Inside United Airlines' Decision to Mandate Coronavirus Vaccines

Political cooperation and an infrastructure of existing relationships and trust built by NGOs and community leaders during Hurricane Maria and a devastating 2019 earthquake allowed for a quick public health response to COVID-19 focused on prevention and vaccination. All trusted public figures, across political backgrounds, advocated wearing masks and getting vaccinated. As a result, Puerto Rico achieved the highest COVID-19 vaccination rate among all other U.S. state or territory. It also had among the lowest Covid-19 death rates since the start of the pandemic.

Wayanad is the first district in Kerala to have vaccinated the entire adult population with at least one COVID-19 vaccine. Rather than waiting for people to make appointments, officials went door-to-door providing all adults with appointment times. The district’s efforts started early, setting up vaccine infrastructure and assigning people appointment dates by where they live. Rapid Response Teams conducted outreach and education efforts, particularly among tribal populations, and made sure people showed up at their appointment. Getting vaccinated with their neighbors also decreased vaccine hesitancy.

One rural hospital in Indiana vaccinated hundreds of immigrants from Central America by working with trusted community leaders and setting up a Hispanic Health Task Force. Health officials held vaccine clinics alongside trusted community members at locations that were familiar to residents, like a local Catholic church that offers Spanish-language services. The hospital and task force initially established community connections to distribute information about COVID-19, so they were able to utilize the connections to increase vaccination rates once the vaccine rolled out.

The island of Malta fully vaccinated 90% of the population over the age of 12 against COVID-19 relatively quickly. They quickly vaccinated the most vulnerable in the population, including the elderly and healthcare workers and sent mobile clinics to where the population was. This, along with an effective media campaign that answered questions and dispelled misinformation, was particularly important in getting people, especially young people, vaccinated. A nationwide culture of trust in doctors was very important in the vaccination success.

Spain achieved one of the highest vaccination rates among Western countries in part because of longstanding trust and confidence in the public health system and data-informed strategies. The public generally trusted the safety of the COVID-19 vaccine because of a history of cooperation and positive public health outcomes. The norm of inter-generational living also gave young people more incentive to get vaccinated to protect their elderly residents and officials used this as part of the public health messaging. Officials also personally called and set up vaccine appointments for everyone they could reach.

The Greater Lowell Health Alliance offered COVID-19 vaccines using a “block party” model where community members enjoy free food, music, activities, and even childcare, while also having access to information about vaccines in multiple languages as well as the ability to actually get vaccinated. This model reduced barriers for immigrants, refugees, and other people who don’t speak English fluently, as well as caregivers who can’t attend vaccine appointments due to their caregiving responsibilities. The relaxed environment, where loved ones can support each other, increased comfort with getting the vaccine.

Dare County, a relatively isolated and rural coastal county in North Carolina, has the highest vaccination rate in the southern U.S. The successful vaccination campaign is due in part to an existing communication infrastructure that local governments and healthcare systems use to coordinate during hurricane emergencies. Existing communication channels and relationships made it easier to publicize mass vaccination sites and get people to register online. Officials also went to great lengths to get more vaccines, petitioning the state for extra doses and even driving to other counties to pick up surpluses.

Taiwan responded to COVID-19 quickly, which helped keep cases low and avoid widespread shutdowns. The country had closely tracked its PPE stockpiles since the 2003 SARS outbreak, has a national health command center to coordinate responses, and uses a well-defined set of procedures to track and manage people under infectious risk or quarantine. Masks are required and provided to every citizen, inbound travelers were quickly regulated, and contact tracing and testing is widely used to prevent outbreaks. Citizens generally listen to authorities, though fines and other sanctions also encourage compliance.

Community health workers are a key part of Connecticut's public health response to COVID-19, particularly in marginalized communities. CHWs connect people to health care and other services, like rental assistance, help with contact tracing, and effectively increased vaccinations by taking the time to answer questions and dispel misinformation. Living in the communities they serve is a critical part of the model’s success and helps clients trust them more readily. The state now offers a CHW certification program, but the largely grant-funded model would be more sustainable with steady funding.

Health centers around Cleveland seek to build trust with residents in order to dispel misinformation and increase vaccination rates against COVID-19. Health officials use social media, engage with trusted messengers like local religious leaders, and acknowledge fears while gently pushing back against misinformation to effectively build trust among the community. Culturally competent and targeted outreach has also been an effective way to convince people to get vaccinated within some immigrant communities.