Strategies for States to Leverage Local Partnerships for Equitable Distribution of COVID-19 Vaccinations
As the United States enters its seventh month of the COVID-19 vaccine rollout, available data show distribution efforts have not produced equitable outcomes. Across states, Black and Latino(a) people have received smaller shares of COVID-19 vaccines compared to their shares of the total population, despite experiencing disproportionately higher rates of COVID-19 cases, hospitalizations, and deaths.,,, In recent months, eligibility for the COVID-19 vaccine has broadened to include all adults and adolescents aged 12 years or older. With open eligibility and adequate levels of vaccine supply, state leaders and their community partners have the opportunity to increase efforts to address inequities, leveraging policy, data, and financing levers to drive access and vaccine adoption among Black, Indigenous, and people of color (BIPOC). Understanding local lessons and engaging in meaningful community-based partnerships, state leaders can efficiently and precisely target state resources in a way that distributes doses equitably and builds a foundation to continue to address long-standing, systemic inequities in public health infrastructure.
State leaders can use their political will, as well as administrative, policy, and funding levers to support community partners in improving access points, addressing structural barriers to vaccination, and establishing rapid data collection and evaluation efforts to track, refine, and scale equitable COVID-19 vaccine distribution solutions. Key strategies are discussed below.
Improving Local Access and Addressing Structural Barriers to Vaccination
The COVID-19 vaccine supply has increased sufficiently to support open eligibility for adults and adolescents age 12 years or older, shifting vaccine distribution efforts from mass-vaccination sites to more local points of access. Key strategies to support local access rely on financing and building partnerships with local leaders, businesses, and community-based organizations who have established trust in the community, understand the best points of access, and have a proven track record of addressing underlying barriers in the community.
Strategy 1: Increase points of access where people work, live, and engage.
Increasing equitable COVID-19 vaccine access for BIPOC involves establishing trusted and convenient administration sites for the COVID-19 vaccine. For example, Massachusetts is funding mobile and pop-up clinics in neighborhoods disproportionately impacted by COVID-19 through grant funding for local municipalities, health departments, and community-based organizations in these communities. In Delaware, Minnesota, and Washington, state and county officials partnered with local organizations such as farms and homeless shelters to bring mobile vaccination clinics to trusted community sites. Officials in West Virginia have set up vaccination sites in high-traffic locations across the state, including fairs and festivals, church parking lots, sporting events, parks, bars and restaurants, shopping centers, and community and civic group sites. States may also consider working with local businesses to establish vaccination sites at places of employment, as 38 percent of Latino(a) adults who are employed and not vaccinated say they would be more likely to get vaccinated if their employer arranged for a medical provider to administer the vaccine at their workplace. In addition, supporting access and education through local clinics, independent pharmacies, and family physician offices leverages trusted resources in the community for medical information, particularly as vaccine efforts transition from adults to adolescents and children. West Virginia demonstrated early success distributing smaller quantities of the COVID-19 vaccine through local, independent pharmacies rather than national chains. Leveraging existing relationships that local pharmacies had with long-term care facilities, the state was able to coordinate matching doses with eligible patients.
Across the variety of local vaccination access points, sites should be set-up in a way that engages community trust, including in a convenient space in the community (e.g., local library, church), with community leaders actively involved in design, communication, and administration opportunities. Sites can be staffed by local community-based organization partners, firefighters, emergency medical services providers, community health workers, and other trusted community service providers. Employing vaccinators who are considered community leaders or champions can also help build trust among BIPOC. For sites staffed by national guard, military personnel, or police, staff should dress in civilian clothes to avoid intimidating community members.
Strategy 2: Address structural barriers to vaccination.
In addition to increasing points of access in local communities, states can support COVID-19 vaccination efforts by addressing the structural barriers to vaccination, such as lack of transportation, paid time off, and child care supports. To address transportation barriers, states can partner with local public transportation agencies to offer complimentary rides to and from vaccination sites (e.g. the New Jersey VAXRIDE initiative) or with community-based organizations to help community members take advantage of the Biden administration’s agreement with Lyft and Uber to offer free rides to and from vaccination sites. Local outreach drives in New Orleans eliminated transportation barriers altogether by partnering with community health center-employed nurses to go door-to-door in neighborhoods with the lowest COVID-19 vaccination rates and offer home-based vaccinations. These types of state coordinated efforts simplify implementation, flow of resources, and accountability processes at the local level, and can be leveraged in the longer-term to address other multisystemic barriers to equity (e.g., access to medical care, food, safe housing).
Lack of paid time off is also a prevalent barrier preventing individuals from receiving the COVID-19 vaccine; in survey data from April 2021, nearly two-thirds of unvaccinated Latino(a) adults and over half of unvaccinated Black adults reported concerns about potentially missing work due to side effects from the COVID-19 vaccine. State leaders can use their “bully pulpit” to encourage or incentivize employers to provide paid time off for vaccination appointments and to recover from COVID-19 vaccine symptoms, and can lead by example by instituting this policy for state employees. In March 2021, New York Governor Andrew Cuomo signed legislation granting public and private employees paid leave in order to get the vaccine.
Strategy 3. Offer vaccination incentives that empower individuals and alleviate barriers to vaccine access.
Several states are establishing incentives to encourage individuals to take-up the vaccine, and these approaches can be effective if non-coercive and address barriers to vaccine access and systemic inequities. Ohio’s includes a raffle that vaccinated individuals can enter to win state university tuition credits. New York launched vaccination pop-up sites inside eight public transit stations across New York city, Westchester, and Long Island and provides free, one-week unlimited subway and rail cards to individuals who get vaccinated at one of the sites. Incentives that resonate with the community (such as transportation vouchers, paid leave, free state university, community college or trade school credits) can serve as an opportunity for states to both increase take-up in the short-term and to build trust in and access to the health system moving forward.
Building Trust and Scaling Efforts at the Local Level
Additional state strategies rely on community engagement and investment to bolster vaccine confidence and enhance data sharing.
Strategy 4. Partner with and fund community-based organizations to build trust, conduct targeted outreach, and combat misinformation and safety concerns.
While access is a primary barrier to COVID-19 vaccination efforts, issues of vaccine confidence and the spread of misinformation remain a concern that states will need to continue to address. Meaningfully engaging, learning from, and supporting local efforts to provide consistent messaging via trusted sources is a key tool for promoting confidence in the efficacy and safety of the COVID-19 vaccine and in understanding barriers in those communities. Washington established Community Outreach Service contracts with community-based organizations to assist with COVID-19 vaccine outreach and made investments in local and ethnic media outlets for community-driven messaging efforts. All communication efforts should be accessible for individuals whose primary language is not English, who lack access to and familiarity with technology, and who have differing visual, learning, and physical abilities. Multiple states have created COVID-19 vaccine communication toolkits that include best practices and can be tailored to local contexts. Messaging campaigns have also progressed to the individual level; Massachusetts is funding the advocacy organization Health Care For All to conduct door-to-door canvassing in neighborhoods disproportionately impacted by COVID-19. States can also provide flexible sources of funding to localities or local organizations that can be applied to address identified local challenges to vaccination. Similarly, states can consider ways to streamline and simplify their funding applications and distribution systems to improve local organizations’ access to funding.
Strategy 5. Establish rapid data collection and evaluation efforts to track, refine, and scale equitable COVID-19 vaccine distribution solutions.
A major challenge for states, providers, and communities has been tracking COVID-19 vaccine administration data, disaggregated for key subpopulations, such as gender, race and ethnicity, and geography and monitoring this data in a timely manner to inform vaccine distribution strategy and community investment. As of the end of April 2021, forty-four states are reporting doses administered by age, forty states are reporting doses administered by gender, and forty-six states (all but Montana, New Hampshire, Oklahoma and Wyoming) are reporting vaccine doses administered by race. However, only twenty-one states reported information about how the administration of vaccine doses by race and ethnicity compares to the state’s underlying population distribution. Rapid data collection efforts, in addition to building a long-term data infrastructure that focuses on equity, are vital to understanding gaps and opportunities at the neighborhood- or county-level.
In addition to quantitative data, states can supplement data collection with qualitative information gathered through direct community outreach and engagement. States can proactively engage local leaders through focus groups or listening sessions as well as include them in a meaningful way on state and local task forces, commissions, and COVID-19 response teams.
Across these short-term strategies to increase equitable distribution of the COVID-19 vaccine, success relies on partnerships with local leaders and community-based organizations who are working on the ground to support vaccination efforts. State efforts to mobilize cross-sector solutions, build durable partnerships with communities, and streamline grant funding approaches for local organizations can support these short-term strategies, while building infrastructure and relationships and identifying policies or regulations that perpetuate inequities, will help states address long-standing systemic inequities in their public health infrastructure.
This expert perspective was developed in partnership with Health Equity Solutions and Families USA.
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