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Engaging in effective COVID-19 vaccine conversations "can be done by a doctor, by a community health worker calling on the phone, or by a teenager with 1,000 followers.”
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Building on a History of Teamwork and Collaboration to Address COVID-19

By IHI Team | Wednesday, November 3, 2021
Building on a History of Teamwork and Collaboration to Address COVID-19 Photo by Ben Turnbull | Unsplash

In Spring 2020, Lupita Rojas, a student at Watsonville High School in Santa Cruz County, California, noticed that many of her peers did not have a trusted source of information about COVID-19. Before and during the pandemic, Lupita had been involved with FoodWhat?!, a local community-based youth empowerment and food justice organization that had joined local pandemic response efforts. Lupita was approached to take a leadership role, and she was eager to help.

In March 2020, she began attending virtual meetings held by community leaders and county officials to learn about COVID updates and efforts to address pandemic-related issues. She also spent time researching the virus and learning about how it was affecting her community. Lupita decided to make a series of weekly videos to share what she was learning, including information about COVID-19 vaccines that had recently become available. She even recorded a video of her own vaccination. Through partnerships forged by FoodWhat?! with the Pajaro Valley Unified School District, Lupita’s videos were emailed weekly to all high school students in the district. And through a partnership with the Santa Cruz County Office of Education, her videos were disseminated to the teaching staff of all alternative education high schools to be shared with students. 

Lupita’s efforts represent just one manifestation of a remarkable collaborative effort in Santa Cruz County, a testament to the possibilities when community-based organizations, government agencies, and community members join forces to address the challenges of the pandemic. The Health Improvement Partnership of Santa Cruz County (HIP) serves as a trusted backbone organization, responsible for facilitating alignment between its members and other entities. Its members include the county public health department, hospitals, federally qualified health centers, and the Medicaid Health Plan. Its partners include multiple organizations and collectives in the community.

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At the start of the COVID-19 pandemic, HIP already had strong partnerships in place. For 15 years, HIP has convened the CEOs of diverse health and human services organizations in the community for a monthly roundtable meeting. This convening has spawned coalitions to address other crises, such as opioid use and mental health issues. “There was an ethos in the community toward collaboration,” said Elisa Orona, Executive Director of HIP. “COVID-19 was just one emergent issue of many that required the collaboration and the vision to do things across different organizations.”

HIP used its standing monthly meeting to launch several others, including a weekly call for clinicians and local leaders, on which more than a hundred providers participated for the better part of a year, exchanging information that helped the county prevent new COVID-19 infections and respond rapidly and equitably when new outbreaks occurred. HIP also established new groups to address leaders’ needs, such as the Federally Qualified Health Centers Committee and a Pediatric Health Workgroup. “There was good will,” said Orona. “We’re all trying to do the right thing.” 

When the COVID-19 vaccine became available, HIP expanded its partnership with the county to initiate weekly vaccine strategy meetings. Orona and her colleagues knew that if they were not proactive and strategic, vaccination would follow the typical health care norm: people with more privilege would get vaccinated first, while those at higher risk from the virus would get left behind, including the largely Latinx farmworker population, non-English speakers, seniors, and LGBTQ-identifying individuals who might be wary of the health care system. She added, “The focus on equity was not new to our community. I would say in the last five years, equity has become more and more of a value.”

HIP and its partners began to think creatively about how to reach these important segments of the community. Hospital systems committed to using their vaccine supply in pop-up locations, such as the Santa Cruz County Fairgrounds, that were geographically convenient for a large swath of the population at greatest risk of COVID-19. For example, at the time of the vaccine rollout, approximately 60 percent of COVID-19 cases were in South County, even though that community comprised only 30 percent of the county’s population. Vaccine providers also partnered with agricultural companies on efforts to reach the farmworker population. “Those have been groundbreaking relationships that I think COVID has fostered,” Orona said. “There are some silver linings.”

The state of California also focused on equity, collecting data on vaccination rates in every zip code and mapping it to a social vulnerability index. The state named this the Vaccine Equity Metric (VEM). In Santa Cruz County, the VEM showed that communities at greater risk for contracting and dying from COVID-19 consistently maintained the same vaccination rate as communities with more resources. By the end of September 2021, the communities at higher risk had a vaccination rate of 75.7 percent compared to 72.4 percent in the communities with more resources. Thanks to collaborative efforts spurred by HIP and others, the county’s vaccination rates did not diverge significantly across zip codes with different measures of social vulnerability. “That was an indication to us that we were getting our vaccines to where they needed to be,” said Orona. 

At this stage, HIP and its member organizations are focusing on the unvaccinated population, trying to make it as easy as possible for people to get the vaccine and to increase receptivity for those who may be hesitant. HIP partners send out vans for in-home vaccination, and anyone who dials 211 can get a free rideshare drop-off at a vaccination site. They do phone outreach with health center staff and others trained to talk with people about their COVID-19 vaccination concerns. The team is using the HEAR model, an active listening technique, to help shape communications:

  • Hear: Could you tell me more about your concerns about the COVID-19 vaccine?
  • Express gratitude: Thank you for sharing that concern. It sounds as though you have been thinking carefully about this.
  • Ask about pros and cons: What would be the bad things about getting a vaccine? How about the good things?
  • Respond: Would it be okay to share some information about your concern?

The staff conducting these COVID-19 vaccination conversations live alongside those they are trying to engage. “If you’re talking to someone who speaks your language, understands your community, and looks like you, you may be more likely to come in or agree to be picked up [for a vaccine appointment],” said Orona. 

As of September 2021, more than 60 percent of the county’s population is fully vaccinated; approximately two-thirds of the population has received at least one dose of COVID-19 vaccine. As the partnership presses forward, they continue to meet people where they are and invoke strategies that resonate with HEAR: listening, engaging respectfully, and trying to allay concerns. “The last mile is going to be about the right people translating the message and getting it out in a really impactful way,” Orona said. “It can be done by a doctor, by a community health worker calling on the phone, or by a teenager with 1,000 followers.”

Editor’s note: The Health Improvement Partnership of Santa Cruz County participated in the IHI COVID-19 Rapid Learning Initiative. IHI gratefully acknowledges Pfizer, Inc., and BD (Becton, Dickinson and Company) for their generous funding support of the COVID-19 Vaccine Rapid Learning Initiative and their leadership and expertise in the drive for vaccine distribution. You may also be interested in:

Learn more about Health Improvement Partnership of Santa Cruz County and their partners.

Identifying the Keys to Effective Vaccine Communication and Outreach

Conversation Guide to Improve COVID-19 Vaccine Uptake

Leveraging Community Partnerships to Navigate COVID-19

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