Photo by Jason D | Unsplash
When health authorities are trying to increase the uptake of COVID-19 vaccines, what are the most effective strategies? Caroline Lembright, COVID-19 Community Outreach Coordinator at The Health Collaborative in Cincinnati, Ohio, says to start by asking, “What works, and what feels gimmicky?”
The Health Collaborative, a regional health improvement organization, is part of a coalition that formed in Southwest Ohio in early 2020 to respond to the COVID-19 pandemic. Partners include Cincinnati Children’s Hospital and other representatives from health care and government. The coalition has been learning, through successes and setbacks, the answers to Lembright’s question.
At first, the partnership enabled the coalition to strengthen their COVID-19 testing capabilities and plan for regional surges. More recently, the focus shifted to distributing the vaccine as widely and as equitably as possible. When COVID-19 vaccines became available in early 2021, the coalition established the Vaccine Working Group, which included all five local health systems, the city and county health departments, state representatives, the Council on Aging, and retail pharmacy partners such as Kroger. The group initially met three times a week (Monday, Wednesday, and Friday mornings) for 30 minutes. “Our goals were to strengthen our rollout, optimize efficiency, and align on public communication,” said Kate Schroder, lead Strategy Officer at The Health Collaborative.
One issue the group tackled early on was that each coalition partner had separate COVID-19 vaccination appointment registration sites. To make vaccine registration easier for the public, The Health Collaborative created a central source of information on their website. This resource included a list of all providers offering COVID-19 vaccines and links to their websites, continually updated eligibility information, and FAQs. In addition, the group collaborated with United Way to set up a 211 telephone help line to provide residents with an alternate way to schedule vaccine appointments by phone. This was especially helpful for older adults.
The coalition was determined to ensure that the COVID-19 vaccine rollout in the region was equitable. They commissioned a Rapid, Adaptive Control of the Epidemic (RACE) team to lead data, analytics, and modeling, in part to track vaccine distribution and its breakdown by demographics. Health departments ensured that the coalition had access to extensive data, including demographics and vaccination rates by zip code. At Cincinnati Children’s Hospital, a team reviews the data every week. In the beginning of the vaccine rollout, when supply was especially limited, the coalition requested 10,000 additional doses from the state to specifically target minority and underserved populations, which they received.
From there, the coalition’s efforts took a variety of forms. In April 2021, the “Get Out the Vax” initiative launched across a 15-county region spanning three states (Indiana, Kentucky, and Ohio). On dedicated weekends, COVID-19 vaccinations were offered at almost 50 sites, including hospitals, pharmacies, recreation centers, schools, and stadiums. On these weekends, public transit was free, and United Way offered codes for free rideshare pick-up and drop-off. Thousands of people received COVID-19 shots through this initiative. The coalition also created a visual to depict the Cincinnati region’s progress toward 100 percent vaccination: a thermometer indicating the percentage of eligible residents who were vaccinated. The thermometer was displayed at Reds baseball games and on billboards around the region.
“One of the best things about our group is that we’ve helped create transparency and healthy competition across partners,” said Schroder. “When hospitals were able to start rolling out COVID vaccines to physician offices, we would ask, ‘Have you started? How many offices? Are you doing pediatrics and adults?’ It created peer pressure.”
As the COVID-19 Community Outreach Coordinator, Lembright scrutinizes the data to identify opportunities to reach people who are eligible but still unvaccinated. She has been working with the Urban League and public health departments on very localized, grassroots efforts. These efforts include implementing findings from Cohear, a Cincinnati-based community engagement and strategy company, which canvassed and led focus groups in the Black and Hispanic communities to ascertain the most effective forms of outreach.
The Cohear report identified several lessons on communicating effectively about the COVID-19 vaccine:
- Listening is as important as educating. Rather than trying to tell someone why they should get vaccinated, it’s “more about listening, saying, ‘Tell us about your concern,’” said Lembright.
- Language, too, is crucial. Terms such as “myth-busting” can sound condescending; more neutral terms such as “FAQs” are more effective.
- It’s also important to be proactive: at community events, you will have a bigger impact by circulating in the crowd rather than waiting for people to come up to you.
Financial incentives can work to improve vaccination rates, the coalition found, but some are much more effective than others. The prominent “Vax-a-Million” campaign, which offered the chance to win $1 million in exchange for getting vaccinated, led to a temporary increase in vaccination rates, but it was short-lived. It also seemed to elicit suspicion for some people, for example, one person said, “Now they are paying me a million dollars to get the shot? Now I know something is fishy.” A statewide Medicaid incentive, which required filling out forms and receiving the money later, also had lackluster results, presumably because of the delay and the bureaucracy involved.
A more successful strategy to improve COVID-19 vaccination rates has been to offer small but certain, upfront financial incentives. For example, several providers, such as the Urban League and the city and county health departments, have provided anyone who got a first dose a $100 gift card on the spot. People not only showed up; they then texted their friends and told them to come, too.
An important area of growth has been data analytics. “Even though the health departments have access to this data, they do not always have capacity to do analysis,” said Schroder. “It’s been a really fruitful partnership.” Racial disparities remain, with 35 percent of Black residents in Hamilton County fully vaccinated, compared with 55 percent of White residents and 67 percent of Asian residents. Being aware of these disparities helps public health departments and other entities, said Schroder, “to more effectively target their efforts.”
Targeting efforts often means working with community-based groups in the neighborhood. The coalition has seen the importance of having community members take the lead on communication. At one event, a woman was hesitant to get vaccinated, but her friend and neighbor was there with the community group, and that made all the difference. Her friend said, “You’re coming with me,” and before long, she was sitting down to receive her first dose.
Editor’s note: The Health Collaborative in Cincinnati, Ohio, 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.
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