Operationalizing Equity in COVID-19 Vaccine Distribution MARCH 2021 Informing Policy. Advancing Health. Contents 3 Framework Summary 3 Principles for Equitable Vaccine Distribution 4 Partnering with Community 5 Transparency 5 Ensuring Vaccine Distribution Methods Meet the Needs of Priority Populations 6 Using Data to Make Decisions 7 Roles and Responsibilities Summary 7 Funding and Resources 8 Additional Needs for Priority Populations 9 Resources 9 References About MDPH The Metro Denver Partnership for Health (MDPH) is a partnership of key stakeholders committed to improving health in metro Denver through regional collaboration and action. MDPH is led by the six local public health agencies (LPHAs) serving the seven-county Denver metro area, including Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties. MDPH is a partnership between public health, health systems, Regional Accountable Entities (RAEs), human services, and regional health alliances. MDPH works alongside regional leaders in behavioral health, environment, philanthropy, local government, education, and other areas to achieve its goals of promoting health and well-being across the region. MDPH’s work impacts nearly 3 million Coloradans — 60% of the state’s population — who live in this region. 2 Colorado Health Institute Operationalizing Equity in COVID-19 Vaccine Distribution MARCH 2021 Framework Summary MDPH’s public health and health care partners have committed to proactive planning for equity The following plan is the Metro Denver in vaccine distribution policies and plans. This Partnership for Health (MDPH)’s proposal for commitment includes the following principles: operationalizing equity in its regional COVID-19 vaccine distribution collaboration efforts. There • Partnering with community as shared are many strategies that health care partners, decision-makers to improve trust, address local public health agencies (LPHAs), and disproportionate COVID-19 impacts, prevent future health disparities, and lay the foundation community-based organizations (CBOs) can 1 integrate into vaccine distribution efforts to for future partnerships. This includes tailoring promote equity. The suggested roles for health communications to reach historically care and health systems — including Federally underserved populations with updated, Qualified Health Centers (FQHCs) and Regional accurate information that is delivered by trusted Accountable Entities (RAEs) — LPHAs, and CBOs leadership and voices within these communities. capitalize on each partner’s respective strengths. • Being transparent with the public about The plan also considers partners’ differing historic and existing inequities, activities capacities, and vaccine supply and allocation underway to address them, and progress made plans. MDPH’s framework outlines suggestions on vaccination efforts. for centering equity within a spectrum of approaches to vaccine distribution. • Ensuring vaccination sites meet the diverse needs of multiple populations and collaborating Principles for Equitable with local providers and community leaders to ensure processes at these sites are culturally Vaccine Distribution appropriate and are responsive to community needs and preferences. Across the Denver metro area, the state, and the nation, segments of the population have • Using data to make decisions: COVID-19 case, been disproportionately impacted by COVID-19 hospitalization, and mortality data combined and the economic impacts of the pandemic with community data including age, race/ response. Coloradans who are Black, Indigenous, ethnicity, socioeconomic status, and health Latinx, and other communities of color, those status at the census tract level will help identify with lower incomes, and individuals who lack priority communities for proactive vaccination documentation are at higher risk of severe illness outreach efforts. Current vaccination data from COVID-19. The circumstances of their lives — can identify needed changes in strategy to fill crowded housing, work environment, underlying gaps. It is important to expand vaccination sites health conditions, and limited access to care — and vaccine availability in under-vaccinated put them at higher risk of severe illness. Historic, neighborhoods and populations, working systemic racism and discrimination have also in collaboration with local providers and generated mistrust in the medical system and community leaders. vaccines, and traditional vaccine distribution methods may limit accessibility. As a result, • Prioritizing funding to support vaccine equity, thousands of the region’s most underserved including support for community partners and residents may be going without the vaccine. leaders. Operationalizing Equity in COVID-19 Vaccine Distribution 3 Partnering with Community Community Partnerships At its core, this work must include robust and MDPH has started a community ambassador authentic community involvement. In order to program to promote the importance of promote trust, community members should be flu and COVID-19 vaccination with priority included as equal partners in vaccine planning populations. LPHAs are partnering with up and distribution efforts. Collaborating using to 24 CBOs who are trusted leaders and shared leadership models with ambassadors and who understand the issues facing their cultural brokers (see below) is one strategy. These communities (see Resources on Page 9 professionals help bridge public health and the section for additional information). In addition community by informing interventions; connecting to promotion and communication, these groups, neighborhoods, or organizations who partners may host clinics and help recruit and can help fill in gaps; and helping immunization schedule community members for vaccination. planners understand historic barriers and Affiliating with a CBO for establishing vaccine challenges to vaccination. sites can help with hesitancy and improve vaccine trust with various communities. Shared Leadership Models Members of MDPH’s Health Equity Workgroup Shared leadership comes out of the environmental are also available to identify the partners and justice movement and is a framework for having locations to implement this work. partners —including community members— share responsibility for change. The community We recommend using MDPH’s Guidelines should be involved in every level of the vaccine for Expanding Immunization Delivery dissemination process, including in identifying During COVID-19 for information on partnerships, problem solving, decision making, leveraging partnerships and developing representativeness, and collaboration. See Figure 1 and strengthening relationships with these for an overview of community engagement tactics. community partners. Figure 1: Community Engagement Continuum Increasing Level of Community Involvement, Impact, Trust, and Communication Flow Outreach Consult Involve Collaborate Shared Leadership • Some community • More community • Better community • Community involvement. involvement. involvement. involvement. • Strong bi- • Communications • Communication • Communication • Communication directional flow is bi- relationship. flows from one flows to the flows both ways, directional. to the other, to community and participatory form • Final decision • Forms partnership inform. then back, answer of communication. making is at seeking. with community • Provides • Involves more on each aspect community level. community with • Gets information participation with of project from • Entities have information. or feedback from community on development to formed strong the community. issues. solution. • Entities coexist. partnership • Entities share • Entities cooperate • Entitles form structures. • Outcomes: bi-directional information. with each other. • Outcomes: Broader Optimally, communication establishes • Outcomes: • Outcomes: Visibility channels. health outcomes communication Develops of partnership affecting broader • Outcomes: community. Strong channels for connections. established Partnership outreach. with increased bi-directional trust building, trust built. cooperation. building. 4 Colorado Health Institute Operationalizing Equity in COVID-19 Vaccine Distribution MARCH 2021 Tailoring Communications Ensuring Vaccine Distribution Effective communication with community Methods Meet the Needs of members is crucial and a major facilitator of Priority Populations successful distribution of the COVID-19 vaccine. When partnering with cultural brokers and Equity strategies should be routinely integrated community ambassadors to target priority into health care partners’ efforts to vaccinate their populations, MDPH’s Guidelines for Expanding patients in ambulatory settings as well as LPHA Immunization Delivery During COVID-19 includes vaccine clinics. There are also multiple opportunities key communication strategies that can help to operationalize equity principles into large-scale address barriers such as vaccine hesitancy. vaccination events that aim to immunize many of our Additional recommendations include: community members at once. • Working with cultural brokers who understand In-House Vaccine Clinics the nuances of various communities to ensure • Establish additional criteria (beyond state culturally appropriate messages are being requirements) for selecting patients from a waiting utilized and how messaging can be tailored. list such as ZIP code of residence (prioritizing • Soliciting community member/CBO feedback communities with high COVID-19