Best Practices for Equitable COVID-19 Vaccination Drive
Many groups with the highest COVID-19 incidence and rates of hospitalization and death are experiencing the lowest rates of vaccination, including Black and Hispanic populations. Physical and/or geographic barriers also may affect individuals with impaired mobility, housing instability, or rural residence. In addition, a survey of military families conducted in December 2020 showed that 7 of 10 families reported concerns about vaccine safety, side effects, and efficacy. In collaboration with HSR&D investigators, the Interdisciplinary Vaccine Team at the VA Puget Sound Healthcare System considered these factors and more in developing an equitable, coordinated, and data-driven COVID-19 vaccination drive for Veterans (carried out from December 21, 2020 to May 30, 2021). Approximately one month in advance of administering the first vaccination in December 2020, the team developed a facility-level framework for an equitable delivery strategy. The team included three general internists as well as representatives from other disciplines (i.e., ethicist, geriatrician, psychologist, and diversity, equity and inclusion expert). The plan included four main domains: allocation, outreach, delivery, and monitoring. Emphasis was placed on personal outreach for vaccine scheduling, and intense collaboration with community stakeholders such as Veterans Service Organizations and other trusted messengers to promote vaccination offerings. Equity was monitored at intervals of every 10,000 vaccinations by comparing the cumulative proportion vaccinated by race and ethnicity, sex, and rural status within each age cohort. The team used the monitoring data to guide adjustments to vaccine operations.
As of July 28, 2021, the VA Puget Sound facility had administered 79,643 vaccinations to 41,386 Veterans, representing 42% of its total population, and including 42% of Black enrollees, 29% of American Indian/Native Alaskan enrollees, and 35% of white enrollees. Key takeaways include:
- Develop an intentional vaccine delivery strategy in conjunction with experts in population-level barriers to vaccination; explicitly include demographic and social determinants of health data to prioritize vulnerable populations in accessing vaccination.
- Utilize multiple communication channels to reach patients in different formats.
- Reach out across departmental lines to expand vaccine delivery outside of the hospital or clinic (e.g., in-home vaccination, pop-up mobile clinics).
- Employ learning health system methods, including using data to identify vaccine candidates, monitoring equity at prespecified intervals – and adjusting operations accordingly.
- Collaborate with trusted community stakeholders from outside the medical establishment to enhance vaccine outreach and acceptance.
- Healthcare systems would benefit from strategically designing their vaccine operations in ways that reduce sources of inequities within their unique target populations, especially by making scheduling accessible and using personalized outreach.
Beste LA, Chen A, Geyer J, Wilson M, Schuttner L, Wheat C, Rojas J, Nelson K, and Reddy A. NEJM Catalyst. Best Practices for an Equitable COVID-19 Vaccination Program. October 2021;(2)10.