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Research Questions

  1. What were the strategies that the nearly 100 EVI CBOs used to promote equitable COVID-19 vaccination in their communities, and how did their work affect individuals, organizations, and the broader community?
  2. What was the local COVID-19–related context in which the CBOs worked, and how did that context change over time?
  3. What were the implementation challenges and lessons learned, including policy recommendations for how to support and sustain a hyper-local, community-led approach during an ongoing public health emergency?
  4. What are overarching recommendations for the longer-term goal of strengthening the public health system in the United States?

The one-year U.S. Equity-First Vaccination Initiative (EVI), launched in April 2021, aimed to reduce racial inequities in coronavirus disease 2019 (COVID-19) vaccination across five demonstration cities (Baltimore, Chicago, Houston, Newark, and Oakland) and over the longer term strengthen the United States' public health system to achieve more-equitable outcomes. This initiative comprised nearly 100 community-based organizations (CBOs), who led hyper-local work to increase vaccination access and confidence in communities of individuals who identify as Black, Indigenous, and People of Color.

In this report, the second of two on the initiative, the authors examine the results of the EVI. They look at the initiative's activities, effects, and challenges, and provide recommendations for how to support and sustain this hyper-local community-led approach and strengthen the public health system in the United States.

Key Findings

There is evidence that the EVI reached its target population and played a role in improving vaccination equity

  • The CBOs participating in the EVI were working in cities with longstanding inequities.
  • Despite these entrenched inequities, CBOs that did not previously work in the fields of public health and health care (as traditionally defined) proved that they could quickly and effectively pivot to address barriers to COVID-19 vaccination.
  • Nationally, the number of first and second doses of COVID-19 vaccines given per month steadily declined; over the same period, vaccinations through the EVI continued to trend upward.
  • The CBOs that participated in the EVI held over 4,500 events where vaccination occurred, provided assistance to get vaccinated almost 155,000 times, gave nearly 65,000 vaccinations, and made almost 15 million connections with people to provide accurate vaccination information.
  • The EVI's primary impact on participating CBOs was the capacity these organizations built and continued to strengthen over time, including building health communication infrastructure and skills; establishing relationships, networks, and communities of practice in their cities; and advocating for equitable policies in their communities.

The initiative encountered challenges related to the need to move quickly to address the COVID-19 crisis and the use of an equity-first approach

  • These challenges and insights from EVI participants pointed to a set of promising practices for implementing hyper-local, community-led, equity-first vaccination and other public health interventions.

Recommendations

  • CBOs should not be seen as stopgaps used to plug holes in an emergency. CBOs need to be incorporated into the public health system on a day-to-day basis and consistently and adequately supported with both funding and technical assistance.
  • The definition of the public health workforce must be expanded to include those that are outside the fields of health care and public health as traditionally defined.
  • All partners, traditional and nontraditional, should be provided with adequate, consistent, and flexible funding; equitably allocated resources, access to high-quality, race-disaggregated, hyper-local, and timely data; and resources to focus on public health communication.

Research conducted by

This research was supported by a contract from The Rockefeller Foundation and carried out within the Access and Delivery Program in RAND Health Care.

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