Open Data

Recommendations to Ensure Equitable COVID-19 Vaccination Access Among U.S. Disadvantaged and Marginalized Populations

At a United States Senate Hearing held in the Spring of 2020, Senator Bernie Sanders stated that "[i]f and when the vaccine comes, it won't do somebody any good if they don't get it." COVID-19 [Covid] infectious disease is a severe public health crisis and the administration of vaccines to inhibit this disease is a Global task. But the Covid inoculation process for socially disadvantaged persons in America, needs to be administered at a targeted local community level. Dr. Anthony Fauci, the Director of the U.S. National Institute of Allergy and Infectious Diseases, has estimated that 70-85% of the U.S. population needs to receive Covid vaccinations in order for America to achieve an effective "Herd Immunity" status against COVID-19 infections. Yet a 2012 research study of flu vaccine uptake in a low-income area of New York City, found that 95% of people who did not get a flu shot stated that the reason they did not, was because access to getting a flu vaccine inoculation was difficult. In order for America to achieve Herd Immunity against COVID-19, rural and impoverished populations need equal access to Covid vaccinations. The following are recommendations to assist DHS/FEMA and the U.S. Department of Health and Human Services (HHS) and their partners, to ensure equitable access to the rollout of the federal COVID-19 vaccination initiative:

1. Use of the CDC's Social Vulnerability Index (SVI) and GIS mapping applications to pinpoint socially and economically disadvantage neighborhoods in each community, broken down by Zip Codes. Doctors, Social Workers, Tribal Elders, and other Community Organizations can be contacted by each county/regional/tribal/territorial government component to gather information on SVI factors in their community and then use GIS units of their governments to map their under-resourced, disadvantaged, and vulnerable populations. FEMA can fund and assist in this effort. This SVI information can then be shared with FEMA and their partners who are currently setting up federal mass Covid vaccination sites across the U.S. and its Territories and Tribal Areas. High poverty and rural areas have been shown to have a shortage of Health Care providers, pharmacies, and grocery stores, which are all currently being used to administer Covid vaccines. And the residents of impoverished, disadvantaged, disenfranchised, and traditionally marginalized populations have higher rates of healthcare access inequities and greater incidence of high risk health conditions for COVID-19, such as: hypertension, diabetes, and heart disease conditions. John Hopkins University conducted a research study that concluded people of color are suffering higher rates of severe disease and death from COVID-19 than white Americans. This study found that Black people in America are twice as likely to die from Covid as their white counterparts, and Hispanic people are one and a half times more likely to die. Native and Indigenous Americans are similarly affected. Additionally, people who reside in areas with high SVI scores, are more likely to have jobs that cannot be done virtually and thus they have to report to work in-person and are accordingly much more exposed to COVID-19 than those who are working virtually, or sheltering at home. Socially disadvantaged groups are also more likely to live in smaller spaces with more people in close contact, which also increases their exposure to Covid. Delaying vaccine access to these population groups in socially vulnerable neighborhoods will increase the total number of Covid cases and the risks of the disease being spread throughout a community. One solution for increasing access to Covid vaccines for this populace, is to set up Mobile vaccination clinics in or near all of the Zip Codes with high SVI scores, which can be converted to a Coronavirus Vulnerability Index (CVI). Such Mobile sites can be located at churches, Public Housing Authority locations, Community Centers, and Homeless Shelters. FEMA's network of Faith-Based and Community Organizations (including COADS/VOADS) can be invaluable resources for helping to locate sites to set up in.

2. Use of Community 2-1-1 and similar Help Phone Lines and websites to disseminate Covid vaccine information and vaccination locations. Covid vaccines are a vital lifesaving tool to prevent illness and death. In Ohio, Cuyahoga County and the United Way of Greater Cleveland have teamed up to hire additional staff for the county 2-1-1 Call Center. These added staff members have been specially trained to answer questions about COVID-19 and vaccination locations. FEMA funding can be used to set up similar Call Centers in every county/terrirory/tribal area. And the SVI/CVI-related information gathered in each locale, can be used to select vaccination sites in each community, and that Mobile vaccination location information can then be passed on to the pubic through these Call Center Help Lines and similar dedicated Covid vaccination websites. The contact information for the Cuyahoga County 2-1-1 vaccine information program is: Miranda Kortan, 216-698-2546, [email protected], and Katie Connell, 440-895-5513, [email protected]

3. Serving the homeless population. People suffering from homelessness are among the most marginalized and vulnerable in American society. The U.S. Housing and Urban Development (HUD) Department has a website of documents formulated by their Technical Assistance Providers that imparts valuable information regarding vaccinating the homeless population: Two articles that FEMA/HHS and their vaccine site partners should review are entitled, "Congregate Setting Vaccination Event Floor Plan," and "Social Media Messages." These articles and/or others on this website, contain a checklist to use for site selection and setup, event types, and other considerations for vaccinating the homeless. Along with the social media examples, there are also sample flyers in different languages. Each Zip Code selected to set up Mobile vaccination sites, should provide flyers, social messages, and Call Center intake employees who speak the languages found in each Zip Code area chosen for a Mobile site.

4. Use of Transportation Networks. In each area that FEMA and their partners set up a Covid vaccination site, transportation to those sites needs to be provided to those in need of it. Many socially vulnerable areas contain a significant segment of elderly, disabled, and low income residents who are without a means of transportation to reach a vaccine site. Uber has teamed up with Walgreens to provide free transportation to Walgreen Pharmacies that are vaccination sites. And Lyft has similarly partnered with nonprofit organizations to provide free rides to vaccine locations. But many socially disadvantaged people, or homeless people, do not reside or stay near a pharmacy. And it is estimated that 2 million Americans aged 65 plus are homebound. And, 5 million have mobility challenges. Visiting Nurses Associations can travel to these populations, as can Area Agencies on Aging, who already hire contractors to visit people in these groups. FEMA funding can help expand programs to reach the homebound and mobility challenged after each community locates them using the SVI/CVI and GIS mapping. A COVID-19 Vaccination Transportation Task Force should be set up in each geographic area that is selected for vaccination sites, in order to organize this type of transportation program.

5. Build vaccine confidence through targeted community engagement. The American Psychological Association (APA) has a publication entitled "Equity Flattens the Curve." This Initiative is designed to reduce vaccine hesitancy from cultural barriers, mistrust of the government, and anti-vaxxer misinformation. Under-resourced and disadvantaged, disenfranchised communities have a higher rate of vaccine hesitancy, and this creates a much longer recovery period for this population and correspondingly, for entire communities that they reside in. FEMA and its partners must develop and execute plans to build trust in the vaccine process to reduce vaccine hesitancy. Many PSA announcements are already being used for this purpose, as well as vaccine information dissemination on websites and social media. But there are gaps in vaccine uptake rates that need to be mitigated in the under-served and under-resourced communities. A specific, targeted campaign to reach these audiences can be funded by FEMA and expanded to create messages in more languages, and more direct message delivery mediums at churches, schools, community health centers, and organizations that serve the socially disadvantage, disenfranchised, and marginalized populations. The APA has two resource guides called "Communication Risks and Benefits: An Evidence-Based Users Guide," and "Framework for Equitable Allocation of COVID-19 Vaccine." The APA website can be found at: In addition, the American Medical Association (AMA) has an online webinar-"Vaccinations: Roadmap for Success," that lists 10 steps to be followed to decrease vaccine hesitancy, especially among the most socially vulnerable groups. A script to use in answering patient questions concerning vaccinations, is also included. FEMA should review these resources and adapt them to use in the current federal Covid vaccine rollout program.

Barb Mills, FEMA


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Idea No. 1680