equity of vaccination

 Equity in Vaccination: A Plan to Work with Communities of Color Toward COVID-19 Recovery and Beyond

introduction
The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

This plan provides elected and appointed officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

The 5 key principles and their associated action items in the plan are:

• Iteration: Repeated engagement with BIPOC communities is necessary. There is a race to get as many people vaccinated as soon as possible, and this urgency must be balanced with the need to build real trust in BIPOC communities. In many areas, this trust is low or nonexistent, which means that building trust will take time. It will require committing to engaging with BIPOC communities, including organizing productive “listen-and-plan” sessions in which community members have the opportunity to explain their thoughts on COVID-19 vaccination and where officials have the opportunity to listen and hear what is being said, and in partnership, put these ideas into action.
   
• Involvement: Moving forward, BIPOC community representatives and advocates must become active collaborators in the public health process. This will involve implementing mechanisms for 2-way communication (particularly with trusted leaders, influencers, and pillar institutions in local BIPOC communities) and engaging with these key representatives as partners, not as audiences to persuade or subordinates to command. One way this can be done is by encouraging BIPOC individuals and community organizers to actively participate in the COVID-19 vaccination campaign in ways that respect their self-determination and strengthen their self-reliance. A longer-term approach is to ensure BIPOC individuals are in positions of power in government and public health.
   
• Information: Effective communication with BIPOC community members is essential in the ongoing COVID-19 vaccination effort. Applying best practices for communication during this time will be useful for moving forward. As a starting point, it is important to recognize that vaccination messages must be tailored to address the specific concerns of local BIPOC communities. This can be done in one of the following ways (or through a combination of these approaches): identify and support trusted BIPOC individuals and organizations who can relay information and help set community norms related to COVID-19 vaccination, apply learning from “listen-and-plan” sessions to frame COVID-19 vaccination in the communities’ own terms, and enlist allies to blanket BIPOC communities with accurate information that can drown out misinformation.
   
• Investment: All of the efforts described above will require investments of time, attention, and funding. At the same time, the vaccination process itself can be viewed as an opportunity for economic revitalization, with the potential to lead communities out of the pandemic and its economic hardships. This type of revitalization is particularly important to BIPOC communities that historically, and presently, are often economically challenged. Practical suggestions for investment include: pull together the necessary resources to ensure COVID-19 vaccination is equitable (meaning, easily available to the most marginalized individuals in the community) and then fight to keep these resources in place moving forward; creatively finance nonprofit and for-profit entities with BIPOC community roots to strengthen the vaccination enterprise; and enlist the help of private capital to support vaccination, for example, by getting transportation companies to commit to providing free rides to and from vaccination sites or by having a local grocery store sponsor a “get vaccinated” poster contest for schoolchildren.
   
• Integration: Looking forward to the end of the pandemic, it is important to recognize that recovery will take time. COVID-19 will have long-lasting physical, psychological, and financial effects, especially in BIPOC communities. Because of this, the COVID-19 vaccination campaign cannot be viewed as a final step in returning to “normalcy.” Instead, it needs to be seen as a step toward a more complete recovery that can, and should, include meaningful social change. This can take place as the recommendations outlined above—including “listen-and-plan” sessions, empowering BIPOC individuals and communities, and investing in equitable public health—are integrated into ongoing community initiatives and as government and public health officials commit to ensuring durable social change and community benefits that include adequate housing, food security, living wages, and leadership opportunities.

This approach will be challenging. Some may argue that a lack of time or funding or interest are barriers that make such an approach unrealistic, especially in the middle of a pandemic that is challenging on every front. However, it is important to keep in mind that challenges like the one we are currently facing often stem from social inequity and provide opportunities to change and improve. Some actions may be more appropriate to prioritize in the near term, but many actions that are crucial for the long term will have more of an overall impact if those efforts are initiated now.

COVID-19 vaccination is the most likely way out of the current pandemic. It is also an opening to create equity and durable benefits for BIPOC communities, who have been devalued and too often cut out of opportunities in the United States. We hope that you consider this and the specific recommendations made in this report as you begin to implement COVID-19 vaccination campaigns in your own towns, cities, and states.