Local Workforces, Community Advocacy and Trusted Messengers: Bright Spots in COVID-19 Vaccine Distribution

Above: Maria Plata, a Health Promotora, goes door-to-door providing residents with information about how to protect themselves from COVID-19 in Immokalee, Fla. Photo by Scott McIntyre for Partners In Health

Jacquelyn Dalton, MPH, Director of Community Engagement, Health Leads
Katie Bollbach, MPH, MPA, Director, US Public Health Accompaniment Unit, Partners In Health
Denise Octavia Smith, MBA, BS, CHW, PN, SFC, Executive Director, National Association of Community Health Workers

The rollout of COVID-19 vaccines in many areas of the U.S. has felt uncoordinated and inequitable, with inconsistent and rapidly-changing rules, processes and communication. And while data on race/ethnicity is only available for 58% of the vaccinated population, the data we do have indicate white people continue to be vaccinated at nearly three times the rate of people of color. 

When we issued our co-created Principles for Equitable Vaccine Distribution, we predicted that the most equitable and effective vaccination efforts would be those centered on three core elements: (1) building trust, (2) investing resources, and (3) expanding access. They would also be hyper-local, and rooted in existing community-based data, networks and workforces. As examples of vaccine distribution from across the U.S. began reaching our collective group, many have confirmed our hypothesis. 

The standout stories below all include targeted, community-specific planning, process, and outreach that leads to increased vaccination readiness and access. These bright spots also offer approaches that can be replicated in other communities. 

Immokalee, Florida: Inaccessibility does not equal hesitancy

Of Immokalee, Florida’s 25,000 residents, 70% work in the labor industry and the majority are migrant farmworkers. Inequities in the community, including limited access to healthcare and poor health outcomes, stem from a long history of exploitation and slavery in the agricultural industry. With multiple households often living in a single trailer, crowded living conditions enhanced COVID-19 transmission, and many individuals faced eviction and food insecurity after missing work due to infection. 

The Department of Health in Collier County––where Immokalee is located–– originally rolled out a vaccination process that included significant barriers for the Immokalee community: online, English-only appointment registration systems, vaccine events hosted during work days, lack of transportation to vaccine events and lack of linguistically accessible information.

In response, Healthcare Network, the Coalition of Immokalee Workers, Mision Peniel and Partners In Health created a vaccination approach with a focus on the “extra mile” of vaccine readiness – helping to overcome the structural and economic barriers to vaccine access. The approach centered on partnering with locally-recruited Health Promotoras, who act as a bridge between the healthcare system and community by conducting household visits, supplying transparent COVID-19 vaccine information, providing COVID-19 testing in local neighborhoods, and helping residents sign up for and get to vaccination appointments. They also serve as navigators to connect individuals to social support, such as rental assistance, food, and medicines. Health Promotoras also raise awareness of underlying structural causes of health inequities by engaging in conversations to explore and understand the barriers that people face to receiving health care, and how the community and health providers might respond to facilitate access.

Key elements of the Health Promotoras approach to build trust, increase access and invest resources include: 

  • Identify eligible Immokalee residents interested in being vaccinated through testing events, home canvassing, visits to churches, interviews on local radio stations, and  handing out information at food distribution events.
  • Host vaccination events in easy-to-reach locations at convenient times – no appointments or documentation necessary; promote through various local and social media channels. 
  • Call eligible patients directly and schedule appointments with reminders – and visit households of patients with no phone number or no answer. 
  • Call farmers/growers to schedule mass appointments for farmworkers and packing house workers.
  • Help with additional paperwork and registration before vaccinations are administered. 
  • While canvassing to register people and during events, identify people with resource, language, and literacy needs and connect them to clinical care and social support.
  • Transport workers by bus to vaccination events; personally transport residents to vaccination sites.
  • Accompany residents throughout the vaccination process to build trust by providing socially, linguistically, and culturally-accessible information.

Next steps for the Immokalee collaboration include utilizing a mobile testing unit as a mobile vaccination unit to help bring vaccines into residential areas, local organizations, and marketplaces to increase access to services for the community. Through this combination of trust, resource navigation and access-building, Immokalee’s health promotoras continue to bring vaccine efforts closer to the community. 

San Diego, California: Local resource data targets vaccination gaps

211 San Diego is a free, 24/7 service, 3-digit dialing code offering communities access to health, social and disaster services. Tailored programs take the client beyond just a referral and into a Community Information Exchange (CIE), an ecosystem of partners that fosters collaboration across multidisciplinary networks. The CIE connects 104+ organizations through direct system access or data integration between systems and helps communities move from reactive to proactive, person-centered systems of care. 

In partnership with the County of San Diego HHSA, 211 San Diego is providing vaccination access support including navigation of COVID-19 related information; navigation and connection to community, health and social services; testing site and appointment support and outreach; and vaccination appointment support for those without access to the internet or someone to help them.

San Diego’s biggest challenges were in supply (availability for first and second dose appointments and completing a 2nd Dose Online Form), location (understanding sites in communities with most need) and appointment access, verification, rescheduling (requirements of email and phone number and social security numbers). Finally, accessibility was broadly hindered by a number of factors including lack of in-home vaccinations for homebound individuals, limited access to information that did not require a computer or internet, language barriers, ability to check appointment availability and transportation assistance. 

When vaccination sites began to open, 211 San Diego received its highest volume of inbound calls in its history – 14,000 calls in one day inquiring about how to make appointments. The team’s CIE system enables it to collect and track vital trend data about barriers to vaccine access to inform key stakeholders. By asking detailed questions about why people were unable to make appointments, against race/ethnicity and zip code data, 211 San Diego could better gain a deeper understanding of unmet needs in specific populations and neighborhoods. The CIE allowed service provider partners to send a referral directly to 211 to help those with complex needs or barriers to access.

Among eligible callers, 61% were unable to make an vaccine appointment, with up to a third lacking a requirement needed to secure an appointment at some sites. The 211 San Diego team discovered 1 in 3 vaccine-eligible callers did not have email, 1 in 7 did not have a cell phone, and 1 in 11 did not have a social security number. Heat maps of these challenges enabled the team to geographically pinpoint specific communities that were most impacted by appointment barriers. Sharing these vaccine call trends played a key role in shaping the vaccine registration requirements at both the county and state level. Stakeholders gained a better understanding of where existing systems inherently block communities from vaccine access.  

Recommendations from the 211 San Diego team include: 

  • Collect, monitor and share data (loudly!)
  • Leverage existing infrastructure, providers, and partnerships (trusted networks like San Diego’s CIE)
  • Set aside appointments for target populations
  • Offer no-appointment sites
  • Create population-friendly sites (signage, chairs, shade, low volume, dimmed lights, concierge services)
  • Develop electronic workarounds (emails/cell numbers)
  • Ensure confidential / anonymous answers
  • Streamline appointment-setting softwares
  • Offer transportation (with signage for ride share programs)
  • Be nimble and transparent

Key Approaches that Create Vaccination Bright Spots 

While these are not the only models of community- and equity-centric vaccine distribution, both reinforce many of the elements of our principles. They are also useful examples of the elements that should be replicated for building strong public health and racial health equity systems broadly – beyond vaccine distribution. These leading and exemplary efforts are two of many that continue to arise across the U.S. with commonalities in their approaches, including: 

  1. Targeted focus on communities and responsive to individual needs using 1:1 conversations
  2. 1:1 or small group technical assistance for vaccine readiness conversations, scheduling appointments and managing paperwork
  3. Pairing vaccination effort with social needs resources (clinical care, child care, food, job and other socioeconomic resources)
  4. Familiar community, neighborhood locations as vaccination sites
  5. Appointment availability outside of 9-5 work hours and on weekends 
  6. Trusted messengers and media to share vaccine education and availability of vaccines as a strategy to increase readiness
  7. Trusted community leaders as health education liaisons and navigators
  8. Breaking down technology (internet and cell phone access) barriers

Learn more about the Vaccine Equity Cooperative and support the effort to uplift bright spots in equitable vaccine distribution: 

Recent Resources

Args

post_type
0post
post_statuspublish
posts_per_page4
meta_query
relationAND
0Array ( )
cat
01
post__not_in
08684
orderby
dateASC
relevanssitrue

Module Settings

post_type_chooseoff|on|off|off|off|off|off|off|off|off|off
loop_stylecustom_loop_layout
shortcode_name[de_loop_template_shortcode]
loop_templatesdivi-blog
custom_loop_templatenone
loop_layout8931
filter_update_animationload-6
no_posts_layoutnone
no_posts_layout_textSorry, No posts.
is_main_loopoff
include_current_termsoff
groupping_post_objectoff
groupping_taxonomynone
show_empty_onloadoff
post_statuspublish
show_current_postoff
posts_number4
post_offset0
post_display_typerelated
saved_typewishlist
acf_linked_acfnone
related_contentcategories
related_acf_fieldnone
related_content_categoriespost_cats
is_category_loopoff
disable_sticky_postsoff
specific_post_objectsoff
related_content_tagsdefault
tax_name_relatednone
acf_name_relatednone
custom_tax_choosepost
acf_namenone
include_sticky_postson
include_sticky_posts_onlyoff
onload_tax_choosepost
sort_orderdate
acf_sort_fieldnone
acf_sort_typestring
acf_date_picker_fieldnone
acf_date_picker_methoddefault
acf_date_picker_custom_day30
order_asc_descASC
sec_acf_sort_fieldnone
sec_acf_sort_typestring
sec_acf_date_picker_fieldnone
sec_order_asc_descASC
enable_loadmoreoff
pagination_positionbottom
scrolltoon
scrollto_fine_tune0px
loadmore_textLoad More
loadmore_text_loadingLoading...
enable_resultcountoff
resultcount_positionright
result_count_single_textShowing the single result
result_count_all_textShowing all %d results
result_count_pagination_textShowing %d-%d of %d results
has_mapoff
map_all_postsoff
map_all_posts_limit-1
map_infoview_layoutnone
map_infoview_layout_ajaxoff
hide_marker_labeloff
map_clusteron
map_center_first_poston
link_whole_girdoff
link_whole_gird_externaloff
external_acfnone
content_section_layoutnone
grid_layoutgrid
columns4
columns_tablet2
columns_mobile1
custom_gutter_widthoff
grid_list_defaultlist
grid_list_positionleft
grid_list_cookie_time30
grid_view_icon||divi||400
list_view_icon||fa||900
icon_padding7px|7px|7px|7px
icon_margin0px|10px|0px|0px
enable_overlayon
show_featured_imageon
show_read_moreoff
read_more_textRead More
show_authoron
show_dateon
date_formatF j, Y
show_categorieson
show_contentoff
excerpt_length270
excerpt_more...
show_commentsoff
meta_separator|
content_visibilityhover
image_hover_animationnone
loop_template_content_alignmentcenter_center
loop_template_color_themelight
loop_template_same_heighton
image_min_height150px
image_max_height500px
pagination_item_background#fff
pagination_item_background_active#ebe9eb
_builder_version4.21.0
_module_presetdefault
grouping_tax_title_font_size14px
grouping_tax_title_letter_spacing0px
grouping_tax_title_line_height1em
title_font_size14px
title_letter_spacing0px
title_line_height1em
excerpt_font_size14px
excerpt_letter_spacing0px
excerpt_line_height1em
loop_template_meta_font_size14px
loop_template_meta_letter_spacing0px
loop_template_meta_line_height1em
loop_template_meta_a_font_size14px
loop_template_meta_a_letter_spacing0px
loop_template_meta_a_line_height1em
loop_template_a_font_size14px
loop_template_a_letter_spacing0px
loop_template_a_line_height1em
pagination_font_letter_spacing0px
active_pagination_letter_spacing0px
background_enable_coloron
use_background_color_gradientoff
background_color_gradient_repeatoff
background_color_gradient_typelinear
background_color_gradient_direction180deg
background_color_gradient_direction_radialcenter
background_color_gradient_stops#2b87da 0%|#29c4a9 100%
background_color_gradient_unit%
background_color_gradient_overlays_imageoff
background_color_gradient_start#2b87da
background_color_gradient_start_position0%
background_color_gradient_end#29c4a9
background_color_gradient_end_position100%
background_enable_imageon
parallaxoff
parallax_methodon
background_sizecover
background_image_widthauto
background_image_heightauto
background_positioncenter
background_horizontal_offset0
background_vertical_offset0
background_repeatno-repeat
background_blendnormal
background_enable_video_mp4on
background_enable_video_webmon
allow_player_pauseoff
background_video_pause_outside_viewporton
background_enable_pattern_styleoff
background_pattern_stylepolka-dots
background_pattern_colorrgba(0,0,0,0.2)
background_pattern_sizeinitial
background_pattern_widthauto
background_pattern_heightauto
background_pattern_repeat_origintop_left
background_pattern_horizontal_offset0
background_pattern_vertical_offset0
background_pattern_repeatrepeat
background_pattern_blend_modenormal
background_enable_mask_styleoff
background_mask_stylelayer-blob
background_mask_color#ffffff
background_mask_aspect_ratiolandscape
background_mask_sizestretch
background_mask_widthauto
background_mask_heightauto
background_mask_positioncenter
background_mask_horizontal_offset0
background_mask_vertical_offset0
background_mask_blend_modenormal
custom_buttonoff
button_text_size18
button_bg_use_color_gradientoff
button_bg_color_gradient_repeatoff
button_bg_color_gradient_typelinear
button_bg_color_gradient_direction180deg
button_bg_color_gradient_direction_radialcenter
button_bg_color_gradient_stops#2b87da 0%|#29c4a9 100%
button_bg_color_gradient_unit%
button_bg_color_gradient_overlays_imageoff
button_bg_color_gradient_start#2b87da
button_bg_color_gradient_start_position0%
button_bg_color_gradient_end#29c4a9
button_bg_color_gradient_end_position100%
button_bg_enable_imageon
button_bg_parallaxoff
button_bg_parallax_methodon
button_bg_sizecover
button_bg_image_widthauto
button_bg_image_heightauto
button_bg_positioncenter
button_bg_horizontal_offset0
button_bg_vertical_offset0
button_bg_repeatno-repeat
button_bg_blendnormal
button_bg_enable_video_mp4on
button_bg_enable_video_webmon
button_bg_allow_player_pauseoff
button_bg_video_pause_outside_viewporton
button_use_iconon
button_icon_placementright
button_on_hoveron
custom_loop_template_buttonoff
loop_template_button_text_size18
loop_template_button_bg_use_color_gradientoff
loop_template_button_bg_color_gradient_repeatoff
loop_template_button_bg_color_gradient_typelinear
loop_template_button_bg_color_gradient_direction180deg
loop_template_button_bg_color_gradient_direction_radialcenter
loop_template_button_bg_color_gradient_stops#2b87da 0%|#29c4a9 100%
loop_template_button_bg_color_gradient_unit%
loop_template_button_bg_color_gradient_overlays_imageoff
loop_template_button_bg_color_gradient_start#2b87da
loop_template_button_bg_color_gradient_start_position0%
loop_template_button_bg_color_gradient_end#29c4a9
loop_template_button_bg_color_gradient_end_position100%
loop_template_button_bg_enable_imageon
loop_template_button_bg_parallaxoff
loop_template_button_bg_parallax_methodon
loop_template_button_bg_sizecover
loop_template_button_bg_image_widthauto
loop_template_button_bg_image_heightauto
loop_template_button_bg_positioncenter
loop_template_button_bg_horizontal_offset0
loop_template_button_bg_vertical_offset0
loop_template_button_bg_repeatno-repeat
loop_template_button_bg_blendnormal
loop_template_button_bg_enable_video_mp4on
loop_template_button_bg_enable_video_webmon
loop_template_button_bg_allow_player_pauseoff
loop_template_button_bg_video_pause_outside_viewporton
loop_template_button_use_iconon
loop_template_button_icon_placementright
loop_template_button_on_hoveron
positioningnone
position_origin_atop_left
position_origin_ftop_left
position_origin_rtop_left
widthauto
max_widthnone
min_heightauto
heightauto
max_heightnone
filter_hue_rotate0deg
filter_saturate100%
filter_brightness100%
filter_contrast100%
filter_invert0%
filter_sepia0%
filter_opacity100%
filter_blur0px
mix_blend_modenormal
animation_stylenone
animation_directioncenter
animation_duration1000ms
animation_delay0ms
animation_intensity_slide50%
animation_intensity_zoom50%
animation_intensity_flip50%
animation_intensity_fold50%
animation_intensity_roll50%
animation_starting_opacity0%
animation_speed_curveease-in-out
animation_repeatonce
hover_transition_duration300ms
hover_transition_delay0ms
hover_transition_speed_curveease
link_option_url_new_windowoff
sticky_positionnone
sticky_offset_top0px
sticky_offset_bottom0px
sticky_limit_topnone
sticky_limit_bottomnone
sticky_offset_surroundingon
sticky_transitionon
motion_trigger_startmiddle
hover_enabled0
grouping_tax_title_text_shadow_stylenone
grouping_tax_title_text_shadow_horizontal_length0em
grouping_tax_title_text_shadow_vertical_length0em
grouping_tax_title_text_shadow_blur_strength0em
grouping_tax_title_text_shadow_colorrgba(0,0,0,0.4)
title_text_shadow_stylenone
title_text_shadow_horizontal_length0em
title_text_shadow_vertical_length0em
title_text_shadow_blur_strength0em
title_text_shadow_colorrgba(0,0,0,0.4)
excerpt_text_shadow_stylenone
excerpt_text_shadow_horizontal_length0em
excerpt_text_shadow_vertical_length0em
excerpt_text_shadow_blur_strength0em
excerpt_text_shadow_colorrgba(0,0,0,0.4)
loop_template_meta_text_shadow_stylenone
loop_template_meta_text_shadow_horizontal_length0em
loop_template_meta_text_shadow_vertical_length0em
loop_template_meta_text_shadow_blur_strength0em
loop_template_meta_text_shadow_colorrgba(0,0,0,0.4)
loop_template_meta_a_text_shadow_stylenone
loop_template_meta_a_text_shadow_horizontal_length0em
loop_template_meta_a_text_shadow_vertical_length0em
loop_template_meta_a_text_shadow_blur_strength0em
loop_template_meta_a_text_shadow_colorrgba(0,0,0,0.4)
loop_template_a_text_shadow_stylenone
loop_template_a_text_shadow_horizontal_length0em
loop_template_a_text_shadow_vertical_length0em
loop_template_a_text_shadow_blur_strength0em
loop_template_a_text_shadow_colorrgba(0,0,0,0.4)
pagination_font_text_shadow_stylenone
pagination_font_text_shadow_horizontal_length0em
pagination_font_text_shadow_vertical_length0em
pagination_font_text_shadow_blur_strength0em
pagination_font_text_shadow_colorrgba(0,0,0,0.4)
active_pagination_text_shadow_stylenone
active_pagination_text_shadow_horizontal_length0em
active_pagination_text_shadow_vertical_length0em
active_pagination_text_shadow_blur_strength0em
active_pagination_text_shadow_colorrgba(0,0,0,0.4)
button_text_shadow_stylenone
button_text_shadow_horizontal_length0em
button_text_shadow_vertical_length0em
button_text_shadow_blur_strength0em
button_text_shadow_colorrgba(0,0,0,0.4)
loop_template_button_text_shadow_stylenone
loop_template_button_text_shadow_horizontal_length0em
loop_template_button_text_shadow_vertical_length0em
loop_template_button_text_shadow_blur_strength0em
loop_template_button_text_shadow_colorrgba(0,0,0,0.4)
box_shadow_stylenone
box_shadow_colorrgba(0,0,0,0.3)
box_shadow_positionouter
box_shadow_style_productnone
box_shadow_color_productrgba(0,0,0,0.3)
box_shadow_position_productouter
box_shadow_style_grid_list_view_buttonnone
box_shadow_color_grid_list_view_buttonrgba(0,0,0,0.3)
box_shadow_position_grid_list_view_buttonouter
box_shadow_style_buttonnone
box_shadow_color_buttonrgba(0,0,0,0.3)
box_shadow_position_buttonouter
box_shadow_style_loop_template_buttonnone
box_shadow_color_loop_template_buttonrgba(0,0,0,0.3)
box_shadow_position_loop_template_buttonouter
text_shadow_stylenone
text_shadow_horizontal_length0em
text_shadow_vertical_length0em
text_shadow_blur_strength0em
text_shadow_colorrgba(0,0,0,0.4)
disabledoff
global_colors_info{}
0.330100059509 seconds