Vaccinating All Kids for COVID-19 May Demand a Block-by-Block Effort

When the Food and Drug Administration approved two COVID-19 vaccines for kids under 5 in mid-June, pediatricians and many parents rejoiced. But not all parents. According to a July Kaiser Family Foundation survey, 43 percent of parents said they are “definitely not” getting their newly eligible children vaccinated.

This dismal statistic should not come as a complete surprise. Last fall's vaccination rollout for 5- to 11-year-olds has stalled; only 10 percent of that age group are up to date. Likewise, only about a quarter of 12- to 17-year-olds have gotten their recommended COVID-19 vaccines.

On the whole, children are at low risk of getting very sick with COVID-19. But vaccinations are still essential: They prevent many infections outright, cutting the chances that kids could pass COVID-19 to their vulnerable family members. And if kids do get sick, vaccinations slash the likelihood of severe illness or long COVID-19. All that means that they can stay in school and keep doing the activities they enjoy.

How can the United States jump-start the momentum for vaccinating all kids and teens? Our research offers some promising approaches.

From April 2021 to April 2022, we tracked the progress of the U.S. Equity-First Vaccination Initiative, which aimed to reduce racial disparities in vaccination rates. It enlisted nearly 100 community-based organizations to get shots into arms in predominantly Black and Hispanic communities in Baltimore, Chicago, Houston, Newark, and Oakland.

It turns out that organizations that previously focused on things like voter registration, census participation, and youth empowerment are also effective at breaking down the barriers to COVID-19 vaccination. Their strategies were hyper-local. They brought vaccinations to people's homes, places of worship, food banks, barber shops, and concert venues. If needed, they provided transportation. As known and trusted members of their communities, they were able to share accurate, trustworthy information about COVID-19 vaccines.

Here, for example, is what one community-led approach looked like in Baltimore: An organization that delivers food to seniors with limited mobility hired local young people as “vaccine ambassadors.” When dropping off meals, they spoke to the elderly residents about getting vaccinated. If there was interest, the vaccine ambassadors used mobile phones to make appointments for the residents and, if needed, arranged transportation.

In Houston, organizers piggybacked on a school backpack giveaway event. In the parking lot, staff went from car to car sharing information in Spanish and English on the impacts of COVID-19 in their community and provided vaccine information. People who decided to get vaccinated could go inside the school and get vaccinated on the spot. Those who weren't ready or didn't have time that day got an immediate text message in their preferred language with information about where they could go to get the shot later.

Very few of these small organizations had done health-related work before the pandemic—and certainly not for vaccinations. But now they are an extension of the public health workforce in their cities.

Together, these organizations held more than 4,500 community events where vaccinations were offered. They put almost 65,000 shots directly in arms, 90 percent of which went to Black or Latino individuals. They helped another 155,000 people with other pressing needs, such as housing and food, that were standing in the way of getting a COVID-19 shot. All told, they made almost 15 million connections with people to explain why, how, and where to get their vaccines.

It all worked, but our research found it often took four, five, or even more touchpoints to help someone get from “definitely not” to “yes” on the vaccine. That means one-time vaccination campaigns can fall short. By contrast, these organizations are working in and with communities, so they are positioned to make these repeated touchpoints. They reinforce messages parents are hearing from their pediatricians and help combat mis- and disinformation, politicization of public health, and systemic access barriers. The U.S. Equity-First Vaccination Initiative demonstrated that it is possible to make steady progress on vaccination rates, even for those with the lowest vaccine confidence and highest barriers to access. The initiative's monthly vaccinations trended up throughout that year. But expectations have to be realistic. This will take time.

Community organizations need help if they are to sustain this difficult work, potentially for years. They need adequate, consistent, and flexible funding from both government and foundation sources. They need access to timely localized data on vaccination rates, case rates, and outbreaks. And they need help in further developing communication strategies and refining health-related messages.

Most importantly, however, community organizations need to be seen as an integral part of the public health workforce, not as a stopgap only to be called upon when needed to “build trust.”

Young children have been last in line for COVID-19 vaccines. Making sure that they have every opportunity to get the vaccine may well require working block by block, even door to door. Community organizations are ready to continue doing just that—if they get the resources they need to keep going.

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Laura Faherty is a physician policy researcher at the nonprofit, nonpartisan RAND Corporation and a general pediatrician. Jeanne Ringel is a senior economist at RAND. They conducted the analytic work supporting the Vaccines National Strategic Plan and co-led the RAND team that participated in the U.S. Equity-First Vaccination Initiative.

This commentary originally appeared on Governing on August 29, 2022. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.