Addressing Disparities in COVID-19 Vaccination

Executive Summary 

The Sars-CoV-2 Pandemic has placed in stark relief those populations too often overlooked by traditional modes of healthcare delivery, and the resulting health disparities that affect these vulnerable communities. The challenge is especially acute in Philadelphia, which is one of the most diverse and racially segregated big cities in the United States. In May 2020, the Philadelphia Inquirer reported that Black patients were dying from COVID-19 at a rate more than 30% higher than the death rate among white patients. In July, it further reported that Black and Hispanic women in Philadelphia were infected at rates five times higher than white women. During the initial release of the COVID vaccines, it became apparent that, despite poorer outcomes with infection, Black, Latinx, Asian, and American Indian (Persons of color [POC]) were being vaccinated at disproportionately low rates.

In response, Jefferson led a robust, multidisciplinary, and dual-pronged effort to address these disparities head on. In Phase I of this effort, Jefferson identified a need to focus equitable invitation efforts for vaccinations to POC and enacted aggressive questionnaire processes to established patients in an equitable process to close the care gap between white and POC patient groups.

After initial vaccination efforts were established, Phase II prioritized the launch of mobile vaccination units to focus on underserved populations and bring the vaccine directly into underserved communities. In April 2021, in response to a request for proposals from the city of Philadelphia to expand or establish vaccination operations for COVID-19, Jefferson’s Department of Emergency Medicine collaborated with the Health Design Lab to implement a robust city-wide mobile vaccination workflow.

Through these efforts, Jefferson has aided in the closing of the care gap between the incredibly diverse populations of our city. Since early 2021 our rates of vaccination in POC have steadily increased, and our mobile vaccination sites demonstrate over 80% of their patient population were POC.  In fact, Jefferson’s efforts were heralded in a meeting with members of the White House Covid Task Force for our utilization of technology in mobile efforts. While there is much work left to do, Jefferson Health remains committed to providing more equitable services to underserved populations and minority groups and working to close the longevity gap that has impacted Philadelphia for far too long.

Lessons learned include:

• “Equality” is defined as the distribution of the same resources and opportunities to every individual across a population. Alternatively, “Equity” is the customized distribution of resources and opportunities across a population to ensure no subset of groups are at a particular disadvantage over others in achieving their maximum potential.
• To provide a patient-friendly workflow for vaccinations, the decision was made to utilize our enterprise electronic health record which maintained workflows and integrations. This despite other resources made available that would have been lower cost to implement.
• Integral to the success of this project were the efforts of the clinical informaticists who were able to quickly and efficiently design a workflow that met the needs of the operational leaders. 
• When working with underserved populations, it is critical to understand and target the specific barriers impeding care access for each community. Our multidisciplinary leadership team partnered with well-established groups in underserved communities to design accessible vaccination clinics that addressed multiple barriers including education, trust, and hesitancy concerns. Integrating the community leaders in the design process allowed us to identify a location and population in need, building a bridge between our clinics and target patient populations. Our partnership with community leaders uniquely positioned us to be a trusted healthcare access point. Often, this collaboration led to co-locating with community events making it easy for patients to be served in a convenient and comfortable setting.