Recognizing the Impact of Medical Reserve Corps Volunteers on the COVID-19 Pandemic Response

Introduction

The COVID-19 pandemic began with conflicting messages about transmission, vulnerabilities, characteristics, and severity of the disease. As global understanding of the virus evolved, so did the knowledge about various methods intended to stop the spread. From the beginning, Medical Reserve Corps (MRC) units collaborated with health departments and affiliates to offer public outreach, serving as role models while adapting to local threat conditions.

Although MRC units have been working in their local communities since 2002, ¹ the onset of the COVID-19 pandemic highlighted the value that these units provide to their local communities. As local health departments expanded their response efforts, both medical and nonmedical MRC volunteers stepped forward to assist in fundamental ways. The demands of the COVID-19 pandemic compelled MRC units to acquire new skills to protect themselves and others from the virus and to operate safely in potentially hazardous environments. Many units grew exponentially, inundated by community members who wanted to help in some way. There was a learning curve in developing systems to accommodate the surge in membership and aligning member skills and training with new roles. While the various systems implemented by MRC units had common threads, each unit responded according to its individual circumstances.

In this commentary, we compare response efforts before and during the COVID-19 pandemic and share lessons learned for future response efforts. Our aim is to bring to light the value of the MRC program by highlighting its vast contributions to public health preparedness and response. We make a case for strengthening MRC units as a permanent resource for emergency response in public health.

Preparedness Activities Before COVID-19

The network of MRC units began in direct response to the terrorist attacks of September 11, 2001, with early MRC units reporting to the Office of the US Surgeon General. ² In 2013, the MRC program transitioned to the Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR), which became the Administration for Strategic Preparedness and Response in 2022. ³ The number of MRC units fluctuates over time as units are created, merged, or dissolved. ⁴ At its highest point in 2014, there were more than 1,000 MRC units across the United States and its protectorates. According to the ASPR website, there were 754 units as of May 12, 2023. The COVID-19 pandemic set the stage for a surge in new units and the addition of thousands of new members. The program encourages unit leaders to recruit, credential, train, drill, and deploy volunteers for emergencies affecting their own service areas and communities. Individual units work with their host agency—usually a public health department, university, or emergency management entity—to match their capabilities with measures that protect area residents. This foundation enabled the entire system of MRCs to address the spread of a novel virus. In general, units take such direction from their housing agency and response partners. MRC units rarely “lead the charge” unless they are asked to do so. ²

When the first MRC units were formed, each unit focused on the needs of their communities. For example, with fewer than 100 members, the Shawnee, Kansas, MRC reported to the city's health department and chose “public health emergencies” as its primary activity. The volunteers were needed most to support vaccination clinics, screen residents for hypertension, and provide related services (Shawnee County MRC coordinator Skye Reid, personal correspondence with unit data, May 12, 2023). By contrast, the New York City MRC had thousands of volunteers, with a major focus on medical and behavioral health responses. Their staff was affiliated with the New York City Department of Health and Mental Hygiene (New York City MRC director Matthew Geiger, personal correspondence with unit data, May 11, 2023). Each MRC unit develops its mission, vision, and goals according to the needs of its region. Units such as the Upper Merrimack Valley MRC in Massachusetts, study the current health issues based on sources including the Greater Lowell Community Health Needs Assessment, ⁵ and the Emerson Hospital Community Health Needs Assessment. ⁶ Both carefully researched documents are updated every 3 years, prioritizing the most significant health concerns at the time of publication. ⁷ Many units with substantial and diverse resources became “all-hazard” MRC units (ie, focused on threats from natural, biological, chemical, and radiological events), continuously preparing for any emergency for which their volunteers are proficient. All-hazards units sometimes buttress their existing skills with those of affiliates, including government entities such as police and fire departments, emergency medical services, and the Federal Emergency Management Agency.

The ongoing activities of all MRC units are intended to provide the greatest good for the greatest number. The Table lists some of the factors that can determine the types of activities and level of services that a unit is able to provide.

Initial COVID-19 Pandemic Response

In early 2020, MRC units across the nation transitioned from their regular activities to confronting the emerging COVID-19 pandemic. This abrupt pivot to a virus-related response changed the composition of many MRC units. ⁸

Decrease in In-Person Participation and Fear for Individual Health

MRC volunteers concerned about their risk factors for the virus—such as their own chronic health conditions or their role as caregivers to vulnerable people—ceased to participate in all in-person activities with their unit. ⁸ Even those members who had been active and dedicated chose to refrain from taking part in the response. This stance was especially problematic for units primarily composed of older adults or retired volunteers. Strikingly, most of these deeply committed volunteers jumped at the chance to help with virtual assignments.

Increase in Membership and Virtual Participation

At the same time, volunteer registration exploded with people who were suddenly and unexpectedly not working, working from home, or seeking ways to tap into a larger sense of purpose. Many units had to be creative about welcoming new members under stressful and restrictive circumstances that required them to maintain physical distancing, reduce social mixing, and apply other safety precautions. Some units moved their onboarding process to virtual methods, such as orientations via Zoom or Microsoft Teams.

Table. Sample Factors That Can Affect MRC Unit Operational Capabilities

Factor	Characteristics	Impact on MRC Unit
Location of host agent and service area	Climate across seasons and the presence of regional hazards	Adaptations for environmental responses (weather, terrain, other)
Population/education	Urban, suburban, rural, tribal, frontier, mixed	Skill sets and number of potential volunteers
Type of host agent	Public health, EMS, university, other	Choice of mission and dependable resources
Unit stability	Established or fluctuating status of host agency and leadership	Level of turnover in staffing, community support, and volunteers
Funding	Ongoing or sporadic	Ability to retain leaders and offer solid programming
Training	Tailored to unit needs	Access to instructors, equipment, and venues

Abbreviations: EMS, emergency medical services; MRC, Medical Reserve Corps.

Shift in How Services Were Provided

Initiatives such as making well-check calls, compiling kits of materials from home, and delivering personal protective equipment (PPE) to doorsteps were the types of activities especially preferred by volunteers. From the onset, older adults were among the hardest hit and in greatest need of support. ⁹ Many struggled with food insecurity, social isolation, access to healthcare, and access to COVID-19 vaccines and boosters when they became available. They faced barriers such as limited transportation, access to and use of technology, and basic pandemic health literacy, and many seniors continued to endure the strain of keeping up with ever-evolving scenarios. It was challenging to obtain vaccination appointments and complete basic but vital activities such as grocery shopping. Many of the earliest vaccination sites required online registration to schedule an appointment. Seniors in general were frustrated by a lack of internet access, not having an email address, and difficulties navigating online systems. ⁹

MRC volunteers helped alleviate some stressors by volunteering to pick up and deliver groceries (including bleach, disinfectants, toilet paper). The recipients were thrilled that this essential human need was being met by kind strangers. Other MRC units set up call centers staffed by “senior navigators” who helped seniors schedule and obtain appointments via the online vaccination registration system. ¹⁰

Sustained COVID-19 Response

Major developments throughout the course of the pandemic shifted the role of MRC responses. ¹¹ Hospitals and healthcare facilities, as well as first responders, faced substantial challenges due to staff members getting sick, working extra shifts, and experiencing burnout and moral injury from the relentless pressure of COVID-19. Similarly, public health departments and other patient care services experienced tension and increasing levels of fatigue, exacerbating preexisting shortages of personnel, finances, and material resources. When MRC volunteers filled in the gaps, communities were better able to provide essential services such as ¹² :

Public testing – Initially, COVID-19 testing for members of the public was hard to come by. MRC units throughout the nation supported venues such as drive-through testing sites. Volunteers also distributed PCR (polymerase chain reaction) test kits to long-term care facilities during outbreaks, as well as PPE in the early phase of the pandemic. When home test kits became available, MRC units were asked to deploy their members to mass distribution sites, where they handed out antigen rapid tests.

Mass vaccination – Early vaccination efforts included large-scale point-of-dispensing sites, which were commonly set up at large venues, such as stadiums and convention centers, and required large numbers of support staff. MRC units assisted at many of these sites across the country. Over time, large-scale point-of-dispensing sites shifted to smaller community outreach clinics, with the goal of reaching those who were the most vulnerable. MRC strike teams supported community vaccination events, including using mobile units, with a broad scope of clients that included farm and factory workers, long-term care facilities, homebound individuals, schools, immigrant community centers, and places of worship.

Mental health – The impact of COVID-19, the loss of loved ones, and the stress of mitigation measures disrupted daily lifestyles and incomes, and anxiety, depression, and other mental health issues escalated. ¹³ MRC units honed their skills as they provided psychological first aid ¹⁴ and mental health first aid. ¹⁵

Contact tracing – Contact tracing was a massive undertaking for local public health departments, requiring hundreds of thousands of phone calls to support data collection and reporting. MRC volunteers assisted with the many contact-tracing efforts conducted by local health departments, schools, and other entities.

Isolation and quarantine – Isolation sites and hotels were set up for those who tested positive for COVID-19, to avoid spreading the disease to others, including vulnerable family members and individuals experiencing homelessness, and especially those in group settings. MRC units responded by delivering meals to those in isolation, assisting with medical screenings at isolation sites, and supporting other needs.

Call centers – From early on, MRC units supported call centers, when public health offices were inundated with questions from the public. These call centers shifted over time to address the constant changes in pandemic guidance, mask mandates, school case reporting, isolation, business reopening, vaccine mandates, and language support. Many call center operations survived the duration of the response and beyond, adapting to needs beyond the pandemic.

Courier teams – MRC units set up courier teams to assist with delivering PPE, test kits, hygiene kits, vaccines, vaccination site equipment and supplies, and pharmaceuticals. These courier teams shifted with the demands of pandemic hot spots and met the needs during the evolving response.

Surge staffing – During various periods when hospitals struggled with low staffing and surges of patients, MRC units stepped in to provide surge staffing support and monoclonal antibody treatments at makeshift emergency department extensions.

Outreach – As vaccine popularity waned, MRC units assisted local public health departments with community outreach to promote vaccination event awareness. MRC units visited homes, businesses, schools, libraries, and human service campuses to promote nearby vaccination events.

Continuation – MRC units have continued to adapt to the changing landscape by providing community engagement, support, and intervention. Not only did this approach sustain the long-term response efforts, but it also strengthened the MRC units by engaging volunteers in creative opportunities.

The approaches used by individual MRC units depended on their size, context, and needs. The breadth of these activities, capabilities, and experiences are illustrated by the examples described in the Appendix.

Lessons Learned

Based on the 2021 volunteer value calculations developed by Points of Light, ¹⁶ MRC volunteers were estimated to have saved local health jurisdictions about US$85 million through approximately 3 million hours of donated volunteer service, including both medical and support services, in response to the COVID-19 pandemic. ⁹ About 80% of all MRC units provided volunteers to help protect health in their communities during the COVID-19 pandemic. The other 20% were either in transition, less active, or engaged in non-COVID-19 activities, such as screening for hypertension, providing various forms of outreach, and maintaining steady-state activities. Most of these units provided vaccinations. The number of volunteers in the MRC network grew from approximately 179,000 in early 2020 to more than 300,000 in 2022. Since the pandemic began in 2020, nearly 75% of MRC volunteer hours were attributed to the COVID-19 response.^12,17 There was a huge collective learning curve in handling the COVID-19 response, including how to safely provide access to crucial services. ¹⁶

Key Improvements to the MRC Response

Virtual Methods Enabled Safer Communication

Community collaboration required units to explore approaches with response partners in new ways. Virtual methods for communication protected responders who had previously limited their contact to in-person meetings, supplemented with conference calls and emails. These efforts not only sidestepped exposure to the virus but also saved time and travel costs because participants could communicate from anywhere. The improved methods of gathering virtually often enhanced community relations for future endeavors. However, the tradeoff was limited opportunities for networking and spontaneous discussions before and after meetings that only in-person gatherings allow.

Data Management Tools Were Updated and Adapted

At the start of the pandemic, existing data management tools were unable to manage the amount of data, supplies, and people that needed to be tracked. By necessity, many updates and solutions were creatively adapted to transform MRC data management capabilities. These technological updates and adaptations have improved the processes of hundreds of MRC units.

Increased Volunteerism to Manage the Pandemic

An encouraging lesson was that many of the tens of thousands of community-minded citizens who joined the MRC to assist during the pandemic have remained as active and engaged volunteers, training and preparing to assist in future efforts. Thousands of new MRC volunteers now make up the national corps, inspired, in part, by the great work accomplished during the COVID-19 pandemic.

Barriers Impeding an Effective MRC Response

The following issues were beyond the control of individual units and the national program in general and must be addressed for MRC units to function at full capacity.

Lack of Awareness

One of the frequent laments shared by MRC leaders is that “nobody knows about us.” While the national MRC program has not done studies to quantify the level of MRC awareness among the general public and potential volunteers, anecdotal evidence about the lack of brand awareness is abundant. At MRC display tables, public festivals, and presentations across various groups, a typical question from visitors is, “MRC? What's that?” Although MRC units across the country have made significant contributions to mitigate the impact of COVID-19 in various ways, there has been little media coverage of their activities.

Furthermore, the name itself generates confusion, resulting in questions such as: “Do you only need medical volunteers? Are you part of the military?” Recruitment efforts must often overcome the public's unfamiliarity with the program, discuss the purpose of the MRC, and explain to curious visitors where they might fit in. By contrast, long-established and well-advertised groups such as the American Red Cross do not face these hurdles.

Recruitment issues are compounded by the fact that each MRC is different. Although it is a huge benefit that units focus on local needs, and have some commonalities through the national program, even MRC units across a single state may be vastly different from each other. Message development for wide-ranging MRC awareness is therefore challenging.

Inconsistent and Restricted Funding

Since its inception in 2002, the national MRC program has had to advocate for a steady and reliable budget allocation. The first 3 years provided “demonstration grants” for new units, of US$50,000 per year, to prove that the model would work. Until the American Rescue Plan^18,19 in 2021 provided 1-time funding of US$100 million to empower the program, the maximum annual funding for the entire network of units remained at US$6 million. Even that nominal amount was threatened each year by proposed cuts in the federal budget, regardless of the current number of units, members, and activities.

Each unit is generally responsible for seeking grants or gathering funds from a range of sources to maintain its operations. Some of the grants pose restrictions that seem unsuitable for volunteer organizations. For example, volunteers would have to purchase branded uniforms or pins that identify them as members of the MRC, unless leaders were able to secure funding from other sources.

Personnel Turnover

Other established volunteer organizations, such as the American Red Cross, have funded staff positions, memoranda of understanding, national protocols, and standardized training and job descriptions to ensure their personnel are financially stable. By contrast, most MRC leaders lack guaranteed income, benefits, or career progression. These and other factors lead to high leadership turnover, further interfering with the ability to provide consistent staffing and messaging.

Lack of Standard Data Management Software

From the inception of the MRC, each unit had to independently determine how to manage its member data. This was understandable during the initial “demonstration project” phase when the MRC network was being tested for feasibility. However, after more than 20 years, there is still no universal database recommended for tracking members across the country.

The primary challenges to adopting or creating a common database system are cost, functionality, and adequate volunteer experience to work with the system. These systems can be costly for individual MRC units to purchase and maintain. Furthermore, they are often incompatible with other resources for general member management, such as logging training records, hours of service, and license renewals. As a result, the ability of MRC units nationwide to gather and summarize member data may be inconsistent, which could compromise their ability to submit standard reports to the national office. During the first 3 years of the COVID-19 pandemic, there was a substantial increase in response data that needed to be recorded in cumbersome systems.

Recommendations

Over the past 20 years, MRC units have proven their value in both steady-state and emergency response scenarios. Therefore, it is vital to strengthen the national program to ensure it remains a consistent contributor to public health and human services at both the local and national levels. Our nation must overcome the barriers that inhibit MRC units from functioning at full capacity going forward. To that end, we recommend the following:

1. 1.

   The US Department of Health and Human Services (HHS) should endorse and fund a national awareness campaign about the MRC. Large-scale, sustained promotion of the MRC would go a long way to reduce the program's anonymity. Visible support from the HHS would increase national awareness that MRC service is important to our country. Advertising conducted by local MRC units has far less impact, especially from units that already struggle to operate with limited funding.

2. 2.

   The federal government should provide sufficient dedicated funding for the MRC program to ensure that units have a reliable budget to maintain operations. After the successful completion of the 3-year demonstration grants in 2005, a fixed annual allocation of US$6 million per year was expected to cover all MRC units. ²⁰ However, this amount has not changed over time, regardless of the increasing number of units—from 500 in 2006 to 724 in 2023—and volunteers or the expanded scope of capabilities and service provided by MRC units. Even that amount is frequently challenged, with the threat of reductions to as low as US$4.5 million. With adequate and consistent funding, units can consistently provide a high caliber of service to support their communities.

3. 3.

   Interested unit leaders should receive career support. Most MRC directors and coordinators are either municipal employees who have taken on MRC leadership in addition to their current roles (often as overworked health directors) or contractors with no benefits whose work is subject to annual reviews with no assurance of continuation. Recognizing MRC leadership as a profession and offering appropriate compensation to unit leaders would reduce turnover rates and promote higher levels of commitment and parity with municipal counterparts. One approach would be to give the National MRC program office the authority to collaborate with HHS affiliates and higher-level organizations to explore solutions.

4. 4.

   Program leaders should have a voice in determining how potential funds can best be allocated. They should be asked about their most pressing needs, as well as potential mechanisms for distributing that funding. When the American Rescue Plan allocated a groundbreaking US$100 million for the MRC program, MRC leaders had to encourage their leadership to solicit their opinions on how to spend the money. The entire program could have benefited from national promotions, the availability of a common database (resulting in economies of scale and consistency), and other deliverables that could benefit all units. However, the funding was made available only through the traditional channel of individual units submitting grant applications for their local use. Furthermore, unit leaders who were already pressed for time had to add the task of applying for the grant to their packed schedules, and specify their requests according to restrictive guidelines. ¹⁸ When unit leaders provided their wish lists early on for use of the new and substantial American Rescue Plan Act funds, their input received only limited acknowledgment. Furthermore, there was no correlation between the requests and the decisions that were made to distribute the funds.

5. 5.

   Government entities and partners should cultivate support explicitly for MRC units. Unit leaders often feel the need to make themselves heard and inform their counterparts about the network's accomplishments. However, it would be more expedient for counterparts to involve MRC units in planning and decisionmaking. Making MRC units more of a stakeholder could also promote the MRC by including positive views of the program in communications with other groups. By taking these measures, the MRC program would be recognized as a valuable contributor to emergency response efforts.

6. 6.

   MRC unit leaders should be provided with and trained on a standardized tool that tracks data and includes features needed to manage MRC units. ASPR leadership should agree to provide units with a user-friendly and intuitive volunteer management system, then MRC could benefit from consistent methods to log member data and activities. Units should be provided with technical support to help them integrate current data and become proficient in tracking member statistics.

Conclusion

For over 20 years, the MRC has demonstrated its potential as a highly capable, versatile, and powerful resource for managing surge capacity needs during emergency response efforts. From the beginning of the COVID-19 pandemic, MRC units responded to urgent requests in historic numbers, as hundreds of thousands of dedicated volunteers stepped up successfully across a full range of deployments to mitigate the impact of the pandemic and save lives. Despite its success in the sustained COVID-19 disaster response, the MRC network remains relatively unknown and chronically underfunded. Given the likelihood of future disasters of all kinds—from disease outbreaks to climate change and severe weather-related emergencies—the United States needs to maintain and strengthen the MRC as a dedicated resource to protect the nation's health and safety.