Tom Sullivan | March 3, 2021
Whereas COVID-19 has illustrated the breadth of health inequities existent in the U.S. health care system and the associated vaccine hesitancy among underserved populations, what is thus far less understood is how to reduce that hesitancy by eliminating related obstacles.
“Hesitancy is removed when we are able to bring a vaccine event that is close to where someone lives, in a trusted place, coordinated with trusted partners — then we see parity in vaccination rates,” said Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services. “I would encourage CEOs to work on operational details when thinking about vaccine deployment.”
Cohen’s insights came during the most recent meeting of the Health Evolution Forum’s Roundtable on Community Health and Advancing Health Equity at February’s end. During the Roundtable, Forum Fellows discussed what they have learned to date about achieving equity in vaccine distribution, including: developing an intentional strategy to advance equity, partnering with organizations that have necessary expertise, leading the organization to leverage relevant data and mobilizing vaccines to people in the community.
Dive deeper: With a new working guide for CEOs, Health Evolution Forum shares 10 emerging best practices for developing an action plan to increase confidence and accessibility to vaccines.
Developing an intentional strategy to advance equity
Establishing large-scale distribution centers and attracting people to them in preparation for mass vaccinations are straightforward enough. “But it is very hard to assure an equitable approach to vaccination,” said Steppe Mette, MD, Senior Vice Chancellor for University of Arkansas for Medical Science Health and CEO, UAMS Medical Center. “The whole effort is dynamic and fluid.”
UAMS, in fact, decided early in the process to sanctify its strategy with a very specific set of goals to not vaccinate groups with anything less than their represented population within Arkansas and it conducted day-to-day assessments of vaccination data against demographic data to design the next week’s strategy, which Mette credited with helping UAMS achieve a balance among underrepresented populations.
The health system also found that purposefully partnering with influencers within targeted communities worked well and he cautioned that the outreach efforts should consider the potential for drawing people from outside a particular population.
“An intentional approach to targeting populations that have already demonstrated, or where we suspect vaccination hesitancy, has been crucial for us,” Mette said.
Tosan Boyo, John Muir Health
Partnering with organizations that have necessary expertise and resources
Leaders are forming non-traditional partnerships to establish vaccine distribution sites more efficiently and effectively than would be possible operating independently.
UC San Diego Health, for example, joined with both San Diego County and the San Diego Padres to stand up a large-scale vaccination site at Petco Park within five days, according to Carrie Byington, MD, Executive Vice President of University of California Health. The initial phase was to vaccinate health care workers and then proceed into outreach to primary populations.
“We’ve now given almost 200,000 vaccines since opening in January,” Byington said. “Petco Park is used to managing large numbers of people. It has great security and was able to bring IT and internet services to the large parking lot and had tents we could use. San Diego Health was able to bring vaccine expertise and logistics for monitoring vaccines.”
Partnering with communities really does work, according to Rod Hochman, MD, President and CEO, Providence.
“We’ve worked with the Ethiopian community in Seattle,” Hochman added. “We went into the community, brought their people in to run the clinic and that made a tremendous difference.”
When working with external partners, Forum Fellows also recommended seeking credible information sources both for identifying useful materials and understanding what needs to be countered.
Commonwealth Fund Vice President for Advancing Health Equity Laurie Zephyrin, MD pointed to the Black Coalition Against COVID-19 by Reed Tuckson, MD, as a content-rich organization that hosts town halls. She also explained that CEOs should expect forthcoming PSAs featuring trusted physicians of color and notable celebrities, which can be useful when working with reluctant staff and the community. “Understanding how to provide the message can be very challenging,” Zephyrin said, adding that the PSAs “can be used to help people in communities of color think more about the vaccine.”
Likewise, leaders also need to understand and counter misinformation, some of which manifests through channels likely unfamiliar to CEOs, which makes involving people who bring scientific credibility and celebrity to counter that all the more important.
“There is a strain of disinformation specific to African-American communities and it’s not just what one might think of as general vaccine hesitancy, it’s a campaign that is in part responsible for younger African-Americans who are vaccine hesitant or who have all sorts of conspiracy theories,” said Mark Smith, MD, founding President and CEO of the California Health Care Foundation. “It’s a nuanced issue and local African American and Latinx and Indigenous and other health care workers can provide a measure of credibility about this.”
Leading the organization to leverage relevant data
When John Muir Health initially began offering vaccines to patients, the health system saw a significant turnout and very low no-shows. The community was excited. One week post go-live, Tosan Boyo, Senior Vice President of Hospital Operations, upon reviewing the data, directed the team to stratify patients vaccinated by race/ethnicity/ to ensure the system was being equitable.
“One of the key themes we found — and again this is why with equity you need to be very intentional — 87 percent of patients were white despite only making up 49 percent of that eligible population. Utilizing an equity lens means we must be very intentional about stratifying quality data to ensure no community is being left behind and disparities aren’t being perpetuated.”
Next, Boyo directed the team to stratify by zip code and found that communities with the highest COVID-19 incidence rates, prevalence rates and hospital admissions were also underrepresented. “We prioritized increasing access to the most vulnerable Zip codes and on top of that we deployed a mobile vaccination clinic to go out to communities. We also partnered with local CBOs to improve our outreach efforts and messaging to reduce vaccine hesitancy.”
Since then, the team assesses stratified data daily basis: how many patients were vaccinated, which communities they came from and type of outreach received. John Muir Health has seen a dramatic difference. “The demographics of our vaccinated patients reflect the diversity of our county and we’re actively meeting our most vulnerable where they are.”
Mobilizing vaccines to people in the community
Guidewell and Florida Blue CEO Pat Geraghty said that large-scale sites in Florida have also been skewed toward White populations rather than underserved communities. State officials, in response, have added churches and a Historically Black College and University as vaccination sites.
In North Carolina, 90 percent of the residents who have been vaccinated are doing so close to home in their county of residence, according to Cohen, illustrating the importance of meeting people where they live, work and worship.
To that extent, AdventHealth President and CEO Terry Shaw added that churches are proving to be effective distribution sites. “We’ve learned that if you get into racially diverse churches, that’s a good approach for making sure people in your community have a way to find a safe place to get a vaccine,” Shaw said.
Guidewell and Florida Blue, for its part, brought forth a pilot with a chain of grocery stores in under-resourced areas. “The point is access. Make the access easy,” Geraghty said. “The next thing we will roll out are mobile units. We must bring vaccines to people instead of thinking people will come to the vaccine. That changes the equation significantly.”
Reaching into another type of community site, the Rebalanced-Life Wellness Association opened the nation’s first Men’s Health and Education Center inside a Madison, Wisconsin barbershop nearly four years ago. Founder and CEO Aaron Perry said that RLWA has since added two sites and has witnessed numerous states replicating his Barbershop/Health Model.
“We’ve been utilizing the barbers because every client that walks in the door trusts their barbers,” Perry said. As part of its work, RLWA has conducted surveys of the Black male community in Madison, which comprises some 15,600 people, or 6 percent of the city’s population.
“We’ve successfully reached about 5,100 Black men from the barbershop. That’s roughly 30 percent of our Black male population,” Perry said. “What the surveys are clearly indicating is that it’s not mistrust. What we’re finding is these guys are just paranoid about what the vaccine is. We’re now putting our messaging behind clearing up that paranoia and, again, tapping into that relationship with the barber is key.”
Providence CEO Hochman and others were adamant that the time has come to “stop talking and take action,” in advancing community health and equity. Perhaps the most pressing opportunity is to begin by addressing vaccine hesitancy and accessibility in underserved communities and populations with people of color.
Ultimately, however, advancing equity will take years of work by CEOs, thought leaders, policymakers and other in health care and ever industry.
“Let’s not forget what we learned here and apply it to the rest of health care because all of this is applicable to so many of the other issues we have in terms of equitably taking care of all populations,” Hochman said. “This is a template: It’s not just about vaccines, it’s about everything we do. We can really make a difference if we put this into place — not just for the vaccine but for all care.”
Editor’s note: Health Evolution Forum is a collaboration of cross-industry CEOs tackling emerging imperatives. The Forum comprises Fellows in Roundtables and Work Groups, including the Roundtable on Community Health and Advancing Health Equity that produced the aforementioned document, Vaccine Uptake in Diverse Communities: A Working Guide for Health Care CEOs. We want this guide to be a working document that updates with the fast-changing realities health care leaders are facing in battling this public health crisis. Please write any recommendations you may in the comments section of the download page (in the report link above) and we may incorporate those into our next draft. Learn more at the upcoming Forum Town Hall.