Supporting COVID-19 Health Equity Through Community Engagement

The Washington State Department of Health recognizes that the COVID-19 pandemic has impacted everyone but has not impacted everyone equally. The COVID-19 pandemic has shed light on existing health inequities, amplified them, and revealed their root causes.

Community Media Outreach Program

Since October 2020, DOH has supported community-driven COVID-19 outreach and communications.

The Community Media Outreach (CMO) program specifically focuses on connecting with priority communities who have been disproportionately affected by the pandemic and experienced access barriers to COVID-19 information, resources and vaccines.

The two documents below provide a summary of the efforts that the CMO program completed between October 2020 through September 2022.

A preview of Washington State Department of Health Community Media Outreach Cumulative dashboards. Click on this image to link directly to the dashboards.

Community Resources

Below are resources for communities that may be disproportionately impacted by COVID-19 and strategies for equitable COVID-19 vaccine distribution.

Agricultural Workers

Vaccination planning

Education, communication, and outreach resources

American Indian/Alaska Native Communities

Education, communication, and outreach resources

Asian American

COVID-19 impact and considerations

Education, communication, and outreach resources

Black/African American Community
Faith Based Communities

Education, communication, and outreach resources

Immigrant & Refugee Communities

Education, communication, and outreach resources

Latinx Community

Education, communication, and outreach resources

LGBTQ Community

Vaccination planning

Education, communication, and outreach resources

Native Hawaiian/Pacific Islander Communities

Education, communication, and outreach resources

People who are in jails, prisons or detention centers

Education, communication, and outreach resources

People with Disabilities

Vaccination planning

Education, communication, and outreach resources

People with Limited English Proficiency

Education, communication, and outreach resources

Slavic/Former Soviet Union Communities
Unhoused People

Vaccination planning

Unhoused youth

Additional Resources

For Employers

General

Strategies for Equitable COVID-19 Vaccine Distribution

We have adopted eight strategies for equitable COVID-19 vaccine distribution, details are below.

1. Engage communities to inform vaccine prioritization and planning

We are committed to getting feedback from communities, partners, organizations, businesses, and governmental entities throughout all stages of vaccine planning and implementation.

During the fall of 2020, DOH led a comprehensive engagement effort to get feedback from disproportionately impacted communities, partners, and sectors about how we should prioritize and allocate the COVID-19 vaccine. We conducted 90 interviews, focus groups, and community conversations with 568 individuals and surveyed about 18,000 people in multiple languages. Read the full report to learn more.

These engagement efforts directly informed our interim vaccine allocation and prioritization guidance. Some specific examples of how we integrated community input into vaccine prioritization:

  • Phase 1a: Community recommended to expand the definition of workers in health care settings to be more inclusive of workers who may be outside traditionally narrow definitions. This resulted in the intentional inclusion community health workers, non-remote health care interpreters, doulas, birth workers, home care aids, and caregivers.
  • Phase 1b, Tier 1: One of the strongest themes during our community engagement efforts was the desire for all communities to protect their elders. Another strong theme was the need to prioritize older adults and elders who are cared for at home. These older adults are not protected through the long term care program in 1a, and can be at a unique risk if living in a household where someone has to work outside the home. We also know that the age for “older adult” or “elder” differs greatly by community, and an age cut-off of 65 years may not be inclusive. This resulted in the intentional and specific prioritization of adults 50 years+ in multi-generational homes.
  • Phase 1b, Tier 2: Another strong theme throughout our engagement efforts was the need to prioritize our essential workers who are at the highest risk for COVID-19 exposure, especially those who have little control over their work environment, are unable to work remotely, and their specific job functions make it difficult to observe protective measures like adequate physical distancing. Almost all of the occupations listed in Tier 2 are a direct result of community input.
  • Phase 1b, Tier 3: There are many different underlying health conditions that can put someone at increased risk for COVID-19 and research is continuing to evolve as we learn more. To err on the side on inclusivity, we intentionally included both the list of conditions that do increase risk for severe illness as well as those conditions that may increase risk for severe illness for Tier 3 eligibility.
  • Phase 1b, Tier 4: We heard very strongly the need to increase prioritization for people who live, work, volunteer, or reside in congregate settings where they have very little control over their environment, especially those in the settings that have been hit unfortunately hard with COVID-19 outbreaks. This resulted in the intentional and increased prioritization of people in various shelter settings (homeless shelters, domestic violence shelters), disability group homes, and correctional facilities.
2. Integrate a pro-equity approach into vaccine allocation and distribution

We are continuing to integrate a pro-equity approach into vaccine allocation and distribution. This includes looking at all the different ways vaccine is distributed, including via health care systems, pharmacies, state run mass vaccination sites, community pop-up clinics, mobile clinics, local mass vaccination sites, and employer based vaccination sites. For each of these, there are opportunities to support equitable vaccine access by:

3. Prioritize allocation and support to providers who effectively serve disproportionately impacted communities

Providers who are best positioned to serve communities disproportionately impacted by COVID-19 include:

  • Providers located in census tracks with a social vulnerability index of 7+
  • Community health centers
  • Tribal vaccination partners
  • Urban Indian Health Programs
  • Free health clinics
  • Mobile vaccination efforts
  • Community-specific pop-up sites
  • LHJ clinics
  • Providers who serve Medicaid or Medicare patients
  • Providers who integrate pro-equity strategies into their operations, planning, and clinics
  • And other providers or sites at the recommendation of communities

If you are a health care provider who serves communities who are disproportionately impacted by COVID-19 and you are interested in enrolling to offer the COVID-19 vaccine, please visit our COVID-19 Vaccine Program Enrollment page or contact covid.vaccine@doh.wa.gov for technical assistance.

4. Invest in trusted community leaders, messengers and organizations

Since October 2020, DOH has supported community-driven COVID-19 outreach and communications. The Community Media Outreach (CMO) program specifically focuses on connecting with priority communities who have been disproportionately affected by the pandemic and experienced access barriers to COVID-19 information, resources and vaccines. The two documents below provide a summary of the efforts that the CMO program completed between October 2020 through September 2022.

5. Ensure all communications, education and outreach efforts are culturally and linguistically appropriate and accessible

“Information is one of the best tools we have in this fight against COVID-19,” said Gov. Jay Inslee. “But not every community has equal access to information. This plan helps ensure every Washingtonian is better able to stay safe and healthy by making sure our state agencies are providing information that is culturally-relevant and accessible.”

In April 2020, the Washington State Department of Health Community Engagement Task Force worked with the Governor's Office to create a COVID-19 Response Language Access Plan. This created a foundation for language access that we continue to leverage for vaccine communications, education, and outreach efforts.

6. Strengthen the public health system's ability to center communities in vaccine outreach and access

The Washington State Department of Health is the lead entity for distribution and allocation of vaccines. We provide guidance to prioritize populations for vaccine. We also enroll providers as vaccinators and determine weekly allocation of doses among those providers in consultation with local public health agencies. We are committed to strengthening our own efforts as well as supporting local public health agency efforts in centering communities in vaccine outreach and access.

Overall considerations for vaccine outreach

  1. Put greater effort in reaching groups missed by traditional channels.
  2. Utilize trusted community messengers, leaders, and community media outlets.
  3. Ensure outreach is culturally & linguistically appropriate and accessible.
  4. Partner with community-rooted organizations and groups who serve BIPOC, immigrant, and refugee communities and communities disabilities.
  5. Learn about the fears, concerns, experiences, and history of the communities you are trying to reach.

Overall considerations for vaccine access

  1. Provide language access services and advertise them ahead of time.
  2. Ensure all vaccine sites are accessible to people with disabilities.
  3. Offer alternative clinic hours and days to accommodate different work schedules.
  4. Prioritize vaccination sites in areas with a COVID-19 Social Vulnerability Index of 7+.
  5. Create transportation partnerships to facilitate access for people with transportation barriers.

Community-specific tools and resources​

7. Foster opportunities for collaboration

To ensure equitable and accessible outreach, education, and implementation strategies, the Department of Health is building a COVID-19 Vaccine Implementation Collaborative. The Collaborative launched in February 2021 but interested partners can join at any time. Collaborative members:

  • Support COVID-19 vaccine planning and implementation efforts as guided by state and federal guidance.
  • Provide feedback on COVID-19 vaccine outreach efforts to ensure messaging is community-driven and builds vaccine confidence and trust within Washington communities.
  • Share COVID-19 vaccine updates and materials with their respective communities/sectors and other Collaborative members.
8. Support a trauma-informed approach to vaccine conversations

Our community engagement efforts have shown us how critical it is to lead vaccine conversations with cultural humility. For us, this means understanding that historical distrust, trauma, and broken relationships are a result of systemic inequities, racism, and medical harm many historically marginalized groups have experienced. We are developing and collecting anti-racism and trauma-informed tools, training, and resources for vaccine providers and partners. If you have resources to add and share with others, please email equity@doh.wa.gov.

Resources

The Department of Health developed a series of videos about using a trauma-informed approach when discussing the COVID-19 vaccine. The videos provide guidance and tools for health care providers and public health professionals to help increase their awareness of trauma in a practice setting, strategies for building trust, and the influence of historical and previous experience of trauma on vaccine hesitancy.

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