The Equity-First Vaccination Initiative aims to reduce racial/ethnic disparities in U.S. coronavirus vaccination rates. Five demonstration sites are using hyper-local, community-led strategies to increase vaccine confidence and access. This interim report highlights the initial work of selected community-based organizations to which the anchor partners are making subgrants, synthesizes lessons learned so far, and suggests policy implications.

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The U.S. Equity-First Vaccination Initiative

Early Insights

by Laura J. Faherty, Jeanne S. Ringel, Malcolm V. Williams, Ashley M. Kranz, Lilian Perez, Lucy B. Schulson, Allyson D. Gittens, Brian Phillips, Lawrence Baker, Priya Gandhi, et al.

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Research Questions

  1. What are the selected CBOs doing to promote equitable COVID-19 vaccination efforts?
  2. What cross-site lessons can be drawn from the EVI in its first few months (through September 2021)?
  3. What policy implications should decisionmakers consider as they seek to support hyper-local, community-driven efforts to reduce inequities in COVID-19 vaccination?

The Equity-First Vaccination Initiative (EVI) aims to reduce racial disparities in coronavirus disease 2019 (COVID-19) vaccination rates in the United States and, over the longer term, to strengthen the public health system to achieve more-equitable outcomes. To accomplish these goals, The Rockefeller Foundation has committed $20 million over one year to fund anchor partners in five major cities—the Open Society Institute—Baltimore in Baltimore, Maryland; the Chicago Community Trust in Chicago, Illinois; Houston in Action in Houston, Texas; United Way of Greater Newark in Newark, New Jersey; and Roots Community Health Center in Oakland, California—to plan and implement hyper-local, place-based strategies to increase vaccine confidence and access for communities that identify as Black, Indigenous, and people of color.

This interim report introduces the initiative and the anchor partners in each of the five demonstration sites, highlights the initial work of selected community-based organizations (CBOs) to which the anchor partners are making subgrants, synthesizes lessons learned across the EVI in its first three months, and suggests policy actions for decisionmakers to consider as they seek to support hyper-local, community-driven efforts to reduce inequities in COVID-19 vaccination.

In just the first few months of the EVI initiative, the CBOs in the five demonstration sites held nearly 1,200 vaccine-related events, provided assistance (e.g., transportation, registration) more than 42,000 times to get people vaccinated, made almost 2 million connections with community members through campaigns and information sessions, and administered almost 16,000 COVID-19 vaccinations.

Key Findings

Three key principles for equity-first vaccination are guiding the EVI

  • Equity-first programming must be delivered at a hyper-local level.
  • It should be led by the communities in which it is implemented.
  • It should be holistic, aiming to achieve vaccination equity in the context of equitable outcomes in health, economic opportunity, and other sectors.

CBOs highlighted several types of access barriers

  • Information about how to get vaccinated is hard to find.
  • Vaccination sites are inconveniently located.
  • Institutions and systems administering vaccinations might not be trusted.
  • Vaccination access requires internet access and technological literacy.
  • Although vaccinations are free, individuals still incur costs related to accessing them.

Organizations are using creative strategies to overcome these barriers and promote vaccination equity

  • Organizations are sharing information through trusted messengers about how to access vaccinations through a variety of mechanisms, ranging from neighborhood flyers to social media messaging.
  • EVI partners are making vaccines more convenient to access.
  • Many EVI partners are helping with registration and providing transportation to and from vaccination events or appointments.
  • Some organizations are offering incentives that are meaningful to the population.

EVI partners identified factors that have enabled progress

  • Three characteristics of CBOs have been critical to implementation of hyper-local approaches to vaccination: mission-driven, committed staff who reflect or come from the communities they serve; deep knowledge of, and history in, their communities; and agility.
  • Partner relationships are essential.
  • Four types of external supports were important: policy leadership; adequate and stable funding; technical assistance; and access to high-quality, timely, race/ethnicity–disaggregated data.

Recommendations

Share accurate, trustworthy, and accessible information

  • Provide funding to CBOs to enable them to collaborate with trusted messengers in their communities and/or hire additional staff.
  • Coordinate messaging and recommendations with CBOs, giving them time to prepare to amplify the message or work to address any unintended effects.
  • Build communication capacity and networks among CBOs and other local organizations to address vaccine misinformation.
  • Provide resources to primary care providers to equip them for difficult, yet efficient, conversations about COVID-19 vaccination.

Provide transportation assistance

  • Collaborate with the private sector to offer free or discounted rides.
  • Ensure reimbursement by public and private payers for providing transportation.

Maximize convenience

  • Ensure that pediatricians can be reimbursed for vaccinating adult caregivers who accompany a child to an office visit or vaccination event.
  • Streamline the process for in-home vaccination and offer sufficient reimbursement.
  • Provide financial incentives for providers to vaccinate their patient population.
  • Provide high-quality, real-time data to target vaccination efforts.

Streamline registration and appointments

  • Expand funding for community health workers, patient navigators, and/or case managers to assist with registration, appointments, or vaccination site location.
  • Support development of technologies to streamline registration, document vaccine administration, and provide information to immunization information systems.

Offset costs

  • Involve communities in designing incentives that are tailored to the community, have value, and will promote rather than hinder equity.
  • Ensure paid time off to get vaccinated, to help family members get vaccinated, and to recover from side effects; or ensure payments for lost income due to vaccination or side effects.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    The Broader Context: Findings from a National Scan of Access Barriers and Strategies to Address Them

  • Chapter Three

    The Equity-First Vaccination Initiative Demonstration Sites

  • Chapter Four

    Early Insights from the Equity-First Vaccination Initiative

  • Chapter Five

    Recommendations Based on Insights to Date

  • Chapter Six

    Summary and Looking Ahead

  • Appendix A

    Methods

  • Appendix B

    What Do Available Data Tell Us About COVID-19 Impacts and Vaccination Rates in the Five EVI Demonstration Sites?

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