COVID-19 Vaccine - Equity and Engagement

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.

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:

• Providing language access services (PDF)
• Ensuring accessibility for people with disabilities (PDF)
• Having an equity-informed extra doses plan
• Partnering with trusted community organizations and leaders
• Conducting intentional and culturally responsive outreach to disproportionately impacted communities
• Learn about other vaccine equity strategies (PDF)

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.

The Washington State Department of Health has an obligation to ensure equitable access to the COVID-19 vaccine. We recognize that community-rooted and community-led organizations and groups are better positioned and equipped to listen, understand, and respond to the needs of their community members in the most culturally relevant and linguistically appropriate way. They are also better equipped to use a trauma-informed lens or approach to their interventions so as to not perpetuate further harm, fear, and distrust that may be exacerbated by governmental entities in times of extreme crisis, like a pandemic.

In 2020, DOH and Desautel Hege launched a new community-based outreach approach to working with community media and organizations to address inequities around COVID-19. Through this program, DOH funds community media and organizations to develop communications and perform outreach to historically excluded and underrepresented audiences. The goal is to ensure priority communities receive culturally appropriate and accessible information about COVID-19 vaccines, prevention, and safe re-opening.

Based on population health data, risk and vaccination, priority communities are identified where additional mile-deep communications can help improve health outcomes. Mile deep (as opposed to mile-wide) communications are defined as activities that go beyond traditional advertising and public education to connect deeply with a community through trusted message carriers, culturally informed communications and outreach in a way that considers access, social determinants of health, systemic racism, and historical trauma.”

Community Driven Messaging Contracts

Since the fall of 2020, we have partnered with DH to support direct investments in community/ethnic media outlets and community based organizations for community-driven messaging efforts.

Community Outreach Services Contracts

Winter Partners (January 2021-March 2021)

Between January and April of 2021, the project contracted with 48 partners – 27 paid media vendors and 21 community-based organizations.

Spring Partners (April 2021-June 2021)

In March 2021 the project conducted a second round of outreach to additional partners to expand the project's reach to more communities to support vaccination and prevention messaging. The second phase of implementation has expanded to 122 partners – 34 paid media vendors and 88 community-based organizations.

Summer and Fall Partners (August 2021 – December 2021)

In March 2021, the project conducted a third round of outreach to additional partners to expand the project's reach to support vaccination and COVID-19 prevention messaging. The third phase has expanded to 134 partners.

Additionally, Washington state has the All in Washington Vaccine Equity Initiative. This initiative supports equitable vaccine access by providing funds to trusted, community-based organizations that can provide linguistically and culturally-specific vaccine education and outreach. These organizations also address access, mobility and transportation barriers. Grant funds are flexible and distributed to organizations serving regions and communities with the highest need.

For a list of recently funded organizations, please visit Vaccine Equity Initiative Grants and Grantees – All In WA.

Since September 2020, the Washington State Department of Health (DOH) has partnered with Desautel Hege (DH) to support community-driven COVID-19 outreach & communications. This effort specifically focuses on connecting with priority communities who have been disproportionately impacted during this pandemic and experience access barriers to COVID-19 information and services. The COVID-19 Community Media Outreach Progress Report – Summary, May 21, 2021 (PDF) provides an overview of these efforts as well as insights for both the project and future public health communications efforts

“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.

• Governor Inslee's announcement to expand language access
• Governor Inslee's language access memo to small and executive cabinet agencies
• COVID-19 Vaccine Campaign and Partner Toolkit Resources – multiple languages, includes videos and materials
• COVID-19 Response Language Access Plan
• Search DOH COVID-19 Materials by Language
• National Resource Center for Refugees, Immigrants, and Migrant Communities Translated Resources Library
• UCLA Multi-lingual Resource Hub
• Communication card: Use this to facilitate communication with people who have limited English proficiency and/or people who are deaf/hard of hearing. This does not replace the need for other language assistance services, but is one tool to facilitate communication

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​

• Childcare settings
• Power & Immunity – Information for protecting our bodies & our communities
• Urban Indian Health Institute – Culturally relevant COVID-19 vaccine resources
• CDC COVID-19 Toolkit for Community-based Organizations
• Ad Council Toolkit for Employers and Corporations

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.

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 created a Discussion Guide for Homeless Service Providers (PDF).
• Black AIDS Institute COVID-19 Resources. The Black AIDS Institute has compiled resources focused on engaging Black communities.
• Discussion Guide for Building Confidence in COVID-19 Vaccines for Immigrant and Refugee Communities (PDF)
• COVID-19 Vaccines and Reproductive Health: Talking Points for Medical Providers (PDF)

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.