Equity as a Pillar in Our Vaccine Rollout

April 15, 2021|11:28 a.m.| Monica Bharel, MD, MPH | Commissioner of the Massachusetts Department of Public Health

Monica Bharel, MD, MPHThis National Minority Health Month, we are raising awareness about health disparities and encouraging communities to be “vaccine ready” at this critical juncture of the pandemic. Read below for a message from Monica Bharel (SHO-MA) on three ways Massachusetts has made equity a pillar of its COVID-19 response. Then, continue the conversation with ASTHO on April 21 at the Prioritizing Equity in Public Health Leadership Summit..

A year ago, it was unthinkable that we would have 600,000 cases and more than 17,000 deaths from COVID-19 in the state of Massachusetts. Many of us know someone who has become ill or has died from COVID-19 and the toll in suffering is immense. I am hopeful that the distribution of COVID-19 vaccine will be a light at the end of this long pandemic tunnel.

In Massachusetts, the three pillars of our vaccine effort are to preserve life, preserve our healthcare system, and prioritize equity by focusing on reaching our hardest hit communities. So, equity is at the core of our vaccine allocation work.

This equity work is based on an existing framework of health equity at our department. When I came to the department in 2015, we opened a new office of population health to better use the data that we collect to understand the impact of the social determinants of health and focus our resources in the areas of highest need. We noticed that no matter what the disease—cardiac, diabetes, substance use disorder, or now COVID-19—it is the same populations of individuals who bare a disproportionate burden of illness. So, we flipped our model from looking at specific conditions or diseases and instead looked at populations most burdened by these diseases and illnesses. We focused on the upstream reasons for this disproportionate impact, such as environmental and social issues and structural and institutional bias and racism.

These same principles hold true for the COVID19 burden. We have two focus areas in our vaccine effort for hardest hit communities: 1) building trust and confidence in vaccine safety and efficacy and 2) helping eligible residents overcome barriers to get vaccinated. I’d like to give you three concrete examples of our recent COVID-19 health equity work.

COVID-19 Community Impact Survey
In the fall of 2020, we deployed a survey to obtain more real time data in order to better understand the immediate and long-term health needs facing Massachusetts residents due to the pandemic and to better understand which populations are most impacted. Over 33,000 people responded, describing COVID-19 impacts ranging from delays in healthcare to access to housing, food, and other factors contributing to increased burden from COVID-19. The results can be found here: https://www.mass.gov/info-details/covid-19-community-impact-survey

The survey’s success has been based on our partnership with community organizations. For example, we mobilized a network of community partners who helped us to reach unprecedented numbers of respondents from highly impacted communities such as the Native American, LGBTQ, non-English speaking, Hispanic, Asian, Black, and individuals from our disability and homeless communities.

We are using the results to prioritize resource deployment and policy actions with a strong focus on equity, such as our current vaccine efforts to reduce barriers and enhance outreach.

Community Feedback on Messaging and Public Campaign
Even before the vaccine rollout in Massachusetts, we knew we needed a statewide information campaign to encourage trust and confidence in the vaccine. We timed this with Phase 2 of our vaccine rollout, when more vaccine would be available.

To learn what messages would resonate, we included our partner communities in the development and testing of our messages. We learned that major concerns included long- and short-term side effects, a lack of trust of pharmaceutical companies and government, and concerns over cost. Barriers included lack of transportation, need for time off work, need for information in native languages, and not having a healthcare provider.

This feedback informed our messaging, social media strategy, and a step-by-step guide for local groups to lead forums to address common questions and concerns.

This feedback and our own research also informed our state public awareness campaign, Trust the Facts. Get the Vax. The ads feature a diverse group of doctors speaking to trust and safety. Our research told us physicians are the most ‘trusted messengers’ for this information and are available in 10 languages.

New Equity Initiative in 20 Communities
The third piece is a new equity initiative focused on the 20 hardest hit cities and towns with the greatest COVID-19 case burden, taking into account social determinants of health and disproportionate impact of COVID-19 on Black, Hispanic, and other people of color.

This initiative includes enhanced assistance, support, and resources with the goal of building trust and improving access to the vaccine. We are listening to each community’s needs and we will build on their existing efforts and plans currently in place.

All of this work is based on two principles: 1) using data to inform evidence-based resource allocation and 2) including the narrative from the community to ensure we are engaging those we are trying to reach and asking them what they need, without assuming we have the answers. We see these initiatives as critical to balancing the need to vaccinate as many individuals as possible with the need for equity.

There’s much work still to do, both in our state and across the country. We should take some hope in that we’ve made progress and continue to learn along the way.