What if I were to tell you that a key solution to solving the ongoing issues of COVID-19 vaccine access, hesitancy and preventing further epidemic risks in the United States was already available to us? Community-led responses to vaccination and health care delivery are the solution. We are fighting a war of misinformation and still a lack of vaccination access. Community health actors and organizations are remarkably effective at remedying both and we should commit to funding their work to reshape our public health sector as we enter the fourth surge of COVID-19 and as we prepare for future health crises.
Through community efforts, built on trust, we can restore faith in a beleaguered public health system and build a sturdy base from which to rededicate our efforts of health for all Americans. This requires committed and sustained funding from states and Congress that supports these aims.
And, while the federal government can provide resources for vaccine delivery, vaccination efforts are stronger when led by communities and supported by local efforts. Problems of access remain absolutely critical to the vaccination effort; I and other researchers recently found that hyper-local responses to the pandemic resulted in better health outcomes and vaccination coverage. We must support local efforts led by communities that will lead not only to higher rates of vaccination, but also a more effective and equitable public health system. Community-led, organized and advocated measures have closed COVID-19 response gaps, clarified misinformation and gotten people to vaccination locations.
“Access” is a broad term and when it comes to vaccination, it’s a problem that leaves those without it feeling like these vaccines aren’t for them and that the health system doesn’t care about them.
It might be unrealistic to reach 100 percent vaccination coverage. However, we must remain committed to increasing vaccination rates. We currently face serious challenges including serving groups with low vaccine uptake, vaccinating children and orchestrating a potential booster dose campaign. Community health leaders need to be at the center of all these plans. We can do better if we commit to it.
Vaccination rates across the United States have slowed, but there are clear ways we can address this issue — and they must be community-led. We must stabilize community health systems as the foundation of equitable and resilient public health systems.
Community partnerships have been used with great success throughout the pandemic; to be successful we need more of this and can do so if states and the federal government invest in community groups. For example, in an alliance with Unidos en Salud, the University of California San Francisco, and the public health department, representatives went door-to-door promoting COVID-19 testing, which resulted in 4,200 COVID-19 tests conducted in four days and 70,000 tests overall. This work provided a platform for the community’s vaccination efforts. As of late June 2021, 70 percent of the Hispanic/Latino population in San Francisco had been vaccinated.
In Alabama, community health actors became concerned with the implementation of the Federal Retail Pharmacy Program, and what reliance on corporations would mean in poor, rural counties with limited retail infrastructure. To address this issue, community health workers produced maps that provided a clear picture of sparse vaccine access in rural, predominantly Black communities. These maps were shared with an influential community advocate who leveraged political and social capital to encourage state leaders to improve access — the state consulted these maps to distribute vaccines using the National Guard.
In Baltimore, Md., where I live, a lack of Spanish-speaking public health workers severely limited any outreach to the Latinx community in the city during the pandemic. Through efforts led by Centro SOL (The Center for Health Opportunities for Latinos), Spanish language materials were made accessible to communicate to this group.
We must use this moment to develop national immunization programs to protect people throughout their lifetime from all vaccine-preventable diseases. It is a crucial aspect of an effective COVID-19 response, but it is also the foundation to building a healthier, more equitable and connected society. We must galvanize our vaccination efforts towards restoring a public health system that listens and speaks with, rather than for, all people in this country.
Dr. Alexandre White is an assistant professor in the Departments of Sociology and the History of Medicine at Johns Hopkins University. He’s a member of the CommuniVax coalition, which recently published Carrying Equity in COVID-19 Vaccination Forward: Guidance Informed by Communities of Color. He co-leads the Hopkins Population Center COVID-19 Data Hub, which offers timely US county-level data on social, economic and health disparities.