Communication and Decision-Making During COVID: Lessons From Virginia

Two hours before the doors were scheduled to open to the public, a line had already wrapped around the building. To a passerby, it might have looked like a holiday sale at Macy’s, but this was not a shopping rush. It was the opening day of a large-scale COVID-19 vaccination site at the Military Circle Mall, housed in the shuttered Macy’s storefront.

When Virginia’s vaccine rollout began in January 2021, the state was struggling. Daily news reports ranked Virginia near the bottom nationally for distribution, an unacceptable position, especially given that Virginia was the only state led by a governor who was also a medical doctor. In a matter of months, Virginia surged up the ranks, thanks to a concerted effort to breakdown communication silos and realign operations. While the health department and emergency management agency already had a solid working relationship, the broader challenge was the number of disconnected initiatives across levels of government, each trying to “solve” the problem without coordination and alignment.

To move forward, Virginia had to fundamentally shift how information was shared. Everyone needed access to the same updates, at the same time, to drive timely and effective decision-making. In a crisis, the ability to get the right information to the right people at the right time is essential to execution.

Traditional hierarchical structures can become challenging when crises span jurisdictions, agencies, and organizations. Virginia’s COVID-19 response revealed a different path forward—one that prioritized communication design over command restructuring and demonstrated that thoughtful organizational coordination can outperform adding resources or new technology.

Virginia’s approach reveals three critical principles for effective multiagency crisis management.

1. Flatten communication structures to enable efficiency. Create lateral coordination channels that preserve organizational autonomy while enabling rapid information sharing and joint decision-making across agencies, rather than dismantling existing hierarchies.
2. Match communication cadence to crisis demands by establishing an optimal rhythm for coordination meetings—frequent enough to prevent dangerous information gaps, but not so frequent as to create bureaucratic drag that slows actual response execution.
3. Front-load strategic coordination in decision-making, establishing shared priorities and frameworks early. This enables individual agencies to act rapidly and autonomously within their areas of expertise, while maintaining coherent and mutually supportive responses.

These principles challenge the conventional wisdom that speed and coordination are competing priorities, instead demonstrating how strategic alignment creates the foundation for both unified direction and distributed action in complex emergencies.

Flattening Communication Structures

Some of the most passionate and dedicated people respond to emergencies, working tirelessly to solve problems and save lives. The roadblock they face is when multiple agencies, each with their own processes, cultures, and command structures, operate in silos. Without cohesion, communication can become noise, and efforts can become disjointed and inefficient.

During the initial stages of the COVID-19 response, the governor’s office, the Virginia Emergency Operations Center, the Virginia Department of Health (VDH), the Virginia Department of Emergency Management (VDEM), and local jurisdictions all held their own meetings. It was impossible for the right people to attend each meeting to facilitate basic coordination. As an outcome, everyone was working with only pieces of information rather than the whole picture. In addition, priorities in the different groups evolved and varied depending on the problem perceived to need the most attention, the agency’s mission, or the needs of a particular jurisdiction.

Broader collaboration was necessary across these agencies. The old mindset of sharing information on a need-to-know basis was no longer acceptable. As a result, Virginia structured a communication forum—one daily meeting that involved all critical stakeholders—and established a single opportunity for all critical information to be shared, digested, and acted upon. This was a huge undertaking, and the start of a transformation that improved alignment and accelerated problem-solving.

Matching Communication Cadence to Crisis Demands

Organizations are familiar with the pressure to move faster. But history has shown that speed alone can lead to chaos, burnout, and, when not well-coordinated, only marginal gains. To make meaningful, lasting change, organizations need more than urgency; they need alignment, trust, and a shared commitment to working together.

To move from reactive chaos to proactive coordination, the key emergency management and VDH stakeholders involved in Virginia’s response to COVID implemented a structured and intentional operating rhythm. This approach reinforced its mission, enhanced cross-team collaboration, and empowered timely execution. The three important elements of establishing an effective operating rhythm are ensuring the right people have the right information at the right time.

• Right people: VDEM leadership began by identifying the key stakeholders needed to form a comprehensive view of the vaccine distribution effort. This included
  • Representatives from all health districts and emergency management offices;
  • Key agencies involved in vaccine logistics; and
  • Executive leadership from the governor’s office, including Constituent Services.

People began to take on the behaviors needed for the forum to be effective through defined roles and responsibilities.

• Right information: With data flowing from local, state, federal, private, and nonprofit sources, filtering the noise was critical. VDEM focused on
  • Identifying decisions that required executive input;
  • Delegating operational decisions with clear guardrails; and
  • Empowering teams to act quickly and confidently.

This was only possible through synchronized communication across the entire stakeholder group, which followed a consistent set agenda.

• Right time: Stakeholders were already overwhelmed with meetings, so timing was crucial. VDEM established a daily 8:30 a.m. communications forum with participation across VDH and other state agencies involved in the COVID response to
  • Share updates,
  • Identify gaps, and
  • Align priorities across the Commonwealth.

Daily meetings were essential in the early stages to build shared understanding. As vaccine distribution stabilized, the meeting cadence gradually reduced. The meeting was still held as needed to preserve the opportunity to share information across the full stakeholder group.

Structuring Decision-Making to Enable Decentralized Execution

When VDEM first came together for the COVID-19 response, decisions were often made when passing each other in the hall, or when catching someone in a meeting. In these environments, decisions can be made based on incomplete or outdated information, and there is potential for a leader to accept or sign off on something that someone else may have just rejected. As a result, decisions can be overturned, mistakes made, and efforts wasted. Decision-making is more effective and more efficient when governed by two simple rules.

1. Establish the decision parameters: Define the decisions that need to be made, and who can make them. Virginia created an entirely new policy group as a coordinating body for decisions that require subject matter expertise oversight, with involvement from state agency secretaries, representatives from the governor’s office, external communications, and key agency leadership involved in vaccine distribution. Virginia defined its decision space, delineating between the decisions that required the policy group’s attention and those that could be answered by subordinates.
2. Set the standards required for decision-making: This includes the information that must be presented, the way in which it is presented, and the time in which decisions need to be made. VDEM and VDH set the standards required for the group to be able to effectively make an informed decision by establishing a simple 2×2 reporting matrix that laid out the decision, background, courses of action, benefits and risks, and a recommendation (See Figure 1). This made it easier for everyone to know what required leadership attention, to inform them appropriately of the risks and benefits, and to ensure decisions were made and shared effectively.

Fig. 1. Sample of a simple 2×2 decision matrix (Source: Virginia Department of Health, 2025).

Key to effective decision-making was the forum agenda. Followed strictly, it provided the chance for critical stakeholders to understand topics for discussion, contribute to Q&A, and be informed of stakeholder decisions.

Investing in and Committing to Change Yield Efficiency Gains 

Initially, putting these three principles in place was not easy, and it took time for Virginia stakeholders to adapt to the new ways of working together. Any new team—especially one that consists of several agencies and localities—goes through a period of “forming, storming, norming, and performing.”  But after a few weeks, changes made to flatten and broaden communications, to ensure a consistent operating rhythm, and to empower clear decision-making resulted in radical transparency.

The forum allowed those in rural areas, urban settings, and suburbs—those closest to the problem—to provide the input needed to adjust plans. Rural areas needed mobile vaccine capabilities. Urban areas needed mass vaccination sites to attract people. Eventually, the suburbs were able to visit mass vaccination sites or their own physicians once there was enough vaccine.

The results were immediate and measurable. Virginia’s vaccine program climbed from 49th to 11th nationally as the new structure took hold. This improvement reflected not just better coordination but also the state’s ability to adapt and innovate under pressure. The transformation was visible in packed vaccination sites like the Military Circle Mall, where efficient operations replaced earlier chaos.

Virginia succeeded by opening communications among the entire enterprise. It required a mindset shift, moving from a “need-to-know” approach to a “who haven’t we told” approach. This kind of open communication reduced the number of meetings needed, provided the most up-to-date information to make informed decisions, and helped identify missing key information to better inform decisions. Speed and coordination, rather than competing priorities, became the throughline to efficiency in saving lives during a pandemic.