Ideas & Insights / All Grantee Impact Stories / Ideas & Insights Grantee Impact Story

Stopping a Covid-19 Surge With Last-Mile Testing

In Maine during a Covid-19 surge, one in four households received tests in their mailboxes, allowing the state to help residents be vigilant.

In Kansas, free home-delivered tests meant a migrant farmworker didn’t have to lose a day’s pay, pull his children from school and drive several hours to the nearest testing site when parents and children in turn presented Covid-like symptoms.

And in New Mexico, an overburdened state health department was able to see tests rushed to remote communities that would have been otherwise unserved. “We are acutely aware of how much work (managing testing) is and how wonderful it is to have a whole group of tests we don’t have to worry about,” said Dr. Miranda Durham, New Mexico’s Director for the Infectious Disease Bureau.

All of these are successes of Project Access Covid Tests (Project ACT), a public-private partnership launched by The Rockefeller Foundation to meet the Covid-19 crisis by helping empower individuals and provide a testing channel for overburdened state health departments while building community confidence in public health systems.

Eight states participated, with 6.5 million tests delivered –often to remote areas far from testing sites and retail pharmacies—and another 2 million waiting in the wings.

A New Standard in the U.S.

Launched on Jan. 28, 2022 with a $7.45 million initial investment from The Rockefeller Foundation, and continuing through June 2023, Project ACT also prioritizes equity, and reaches highly vulnerable communities in a diverse set of states by partnering philanthropy with government and for-profit companies, including Amazon, iHealth, and CareEvolution.

Tests are delivered straight to homes, often in rural areas.

  • We are the glue that brings all the pieces together to get people tests quickly, and we’ve set up a system that can be scaled or adapted to meet other public health crises.
    Andrew Sweet
    Vice President, Global Covid-19 Response and Recovery, The Rockefeller Foundation

“Throughout the pandemic, The Rockefeller Foundation has emphasized the importance of testing as a critical tool to slow and stop a surge. This program gets those essential tests directly to homes in the last-mile service area,” Sweet said.

The project was among the first of the RF Catalytic Capital (RFCC), a charitable offshoot of The Rockefeller Foundation incorporated in September 2020 to scale up funding for solutions that can enable an equitable recovery from the Covid-19 crisis as well as catalyze more inclusive access to opportunity in the United States and globally.

Built on and scaled the NIH’s Say Yes Covid Test initiative, Project ACT provides free tests in boxes of five delivered directly to homes.

Project ACT Business Model.

“Testing is the easiest and most effective way to slow a surge of an infectious disease,” said Mara G. Aspinall, a healthcare industry pioneer and leader, and an advisor to The Rockefeller Foundation, who at Arizona State University cofounded the first program dedicated entirely to diagnostics as an independent discipline.

“People want power, and diagnostics bring them the power of information,” she said. “It also offers privacy and convenience. Home testing is going to become the standard.”

Further, Project ACT “confirmed that states have a critical role to play in implementing programs in health emergencies because state officials understand the culture of their state and how to reach their population,” Aspinall said. “One state might need to target rural areas, while another state might need to focus on low-income residents.”

Jan. 30 is the third anniversary of the day the World Health Organization declared the Covid-19 outbreak a Public Health Emergency of International Concern, and although Covid-19 is less scary and fatal than it was initially, Sweet said future health emergencies are inevitable, whether due to climate change or increasing human encroachment on animal habitats.

Building Confidence in Public Health Systems

That’s one reason building confidence in public health systems is so important, and Project ACT helped show state health departments to be reliable and equitable.

A 2021 poll found that the public’s positive rating of the nation’s public health system declined from 43 percent to 34 percent from 2009 to 2021. State health departments fared a little better – 49 percent said their state health department was doing an excellent or good job at protecting the public from health threats and preventing illness.

Testing is the easiest and most effective way to slow a surge, says Mara Aspinall.

Greater trust means communities are more likely to follow public health guidance and take preventative measures, even if they are inconvenient, during health emergencies.

Project ACT helped both by reaching vulnerable communities, and by allowing state health officials to focus on other issues.

“Project ACT enables us to send free at-home tests directly to those in need, including rural Maine where testing access is limited, while avoiding the logistical challenges of storing and distributing tens of thousands of tests,” said Maine Health and Human Services Commissioner Jeanne Lambrew.

Kansas Focused on Migrant Farmworkers

Kansas purchased 250,000 tests, and state officials recruited five case managers and seven health promoters across the state. Seventy-one percent of the contacted homes responded positively; those that did not participate were generally part of the population that opposed vaccinations and didn’t want to discuss Covid testing.

Kansas officials initially focused on zip codes where they knew migrant and seasonal farmworkers were located, and had particular success in the northwest quadrant of the state, an area of High Plains where counties are classified as “frontier,” population density is fewer than six people per square mile, and mass testing sites would be inefficient.

Agriculture is the largest industry in Kansas, contributing about $65 billion annually to state coffers. Nearly 85 percent of the state’s farms are individually or family-owned. The state, with a population of about 2.9 million is home to approximately 32,000 migrant workers and a leader in wheat, grain, sorghum and beef production.


Flier in Spanish displayed at community vaccination events to help farmworkers in Kansas order Project ACT tests.

In particular, the cattle industry, which is the third-largest in the country, relies heavily on migrant workers. One dairy farm worker used a Project ACT at-home test and tested positive for Covid-19, subsequently quarantining and avoiding exposing hundreds of coworkers. The program also helped reinforce public health systems in general, making the state better prepared for any future crisis.

“Project ACT has been a great solution for us in our rural and underserved communities,” said Dr. Joan Duwve, State Health Officer, Kansas Department of Health and Environment. “It has given us the tools to reach vulnerable populations that had limited or no access to Covid testing.”

Reaching Those Who Would Have Gone Unserved

The issue of equity was noted in North Carolina, which secured 745,000 tests. The tests helped the state reach “communities with a historic lack of access to health care,” noted Kody H. Kinsley, Secretary of the state’s Department of Health and Human Services.

Michigan secured 1.7 million tests and their outreach led to a record-breaking 53,000 requests received in 48 hours. In Maine, which secured 1.4 million tests through the program, 25 percent of households received a Project ACT pack of tests to date.

“We did a push to encourage ordering before Thanksgiving and another one before Christmas. It is great publicity to say we are doing this, and this program makes it possible. Sending the tests out on our own through our warehouses would have been an enormous challenge,” said Kristen M. McAuley, outgoing Director of Public Health Planning in Maine.

Project ACT website.

“Through the state, we were sending out tests to congregate care facilities, community agencies, private physicians, and there were a couple mobile testing initiatives. But we wanted to have bases covered in terms of individual households,” added Andrew Finch, the incoming Director. “Through this program, we reached people who would have been hard to reach otherwise.”