CDC on the heels of Ebola, in 2014, but her first real assignment related to pandemic response came with the Zika virus. Deploying to Atlanta, she served on the State Coordination Taskforce as Caribbean Desk Officer, tracking emergency logistical requests, facilitating daily conference calls and submitting status updates on response operations in Puerto Rico and the U.S. Virgin Islands. “I did a detail at EOC [the CDC’s Emergency Operations Center] headquarters,” she said. “They had field teams deployed across the Caribbean and in South Central American countries. It was a scary time for maternal and infant outcomes, especially for babies born prematurely. People didn’t want to travel.”

While Zika inspired significant fear, its particular path of transmission spared affected countries the current upheaval. “It’s so much deeper with COVID-19,” said Johnson. “I mean, I’ve got mosquito repellent, right? [COVID-19 mitigation strategies] ask a lot of people and organizations in order to prevent exposure. You have to cloister yourself in your home away from people, and that involves widespread global economic and societal impacts.”

Johnson maintains readiness for emergency details and serves on the CDC Global Rapid Response Team, a group made up of responders on call several months out of the year to respond to domestic and international public health emergencies. She deployed to the San Francisco airport quarantine station to screen travelers last January, just as the first U.S. COVID-19 case appeared. The early days of the virus coincided with the Chinese Lunar New Year, which involved significant visitor travel from China to the United States, including direct flights from Wuhan.

It was a highly challenging and rewarding experience. “You’re greeting travelers, screening people for symptoms, documenting where they have come from, and clearing them for onward travel with Customs and Border Patrol.” She spent three weeks of long days providing this enhanced surveillance.  “It was a tense time because [the virus] started to really hit the news. It exploded right before our eyes.”

When her deployment ended, Jennifer spent two weeks in quarantine and then went right back to work with the Tennessee Department of Health, Emergency Preparedness Program, which needed all hands on deck to prepare for the first Tennessee cases. “I have a unique position in that I’m a field-assigned federal person. I am filling key roles at a state-level health department; they don’t have a local person to do them.”

Johnson predicts that COVID-19, like Hurricane Katrina and 9/11, will transform the practice of public health. “[Major disasters] change how you practice in the field, period. Katrina [taught us] about messaging and stigma. COVID-19, I think, has taught us to invest in preparedness, and those conversations should hopefully be easier to have [now].”

The Tennessee Department of Health is using those lessons to constantly improve response levels. Under the aegis of a central task force called Unified Command, which includes the governor, health commissioner, military adjutant general, and the director of emergency management, they are currently conducting vaccine distribution and continuing to implement rural COVID-19 testing. Johnson is supporting efforts to prepare alternate care sites and train personnel in the event of a case surge that the health system cannot handle. She has a useful metaphor for the potential hospitalization crisis.

“I’ve described COVID-19 as a slow-moving tidal wave. It’s moving so slowly that you almost get comfortable with the fact it is sitting there looming. We can’t relax. You have to be ready”

“I’ve described COVID-19 as a slow-moving tidal wave. It’s moving so slowly that you almost get comfortable with the fact it is sitting there looming. We can’t relax. You have to be ready,” she said. In Memphis, they converted an old newspaper building into a 402-bed hospital, and in Nashville they rehabbed an unused wing of Nashville General to accommodate 67 more. She has directed functional exercises at each site to test readiness to activate and provide surge support.

“Say we’re going to test capabilities,” she explained. “’Can you all report for duty? Do you all know how to get to the building? Can you get into the building? How do you get patients from floor-to-floor without contaminating everybody here?’ We went through the whole thing from intake to discharge.”

Johnson gives much credit for her professional rise and relevance to lessons learned at SPIA, citing Dr. Hal Rainey’s organizational theory courses as the most impactful on her career. “He would take stories from real students who had gone on [to work in public administration].” These real scenarios would help the class brainstorm solutions to public problems, which always seemed to come back to a common denominator. “We have a mission here, but people you cannot get away from. If you cannot manage or incentivize or persuade or motivate people, you may not successfully achieve your mission.”

Johnson studied abroad twice while at SPIA, in Seoul, South Korea with the MPA program, and in Haifa, Israel as part of a global health certificate. “I didn’t leave any meat on the bone in grad school. If I could go somewhere, I went. Those were monumental learning opportunities for me.”

The exposure included a snapshot of the health systems, governance systems, and cultural norms in these countries. She accompanied nurses on in-home visits in Israel and assessed policy problems in Korea, learning about reciprocity.

“At the end of the day, they’ve invited you to come to this country. I wanted to make sure I delivered quality products to people in exchange for what I was getting. To tie that [to my day job], I’m a federal guest in any given health department. I cannot come in there and say, ‘the CDC is here to help; listen to me.’ I’m there to learn, absorb, and add value.”

This role gives her plenty of opportunities to pull from those lessons. “I think [my UGA experiences] prepared me to enter into uncomfortable spaces, learn what I can, and make a difference,” she said.

Johnson’s advice to students beginning programs in public health or public service would be to stay flexible. “As soon as you get used to something, it may change, and you will still have the same mandate. Whether laws change, where the leaders change, whether programs change, or funding is cut, things can rapidly change. But your mission will always kind of be constant, right?”

Johnson extends her passion for preparedness to her community, volunteering on the board of an organization called EARS, or Emergency Awareness and Readiness Services for the Deaf, Blind, and Hard of Hearing. The group is responsible for coordinating training and providing critical, credible information for these populations. She also mentors new CDC public health associates, and constantly looks for more ways to improve the state of public health and her community at large.

“I’m in my home state working on this,” she said. “I want my family’s health care system prepared for the worst. [This connection] makes me proud. I was born in Nashville General Hospital.”

A streak of personal determination also helps. “I just don’t do ‘no,’” she said. “Ben Franklin’s quote is on my mousepad. ‘Well done is better than well said.’”