Strategies for increasing vaccination equity

Mass. needs to reach deeper into hardest-hit communities

BY MANY ACCOUNTS, Massachusetts stands out as one of the top five states in fully vaccinating its citizens. To date, 4.1 M residents are fully vaccinated and an additional 542,000 are awaiting second shots. However, a deeper dive into this data reveals stark disparities in vaccination rates.

Overcoming the myriad barriers to getting shots into residents’ arms will have a profound public health impact. Now is the time to set a lofty but practical goal. Fully vaccinating more than 5 million Massachusetts residents (75% of our citizenry) is doable and the state can reach this critical goal well before all of our youngest children may become eligible for the vaccine that is expected to occur sometime in the Fall.

How do we get to 5 million or more individuals fully vaccinated? First, let’s start by making sure that the 542,000 individuals who received their first shot get their second one. With barely a nudge, we can expect that at least 515,000 (95%) of these individuals will return for their second shot, contributing quickly to our vaccination goal.

Next, we suggest a new statewide strategic plan targeting high-risk communities and populations younger than age 30 coupled with a corresponding public education and communications campaign. This new strategic plan must be vetted by public health experts, medical practitioners, community members, social services providers, and racial justice advocates. Communities at greatest risk of the spread of COVID — those with the most inextricable link to race and poverty — have the most compelling need for vaccines. For example, of the 25 cities in Massachusetts with the largest Black and Hispanic populations, 22 are among the state’s 50 cities with the highest rates of COVID. State data demonstrates that there is a clear link between being Black, Brown, or low-income and risk of getting COVID.

The 50 Massachusetts communities with the highest COVID infection rates have adult (60 percent) and pediatric (39 percent) vaccination rates that are 11 percent and 30 percent lower than the 50 most prosperous communities where the COVID rates are far lower. Attaining the same level of vaccinations as in the more prosperous 50 communities would lead to 244,247 more fully vaccinated individuals and a major step toward reaching our 5 million goal.

A comprehensive campaign that centers on equity and deploys vaccine ambassadors working with respected community-based organizations in the 50 high-risk communities can counter disinformation, provide assurances of vaccine safety, remind residents that the vaccine is free, and guide them to the closest vaccination site. The state has taken steps in 20 of these cities, but vaccination rates continue to languish in many of the high-risk communities. Chelsea, Revere, and Framingham have bucked these trends by leveraging community-led, peer-based strategies to get their residents vaccinated. We can benefit by learning from these successes and scaling these models to all the high-risk communities.

Massachusetts has done an exemplary job in fully vaccinating 81 percent of our residents older than 30 years of age. However, we must do a better job vaccinating those younger than 30 years. Vaccination rates for 16-19 year olds have begun to plateau at 57 percent and nearly 400,000 of the 1 million 20-29 year olds have not been vaccinated. Although 12-15 year olds became eligible five  weeks ago, only 43 percent have been vaccinated. Reaching even 70 percent of unvaccinated 12-29 olds results in more than 500,000 newly vaccinated individuals.

We can undertake efforts to involve as many schools as possible in communicating about and providing vaccines. Many school districts hold very successful influenza vaccine clinics and schools are places families generally feel comfortable and can easily access; therefore, they could be ideal locations where all household members could be vaccinated. Deploying mobile vaccination clinics in high-traffic areas and work sites and reimbursing businesses to offer work incentives, such as time off to get and recuperate from the vaccine are additional viable strategies. Importantly, most primary care offices are still not able to obtain vaccine and we must encourage thesState to make it more feasible to provide vaccines.

Finally, it is time to ramp up the state’s “Trust the Facts: Get the Vax” campaign to align and complement initiatives aimed at high-risk communities and youth. A well-designed, focus group-tested education and communications campaign can complement the “boots on the ground’ approach and encourage individuals on the fence to get vaccinated. Social media platforms such as Instagram, Facebook, WeChat, and TikTok should be part of a comprehensive communications and outreach plan to address COVID vaccine mis/disinformation.

Meet the Author

Alan C Geller

Senior lecturer, department of social and behavioral sciences, Harvard T.H. Chan School of Public Health
Meet the Author

Lloyd Fisher

President, Massachusetts chapter, Am Academy of Pediatrics
Meet the Author

David Gao

Rising fourth year medical student, University of Illinois at Chicago
Meet the Author

Tami Gouveia

State representative, Representing Acton
Using these strategies, Massachusetts can be the national leader in vaccine equity by reaching deeper into our hardest-hit communities. Now is the time to vaccinate fairly, broadly, and equitably in order to save lives and achieve the true vaccine equity that we all covet. As public health orders are lifted, raising the rate of full vaccinations for all is our remaining equalizer.

Alan C. Geller is a senior lecturer in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health; Lloyd Fisher is the president of the Massachusetts chapter of the American Academy of Pediatrics, David Gao is a rising fourth-year medical student at the University of Illinois at Chicago, and Tami L. Gouveia is the Massachusetts state representative from Acton.