Long shot: Vaccination campaigns move at the speed of trust

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.

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.

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.

After becoming a COVID-19 hotspot, Guadalupe built partnerships and built trust among community members to effectively track cases, dispel misinformation, and increase vaccinations. The Town Council partnered with Pascua Yaqui tribal leaders, the broader Maricopa County, Native Health, and a COVID-19 response team composed of faculty, staff, and students at Arizona State University to lower infection rates. A combination of at-home testing, contact tracing and, eventually, vaccination events helped, as did the use of promotoras – community health workers who talk with residents to help ease anxiety.

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.

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 key to United Airlines successful vaccine mandate, even in areas that have low vaccination rates, was gradually phasing in the mandate after a year-long effort laying the groundwork. The airline worked with the union to set up vaccine clinics at its major hubs and offered incentives to employees who got vaccinated. Incentives, like extra pay or vacation days that declined over time until they expired, led the majority of employees to get vaccinated, and the mandate proved to be the final push that was needed.

Community health workers from One World have gained community trust over the years and now go door-to-door to talk with residents about the COVID-19 vaccine and dispel misinformation. They provide resources in Spanish and carry vaccines in a refrigerated bag so residents can get vaccinated on the spot. The group has invested a lot of money, time, and personnel having intensely personal conversations with people. They also host pop-up clinics in the community and allow at-home vaccination appointments. The areas served by One World has seen more vaccinations than almost anywhere else in Nebraska.

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.