Communities of color have long faced greater economic and social challenges compared to their white peers — such as less job flexibility, crowded housing environments, and limited access to high-quality education and health care. But when the COVID-19 pandemic hit, it underscored the health and racial disparities faced by Black and brown communities and has highlighted the importance of addressing social determinants of health. Lack of access to health care and other key resources has put individuals living in communities of color at greater risk of getting COVID-19 — with Black and Latino patients three times more likely to die from COVID-19 and about four times more likely to be hospitalized with the disease than white, non-Hispanic patients.

As vaccines continue to roll out across the United States, it’s becoming evident that hesitancy isn’t the only driver behind communities of color not getting the vaccine — it’s access. While early data showed Black and Latinx communities were less inclined to receive the vaccine, new reports show that the intent to get vaccinated among these populations has significantly increased. Still, access remains a challenge.

For some individuals, it may be having difficulties navigating vaccine registration sites due to language barriers or long queue lines. For others, it could mean not having the ability to spend long hours searching online to book an appointment because they don’t have a desk job with a computer. These challenges not only hinder access but can also contribute to vaccine hesitancy. Because individuals faced these barriers at the beginning of the rollout, vaccination rates among communities of color are still lagging, despite a willingness to get vaccinated. Removing functional barriers and targeting vaccine information and messaging to specific populations are just a few ways to enable greater access and build vaccine confidence.

Focusing first on access, then on hesitancy

COVID-19 vaccines are an effective solution to achieving community protection, but only if administered widely. States across the country accelerated vaccine distribution by opening up mass vaccination sites, which have been successful in increasing vaccination rates, but present challenges to access and convenience for many vulnerable populations.

In Massachusetts, by early May, hundreds of thousands of residents had been vaccinated through seven mass vaccination sites, with more than a million doses being administered. However, leaders across health care and the government quickly recognized that in order to get vaccinations to vulnerable populations, they also needed to determine a more locally driven approach.

“While Massachusetts set up mass vaccination sites in different areas of the state, these locations are not always easily accessible for many residents, particularly those in hard-hit communities,” says Gregory Wilmot, chief operating officer and senior vice president of the East Boston Neighborhood Health Center.

That’s why in early June, Governor Charlie Baker announced that the state would close four out of the seven mass vaccination sites to shift resources and reach more communities of color and other populations where vaccination rates were lagging. This strategy includes investing in regional sites, expanding mobile clinics, and increasing vaccine supply to primary care doctors.

In addition to concerns around access and convenience, vaccine hesitancy is often influenced by other factors such as mistrust in the vaccine itself and the health care system, language barriers, and limited access to information about COVID-19 vaccines. When the first doses of the vaccine started rolling out in December 2020, only about half of Americans said they would get the vaccine, and those numbers were significantly lower among Black (24%) and Hispanic respondents (34%). Now, vaccine hesitancy rates among Black and white Americans are more or less equal, with some reporting resistance based on the type of vaccine offered.

Many Americans prefer a certain vaccine brand — one survey found that 36% preferred Pfizer, significantly higher than those who preferred Moderna (19%) or Johnson & Johnson (17%). In addition to brand hesitancy, a portion of the U.S. public wants to “wait and see” how the COVID-19 vaccine works for other people before getting it themselves. As of April 2021, about 15% of Americans were still in this “wait and see” category, with the majority of those respondents being from communities of color.

“Hesitancy has morphed and changed so many times, and factors differ by community,” says Adam Scott, senior vice president of health care services at the recently combined Harvard Pilgrim Health Care and Tufts Health Plan. “Concerns around transportation, documentation, and vaccine side effects are typically top-of-mind for people who may be hesitant to get the vaccine. However, as you dive deeper into hard-hit communities, you start to see greater varying challenges that are affecting vaccine hesitancy, such as literacy and access to health care information.”

Reports have shown that language barriers and literacy gaps prevent many non-English speakers from receiving quality health care — an issue that has been further exacerbated by the pandemic. Improving vaccine education and identifying barriers in underserved communities with low vaccination rates is a major focus of the Biden administration. Even with the administration’s efforts, addressing language barriers and literacy gaps will still need to be a community effort.

Meeting community members where they live

In an effort to bring vaccinations to the communities that need them most, Harvard Pilgrim Health Care and Tufts Health Plan, in collaboration with East Boston Neighborhood Health Center, Holyoke Health Center, Chicopee Health Center, Latino Equity Fund, and Last Mile Vaccine Delivery, launched the Mobile Vax program — an initiative aimed at vaccinating more people in Black, Latino, and non-English speaking communities in Massachusetts.

Harvard Pilgrim and Tufts Health Plan have long been committed to responding to racial and social inequities across the region. After listening to the needs of the community, the newly combined organization quickly learned that while mass vaccination sites were increasing vaccine access, it was not meeting the needs of underserved populations that were at the highest risk.

“We have known from our five-decades-long history of the disproportionate access to health care in Black and brown communities — it’s something we live and breathe on a daily basis,” explains Wilmot.

“As a community health center, it’s always been our mission to bring health care services into the community. We were thrilled that Harvard Pilgrim and Tufts Health Plan shared that sentiment and wanted to partner to launch an initiative that would bring vaccines to these hard-hit communities as opposed to bringing the community to mass vaccination sites.” 

— Gregory Wilmot, chief operating officer and senior vice president, East Boston Neighborhood Health Center

East Boston Neighborhood Health Center, the state’s largest health center, has vaccinated between 7,000–8,000 people per week through various methods, including the partnership with Tufts Health Plan and Harvard Pilgrim Health Care’s mobile COVID-19 vaccination van. The focus has been on delivering doses to the communities the Health Center serves across East Boston, Chelsea, Revere, Everett, Winthrop, and the South End. As of May 18, 2021, state data showed that the highest number of Latinx who have been vaccinated are in East Boston (02128), Chelsea (02150) and Revere (02151). This is a testament to the efforts led by EBNHC, community partners, and local municipalities to educate, engage, and vaccinate the community.

Equity is all about being on the ground and meeting people where they are, in the language that they speak. “It’s easy to convince people to do something when you have a physical object in front of them,” explains Scott. “We launched one of the mobile vax clinics in a populous area in Central Square Park [in East Boston], which proved to be very successful. Through our on-the-ground efforts, we were able to convince people to get vaccinated who otherwise weren’t planning on getting the shot or didn’t have access.”

Throughout April and May, the mobile clinics visited vulnerable communities including East Boston, Chelsea, Holyoke, and Chicopee. The mobile vaccination clinics have the capacity to administer up to 500 vaccinations a day. During its first week of service, the mobile vaccination clinics vaccinated nearly 700 individuals. Several of these individuals were non-English speakers and required the cultural and language support provided by ASG, a multicultural marketing agency. The organizations hope to continue their mobile vaccination program in the months to come, especially as vaccine eligibility expands for adolescents.

“Our teams are spending a lot of time on the vax bus interpreting. Not only are they interpreting the standard language, but also explaining, in Spanish, the deeper details about the vaccines.”

— Adam Scott, senior vice president, health care services, Harvard Pilgrim Health Care and Tufts Health Plan

“Leveraging a homegrown model informed by decades of culturally competent care, we have established best practices and implemented innovative programs to establish multiple levels of interpretation support,” says Manny Lopes, CEO of East Boston Neighborhood Health Center. “Perhaps most importantly, we have shared the playbook with our partners to ensure it could be replicated widely. We commend our partners at Tufts Health Plan and Harvard Pilgrim for expanding language access and working alongside us to prioritize health equity across the state.”

Increasing access to COVID-19 vaccines is a critical step toward creating a more equitable health care experience for individuals who have been disproportionately affected.