Equity in Vaccination is a Community Effort

By Lily Alexander, Jen Dev, and Meredith Li-Vollmer

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As of this month, over 85% of all eligible King County residents have completed their vaccination series. If you look at just residents ages 16 and older, over 80% have received the two-dose series across racial groups and geographies in King County.

The high levels of vaccination are even more striking in light of existing and continuing inequities that have created obstacles to vaccination for people. It’s much harder to get vaccinated if there aren’t healthcare providers providing vaccination near you. It’s more difficult to sign up for an appointment if you don’t have online access at home. You may be less inclined to get a vaccination if you’ve experienced racism in the healthcare system, or if you can’t find information about it in your language.

“We saw that people were afraid of just getting the vaccine because they didn’t understand the paperwork, or where to go, or just what the vaccine was or why they should get the vaccinations,” said Sagal Abdi, Health and Wellness Coordinator at Living Well Kent, an organization that serves immigrants in South King County.

Vaccinators from Seattle Children’s Hospital helped out at community vaccination event offered by Living Well Kent. (photo: Living Well Kent)

When vaccinations began in 2021, Living Well Kent started to hold informational sessions about vaccine as part of their COVID response work. They also coordinated with Seattle Children’s, Odessa Brown Clinic, Country Doctor, and Othello Pharmacy to offer vaccination at events where they provided food vouchers, diapers, and other services.

“We have the trust when it comes to the community and it helped people get more comfortable with the idea of getting vaccinated,” said Abdi.

This trust was fundamental, especially in Black and Brown communities where historical and personal experiences with racism in the health system have led to high rates of distrust. The dedicated efforts of organizations with deep roots in communities across King County have made all the difference. Together, we’ve centered an equity approach to vaccination that continues to make progress in increasing vaccination rates.

Setting goals to address inequity

Systemic and structural inequities shape who first has access to vaccines and who has more barriers to getting vaccinated. Although the levels of vaccination are generally high across King County, disparities in vaccination played out every step of the way, overlapping closely with socioeconomic and racial disparities in the county.

The rates of vaccination in north and east King County far outpaced those in South King County whenever vaccination was made available for a new age group. For example, currently, in North Seattle and Shoreline, 75% of the children aged 5-11 have completed their two doses, but only 25% of children in the same demographic living in Kent, Auburn, and Federal Way have completed their initial series. 

Similarly, rates of vaccination have shown inequity by race.  In King County, 58% of Asian Americans and 50% of Whites have received a booster dose, but only 30% of Blacks and 28% Hispanic/Latinx residents have a booster.

To address these inequities, Public Health – Seattle & King County set goals to provide equitable access to vaccine by focusing on communities that are at highest risk for COVID, live in areas that have had the most cases and face the most barriers to vaccination. Community partnerships and outreach have been central to meet these goals.

A one-size-fits all approach won’t work for everyone

When vaccination was first rolled out, demand was high. Public Health decided to place the biggest volume vaccination sites in south King County to better serve a region with fewer healthcare providers and more impact from COVID. Community navigators and partners spent countless hours reaching out to their networks to help them sign up for appointments and get them to the vaccination sites.

But as time went on, we found that some people were not well served by our mass vaccination sites, including those who lived far way, needed additional accommodations, didn’t see themself represented by vaccination staff, or spoke languages other than English.

“Our mass vaccination sites were pivotal in getting us to where we are now with vaccination rates,” said  josh martinez, Program Manager for the COVID-19 Place Based Strategy. “But for people who are refugees or may have sensory processing challenges, for example, a large mass vaccination site might not be a comfortable place.”

To expand options, Public Health started working directly with community and faith-based organizations to provide technical support to help them host their own community vaccination events.

Community organizations have been crucial to vaccination events, like one held at the Beverly Park Baptist Church in White Center organized by the Khmer Health Board and the Khmer Community of Seattle and King County. (photo: Ben Stocking)

“These events are organization-led. We’re here and provide vaccine but we recognize that we are coming into safe spaces,” said Naisha Williams, who served as the COVID-19 Vaccine Equity Program Manager and community vaccination events lead for Public Health – Seattle & King County.

On an average week, the community vaccination events team helps support 10 to 15 community vaccination events, with priority given to communities of color in south King County. These vaccination events are driven by the organization’s vision and vary tremendously from event to event, Williams said.

“One minute we’re in a temple and another day we’re at a breastfeeding event. We don’t have that template of this is how our event works.”

Outreach needs to be holistic

Our community partners alerted us to the many people who were not getting vaccinated because they had too many other financial, social, and health hardships they were facing during the pandemic.

“A lot of communities said, ‘we have families that cannot even pay their rent.’ So how can we expect them to want to get vaccinated when that’s not their main concern? Their main concern is rental assistance,” said Taylor Gaston, Place-Based Strategy Program Manager at Public Health – Seattle & King County.

Public Health developed a place-based strategy to address the other social and health needs of a community and connecting them to resources beyond just vaccine, such as rental assistance, health insurance enrollment, and transportation.

Much of this resource-connecting and relationship-building work has been focused in communities of color in Kent, Auburn, Federal Way, Tukwila, and Skyway, where COVID-19 has hit hardest. For example, the Afghan Health Initiative received support from Public Health to coordinate a health event for Afghan refugees, many of whom have been resettled in South King County. In addition to providing COVID-19 vaccine, the event connected people to rental assistance support, health insurance enrollment, and ORCA Lift sign-ups. The Afghan Health Initiative provided food.

The idea of this “whole person” model of vaccine delivery is relational and it is long-term. “The idea is that Public Health isn’t only here for you during the pandemic – we want to play a more significant role in people’s lives going forward,” said martinez.

As Abdi at Living Well Kent put it, “There’s so much to a person when it comes to their health.”

Creating more places to get vaccinated where providers are scarce

Systemic racism, redlining, and underinvestment has resulted in a scarcity of medical providers in south King County compared to Seattle and north King County. Because of these existing infrastructural disparities, vaccine doses are more widely distributed to places like Seattle, where there is the highest concentration of medical providers but where the need is not as great.

For example, even though 40% of kids under 12 live in south King County, only 10% of the initial pediatric vaccine supply went to south King County due to a lack of providers. And not all pediatric clinics and pediatricians in the area were enrolled in the COVID-19 vaccine program when the vaccine rolled out.

Public Health has been tackling these disparities in vaccine distribution by reaching out to all providers, particularly those in South King, to build relationships, enroll them in the vaccine program, and connect them to vaccine doses.

“We want to support all our pediatric providers to be vaccine providers,” said Whitney Taylor, Community Engagement Program Manager for Public Health – Seattle & King County.

An equity approach works

The vaccination efforts continue with the need to get children vaccinated and everyone eligible boosted. And the dedication of our partners at community organizations, schools and childcares, healthcare providers, pharmacies and businesses has shown results.

“We started off with a community that the majority wasn’t vaccinated at all and they were afraid to get the vaccine,” said Abdi. “And then a week ago, Living Well Kent had our latest pop-up clinic. I was calling everybody for the booster shot, and the majority of our whole entire community had their booster shot. I was like, ‘Wow, there’s such a difference from how it started off, because we were able to bridge that gap.’”

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This is the first post in an Equity and Vaccination blog series sharing some of the approaches used by Public Health – Seattle & King County to more equitably serve all communities across the region. Forthcoming posts will spotlight community voices and the ways Public Health and our community partners are working to listen, recognize, and address the persistent vaccine disparities. 

For more on Public Health’s vaccine strategy, visit www.kingcounty.gov/covid/vaccine.

Originally published March 29, 2022