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. 2023 Apr 3;21(2):85–94. doi: 10.1089/hs.2022.0096

A Path Forward: COVID-19 Vaccine Equity Community Education and Outreach Initiative

Risha Irvin 1,✉, Maya Venkataramani 2, Panagis Galiatsatos 3, Jeanne D Hitchcock 4, Nondie Hemphill 5, Margaret Dearey 6, Benjamin F Bigelow 7, Lisa A Cooper 8, Nancy Edwards Molello 9, Katie J O'Conor 10, Kathleen R Page 11, Sherita H Golden 12
PMCID: PMC10079247  PMID: 36791317

Abstract

COVID-19 vaccines offer hope to end the COVID-19 pandemic. In this article, we document key lessons learned as we continue to confront COVID-19 variants and work to adapt our vaccine outreach strategies to best serve our community. In the fall of 2020, the Office of Diversity, Inclusion and Health Equity at Johns Hopkins Medicine, in collaboration with the Office of Government and Community Affairs for Johns Hopkins University and Medicine, established the COVID-19 Vaccine Equity Community Education and Outreach Initiative in partnership with faith and community leaders, local and state government representatives, and community-based organizations. Working with community and government partnerships established before COVID-19 enabled our team to quickly build infrastructure focused on COVID-19 vaccine education and equity. These partnerships resulted in the development and implementation of web-based educational content, major culturally adapted media campaigns (reaching more than 200,000 individuals), community and faith education outreach, youth-focused initiatives, and equity-focused mobile vaccine clinics. The community mobile vaccine clinics vaccinated over 3,000 people in the first 3 months. Of these, 90% identified as persons of color who have been disproportionately impacted during the COVID-19 pandemic. Academic–government–community partnerships are vital to ensure health equity. Community partnerships, education events, and open dialogues were conducted between the community and medical faculty. Using nontraditional multicultural media venues enabled us to reach many community members and facilitated informed decisionmaking. Additionally, an equitable COVID-19 vaccine policy requires attention to vaccine access as well as access to sound educational information. Our initiative has been thoughtful about using various types of vaccination sites, mobile vaccine units, and flexible hours of operation.

Keywords: COVID-19, Health equity, Community education, Community partnerships, Vaccines, Epidemic management/response, Risk communication

Introduction

COVID-19, an infectious disease causing respiratory symptoms and failure, emerged in late 2019 and led to massive shutdowns in the United States by March 2020.1 The COVID-19 pandemic has been characterized by several waves of infection in the United States and has resulted in over 1.1 million deaths.2 A disproportionate number of COVID-19 cases, hospitalizations, and deaths in the United States have been among Native American/Alaskan Native, Black/African American, and Hispanic/Latinx populations, which have been linked to structural racism, residential racial segregation, lack of access to healthcare, and medical comorbidities.3-5 This same trend has been seen in Baltimore, a majority Black/African American city with a rapidly growing Latinx community, and has spawned heightened collaborations between academic medical centers, public health and government entities, and community partners to educate the most vulnerable communities about COVID-19 vaccinations and other prevention practices.6

Public health officials have noted that social distancing and masks are crucial preventive measures, but their greatest hope for an end to the COVID-19 pandemic has been placed in vaccines.7,8 Data across the United States have suggested high rates of hesitancy around COVID-19 vaccines among several populations due to distrust in medical systems, research, and government as well as a longstanding antivaccine movement.9 Local data suggest that medical distrust due to historical and ongoing harms at the hands of medical and scientific establishments runs deep in the Baltimore community, as it does in many other cities, and seems to have contributed to COVID-19 vaccine hesitancy.10-12 Pre-COVID-19 data also suggests that healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended treatment across many chronic diseases, whereas provider trust is associated with increased adherence.13,14 If COVID-19 vaccine uptake is low in certain communities, immunity inequity may emerge and COVID-19 may continue to disproportionately ravage segments of the population.4-6 Establishing trust is proposed as a likely mechanism to increase COVID-19 vaccine uptake in communities.

With community input, we recognized early on that a comprehensive COVID-19 vaccine equity strategy would be needed to provide community access to accurate vaccine information and provide forums in which all questions and concerns could be answered. This would enable all individuals to make an informed decision about COVID-19 vaccines. In this article, we describe the COVID-19 Vaccine Equity Community Education and Outreach Initiative developed by Johns Hopkins Medicine and University in collaboration with our community partners and summarize key lessons learned as we continue to confront COVID-19 variants and work to adapt our strategies to best serve our community.

Methods

In the fall of 2020, the Office of Diversity, Inclusion, and Health Equity at Johns Hopkins Medicine in collaboration with the Office of Government and Community Affairs for Johns Hopkins University and Medicine collaborated to establish and lead the COVID-19 Vaccine Equity Community Education and Outreach Initiative.15 The goal of this initiative was to assemble a team to promote and coordinate equitable vaccine education and access, with a focus on key demographic populations in Baltimore, where the African American population accounts for 62% of the total population and Latinx populations account for 5%. In Baltimore and the Washington, DC, region, the Latinx population is the fastest-growing minoritized group.16 COVID-19 data at the time also revealed that African American and Latinx populations were disproportionately impacted by COVID-19 with respect to case rates, hospitalizations, and deaths.3 Key internal and external partners were identified (Figure). Internal partners working on aspects of COVID-19 community outreach across Johns Hopkins were convened to ensure streamlined and aligned strategic planning and resource utilization so that trusted representatives of all local communities were engaged. External partners included local faith and community leaders, local and state government representatives, and community-based organizations. For example, representatives from an African American-focused COVID-19 vaccine education community group—established during the pandemic by a group of scientists at the Johns Hopkins Vaccine Initiative to educate faith and community leaders—also served on the COVID-19 Vaccine Equity Community Education and Outreach Initiative. In this model, the faith and community leaders brought feedback to the COVID-19 Vaccine Equity Community Education and Outreach Initiative group about scientific mistrust and vaccine barriers based on feedback from their respective membership and collaborations in the community. In addition, community forums were held with many of the collaborating organizations to understand the importance of vaccine messaging, access, barriers, mistrust, and equity. This information was then used to inform strategy in a continuous feedback loop. A youth-focused arm of COVID-19 vaccine education was also established in partnership with HeartSmiles,17 a Baltimore-based nonprofit organization that provides youth with mentorship, enrichment, and leadership development opportunities. Among the different entities, leadership, full group, external, and internal meetings took place periodically in 2020 and 2021. The groups defined primary vaccine messages, tactical marketing and communication strategies, and primary trusted community messengers as the areas of focus for the full group. This effort was to ensure that community members could make informed decisions about COVID-19 vaccines in the wake of misinformation and hesitancy in Baltimore and the surrounding areas. The Johns Hopkins Government and Community Affairs colead also served as our liaison to the broader Baltimore City Public-Private Partnership between Johns Hopkins Health System, University of Maryland Medical Center, and CareFirst BlueCross BlueShield to facilitate vaccine educational message alignment across other key stakeholders in Baltimore.15

Figure.

Figure.

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Conceptual framework and key partners in Johns Hopkins Medicine and University COVID-19 Vaccine Equity Community Education and Outreach Initiative. Abbreviations: BUILD, Baltimoreans United In Leadership Development; CareFirst, CareFirst BlueCross BlueShield; Centro SOL, Johns Hopkins Center for Salud/Health and Opportunities for Latinos; CoVPN, COVID-19 Prevention Network; JHHS, Johns Hopkins Health System; MIMA, Mayor's Office of Immigrant Affairs; ODIHE, Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; UMMS, The University of Maryland Medical System.

Results

Educational Content and Community Forums

The following areas of educational content and programming were developed under the COVID-19 Vaccine Equity Community Education and Outreach Initiative.

Web-Based Educational Content

Johns Hopkins Medicine developed an Equity for COVID-19 Vaccines and Care website18 to educate staff and the public about the work Johns Hopkins Medicine was doing with the community to address the devastating health disparities seen from the coronavirus pandemic. The website contains a toolkit for community organizations in both English and Spanish.19 The following resources can be downloaded: COVID-19 Vaccine: 12 Things You Need to Know20; COVID-19 Vaccines: What You Need to Know (infographic)21; Facts About COVID-19 Vaccines22; Getting the COVID-19 Vaccine23; After the COVID-19 Vaccine24; and Steps for Reopening Faith-Based Organizations Safely.25 Videos discussing COVID-19 disparities, the COVID-19 vaccines, and demographics of the COVID-19 vaccine trials are also available.26,27 The COVID-19 disparities and vaccine education video series has been viewed over 3,000 times and the vaccine trials demographics video has been viewed over 20,000 times.

Community Town Hall Events

Johns Hopkins Medicine and University sponsored several town halls with our employees to foster health equity internally as the health system is one of the largest employers of our community members in Baltimore.28 These town halls featured our diverse clinical experts and the largest event, sponsored by the university, was attended by over 500 employees. The majority of town halls were held in English, but several Spanish-language town halls were hosted to cover the same content and to address questions specific to the Spanish-speaking community, as Spanish is the second most common language locally.

In January 2021, Dr. Kizzmekia Corbett led a forum at Johns Hopkins University along with other faculty and community leaders to explain the process she and her team at the National Institute of Allergy and Infectious Diseases executed to develop and test the Moderna (mRNA-1273) COVID-19 vaccine. The forum also highlighted the disproportionate impact of COVID-19 on minoritized communities and community engagement strategies. The forum was attended by over 1,400 people across Baltimore and beyond including: Canada, Colombia, Ethiopia, Kenya, Republic of Korea, Nigeria, South Africa, and the United Arab Emirates.29

Johns Hopkins Medicine clinicians also spoke at many community events that were organized through this initiative (March to June 2021). For education forums officially organized through this collaboration, community members were reached through education events in 9 speaking engagements hosted by the following community-based organizations: Housing Up, Jai Medical Center, Enoch Pratt Free Library, Jamil-ul-Jalil Islamic Organization, Maryland Department of Health Spring Grove Hospital Center, Eckerd College Centene Corporation Superior HealthPlan, and Carnegie Science Center.

Major Media Campaigns

Based on feedback from our community partners about trusted media outlets in the Black and Latinx communities, we partnered with Urban One (Radio One), AFRO News, and El Tiempo Latino to host virtual community vaccine education forums that included Johns Hopkins medical experts and trusted members of the community who were vaccine advocates (see Table). Radio One is one of the nation's top urban radio networks. In June 2021, we hosted a virtual event on their Baltimore (Praise 106.1 Baltimore) and Washington, DC (Praise 104.1 DC), Facebook pages, with a total program reach of over 23,000. The following month we hosted an event with AFRO News, a weekly African American newspaper published in Baltimore. It is the flagship newspaper of the Afro-American journalism enterprise and the longest-running African American family-owned newspaper in the nation, established in 1892. This event, hosted on AFRO News's Facebook page, was a light and entertaining discussion dispelling common and uncommon misinformation about COVID-19 vaccines, the pandemic, and the disease, and included musical selections, person-on-the-street interviews, comedic presentations, and factual information. The total reach of this event was over 21,000, with most viewers being adults aged 25 to 44 years, a group that has been particularly vaccine hesitant (see Table). Finally, during Hispanic Heritage Month in September 2021, we partnered with El Tiempo Latino, the largest Spanish-language newspaper in the Baltimore and Washington, DC, region. This Facebook Live event, delivered in Spanish, focused not only on COVID-19 variants and vaccines, but also on the impact of the pandemic on the workforce and tips for employees to better serve the healthcare needs of their employees. This program reached over 130,000 people, including a majority young adult audience.

Baltimore City and Johns Hopkins Faith Partnership

The Mayor's Office of Neighborhoods, Baltimore City Health Department, and Johns Hopkins University and Medicine entered into a partnership31 to advise houses of worship of all faiths on strategies to safely reopen as coronavirus-related guidance evolves. The partnership comprises several major components:

  • A press event on April 26, 2021, featured 2 Johns Hopkins medical experts (Dr. Sherita H. Golden and Dr. Panagis Galiatsatos), the mayor of Baltimore City, the health commissioner, and a local faith community leader.

  • A virtual COVID-19 educational session for local clergy on May 25, 2021, featured several Johns Hopkins medical experts (Dr. Lisa A. Cooper, Dr. Sherita H. Golden, and Dr. Panagis Galiatsatos), including our senior director of infection prevention for Johns Hopkins Health System, and was moderated by a local faith leader. This event had the largest turnout of any virtual session the mayor's administration had hosted to date.32

  • A pilot program provided in-person guidance for Baltimore-based houses of worship of all faiths and helped them comply with the city's public health mandates and learn about reopening best practices to prevent COVID-19. From July through August 2021, we performed in-person consultations at 9 places of worship of various faiths in Baltimore based on our recommended best infection prevention practices.33 Virtual consultations were provided to houses of worship as well.

Table.

Major Media Campaigns by the COVID-19 Vaccine Equity Community Education and Outreach Initiative

Event Description Speakers and Program Links Program Reach
Urban One (Radio One)
A free, virtual community conversation about safely reopening the Black community held in collaboration with Radio One, one of the nation's top urban radio networks, aired live on the Facebook pages of Praise 104.1 DC and Praise 106.1 Baltimore on June 22, 2021.		 The event featured:
• Cheryl Jackson, midday host of Urban One's Praise 106.1 Baltimore and Praise 104.1 DC
• Sherita H. Golden, MD, MHS, vice president, chief diversity officer, Johns Hopkins Medicine
• Panagis Galiatsatos, MD, MHS, cofounder, Medicine for the Greater Good, Johns Hopkins Medicine
• Anthony Brown, gospel recording artist
• Rev. Keith Battle, founder and senior pastor, Zion Church
• Rev. Dr. Howard-John Wesley, senior pastor, Alfred Street Baptist Church
• Dr. Henry Davis III, pastor, First Baptist Church of Highland Park
Praise 106.1 Baltimore Facebook Live Video30: https://www.facebook.com/watch/live/?v=888441868419472&ref=watch_permalink 		Praise 104.1 DC:
• Reach: 9,412
• Impressions: 21,769
• Video views: 5,400
• YouTube DC views: 306
• Total video views: 5,706
• Likes/loves: 53
• Comments: 44
• Shares: 44
Praise 106.1 Baltimore:
• Reach: 13,899
• Impressions: 22,548
• Video views: 4,769
• YouTube Baltimore video views: 143
• Total video views: 4,912
• Likes/loves: 194
Comments: 48
Shares: 36
AFRO News
A free vaccine education event aired on July 13, 2021, on the AFRO News Facebook page. The event was a light and entertaining discussion dispelling common and not so common misinformation about the COVID-19 vaccines, the pandemic, and the disease. It included musical selections, person-on-the-street interviews, comedic presentations and factual information. The event was prerecorded and featured a number of experts including community and Johns Hopkins leaders. During the Facebook Live session, 2 Johns Hopkins physicians (Sherita H. Golden, Panagis Galiatsatos) answered questions via comment section of the Facebook Live through our Johns Hopkins Medicine Facebook account.		 The event featured prerecorded segments from:
• Dana M. Peck and Kevin MPECKABLE Peck, the AFRO event hosts
• Dudley Stevenson, singer, songwriter, and producer
• Dr. Frances Toni Draper, chairman of the board and publisher of the AFRO American Newspapers
• Jay Brooks, comedian
• Sherita H. Golden, MD, MHS, vice president, chief diversity officer, Johns Hopkins Medicine
• Brandon M. Scott, mayor, Baltimore City
• Panagis Galiatsatos, MD, MHS, cofounder, Medicine for the Greater Good, Johns Hopkins Medicine
• Karsonya (Kaye) Wise Whitehead, PhD, American author and associate professor of communication, African and African American Studies at Loyola University Maryland
• David Kwabena Wilson, EdD, president of Morgan State University
• Sisqó, American singer, songwriter, dancer, record producer, actor, and member of famed music group Dru Hill
• Kayode Ayodele Williams, MBA, MBBS, medical director, Johns Hopkins Priority Partners		 Stats:
Promotion reach: 47,616
Facebook Live reach July 13: 19,300 reach
• 64% women; 36% men
• Majority ages 18 to 54 with majority 25 to 44
Facebook Live rebroadcast July 15: 1,300 reach
Facebook Live rebroadcast July 18: 756 reach
Total reach: 21,356
Total impression: 21,447
Engagement: 344
Comments: 126
Shares: 79
El Tiempo Latino
We collaborated with El Tiempo Latino, the region's top Spanish-language news outlet, on hosting a series of education events about COVID-19, the vaccine, and safely reopening the Latino community on El Tiempo Latino's Facebook Live to kick off Hispanic Heritage Month.		 The event was moderated by Ricardo Sánchez-Silva, senior editor and reporter, and featured:
• Kathleen Page, MD, associate professor of medicine, Johns Hopkins University School of Medicine
• Inez Stewart, MEd, senior vice president, human resources, Johns Hopkins Medicine
• Sara Suarez, Emmy award-winning news director of Noticias Univision in Washington, DC, and New England		 Total reach: 131,200
Shares: 205
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Youth-Focused Initiative with Project HeartSmiles

In collaboration with HeartSmiles,17 we engaged 7 high school students from Baltimore in creating youth-focused educational messaging around COVID-19. The Heartbeats, as the students engaged with HeartSmiles are referred to, met weekly with members of our team. The Heartbeats underwent an initial, brief training curriculum adapted from the Johns Hopkins Health Education and Training Corps COVID-19 curriculum (sessions covered COVID-19 basic biology, vaccines and using social media for education campaigns).34 Subsequent meetings were used to workshop educational messaging needs and ideas that focused on reaching youth. The Heartbeats were encouraged to incorporate their unique voice and knowledge of the specific concerns surrounding COVID-19 that were relevant to their peers. With feedback and guidance from the Johns Hopkins team, youth produced educational posts and short videos, intended for distribution from Johns Hopkins-related social media accounts.

Sound Truck for Public Health Messaging

To promote COVID-19 preventive precautions in African American communities, Johns Hopkins Medicine partnered with the Baltimore Chapter of the National Association for the Advancement of Colored People, Philantropik, Justice Chapel, and other collaborators to develop a public health education campaign targeting geographic areas and demographic segments that had not been responsive to traditional outreach efforts. The July 2021 campaign, amid the Delta variant surge, promoted COVID-19 vaccination through banners and an audio recording of the Johns Hopkins COVID-19 Call Center number so community members could schedule vaccine appointments at an area mobile site. The ZIP codes covered included those with residents disproportionately impacted by COVID-19 and those with a high number of individuals from minoritized groups.

Community Partner Mobile Vaccine Clinics

During the earliest public phases of vaccine distribution, we partnered with the Baltimore City Health Department and multiple organizational partners to facilitate mobile vaccination in the communities who were hardest hit by COVID-19 and also, perhaps not coincidentally, experienced the highest healthcare access barriers. We collaborated with Baltimore City Health Department on a strategic approach that used multiple factors to identify and prioritize vaccination initiatives. In accordance with government guidelines, our earliest phases focused on older adults and individuals with disabilities. Once eligible, we also expanded to include other high-risk populations including refugees, survivors of violence, individuals experiencing homelessness, and individuals experiencing substance use. A major part of our strategy was leveraging trusted locations and relationships to promote community safety and encourage vaccine uptake. We vaccinated older adults and individuals with disabilities in familiar settings, including their homes, cars, churches, schools, and other local centers. We vaccinated refugees and violence survivors in their safe houses and shelters. We vaccinated individuals experiencing homelessness and substance use at familiar locations where they already received other health services from trusted partners.

In the first 3 months, we successfully vaccinated over 3,000 individuals with at least 1 dose, 95% of whom fully completed vaccination. Of the 3,000, over 10% were individuals with disabilities and their caregivers, leveraging a partnership with Kennedy Krieger Institute, a Johns Hopkins affiliate that focuses on children, adolescents, and adults with neurological, rehabilitative, or developmental needs through inpatient and day hospital programs, outpatient clinics, home and community services, education, and research. By design, our clinics focused on communities of color, with overall 90% of our vaccine recipients identifying as such. Among vaccine recipients, 72% identified as non-Hispanic Black/African American, 15% as Hispanic (White, Black, or multiracial), and, in aggregate, 4% were from Native American/Indigenous, Asian, multiracial, or other racial-ethnic backgrounds. These efforts, which were expanded through support from the Maryland Health Services Cost Review Commission, have now resulted in the administration of over 36,000 vaccine doses.

Outreach to the Latinx Community

In May 2020, a coalition was established between the Johns Hopkins Health System, religious leaders, and community organizations to open a bilingual COVID-19 hotline and implement free SARS-CoV-2 community-based testing.35 Once COVID-19 vaccinations received emergency use authorization, the coalition participated in more than 40 Spanish-language community informational forums and weekly “Ask your doctor” Spanish-language Facebook Live shows hosted by a local influencer; the Facebook Live shows are ongoing. In addition, the clinical director, Kathleen R. Page, was designated a bilingual Maryland GoVAX COVID-19 vaccine ambassador. Through a crowdsourcing contest soliciting ideas for naming a Spanish-language COVID-19 social marketing campaign, the winner, Mejor Vive Sin Duda (“Better to live without doubt” in English), was selected by community members and a Spanish-language website36 and social marketing campaign was developed around this concept. The website has received over 8,100 unique visitors—the majority directed through social media.

In February 2021, the coalition partnered with the Maryland Vaccine Equity Task Force to expand access to the COVID-19 vaccine for low-income Latinx immigrants and established a twice-weekly vaccination clinic staffed by Johns Hopkins Health System at the Sacred Heart Church in Baltimore (the same site used for COVID-19 testing in 2020).37 Through January 2022, 10,078 unique individuals (majority Latinx and limited English proficiency) have been vaccinated at this site, with a total of 15,125 doses administered.

Discussion

The COVID-19 pandemic presented an unprecedented public health crisis in the United States. Longstanding health inequities were brought to the forefront amid this national emergency. By using previously established community and government partnerships, our team at Johns Hopkins was able to quickly build infrastructure focused on COVID-19 vaccine education and equity. This strategy focused on those disproportionately impacted by COVID-19 and in populations with the greatest need in our service area including Black/African American and Hispanic/Latinx populations.3-5 Through multicultural media, education programs, and vaccine clinics, we estimate that more than 200,000 persons were reached by these initiatives. Notably, the Johns Hopkins Bloomberg School of Public Health through the Center for Indigenous Health in collaboration with Native American LifeLines in Baltimore focused efforts on vaccine rollout to urban Native American communities in Baltimore who were also disproportionately impacted by COVID-19.3

Baltimore, among many cities in the United States, has community members whose trust has been deeply violated by the healthcare system. The resulting lack of trust in medical institutions is rooted in historical ethical misconduct in research and continued systemic racism in access to care and treatment.38 This fractured relationship between the community and the medical system is one factor that has contributed to COVID-19 vaccine hesitancy.39 Increasing vaccine adherence amid the COVID-19 pandemic is crucial as vaccines are essential for preventing severe disease, hospitalizations, and death.7 To educate the Baltimore and surrounding community on vaccines, our partnership team used a multipronged approach. Community partnerships, education events, and open dialogues between the community and healthcare leaders using nontraditional multicultural media venues reached many persons who were vaccine hesitant and facilitated informed decisionmaking. Notably, this work relied on continuous feedback from community partners and the respective members of their organizations. This enabled the team to adapt messages as needed and provide accurate information on COVID-19 vaccines through community sessions. Racial and ethnic minoritized populations in the United States are unequally impacted by the COVID-19 pandemic and thus require targeted efforts to expand education and vaccine access.40

To achieve health equity, COVID-19 vaccine policy requires access to vaccines and sound educational information. Our initiatives have used multiple innovative partnerships to deliver vaccines and vaccine education to vulnerable communities, including senior housing, faith-based organizations, community centers, and mobile vaccine units. These efforts have also incorporated population-centered settings and timing to broaden their reach. Additionally, we have demonstrated the effectiveness of providing educational opportunities on both COVID-19 infection and COVID-19 vaccines tailored to specific audiences using their trusted messengers.

Several key lessons learned from this work can be helpful to other organizations in continuing to address COVID-19 community education as the pandemic continues and new variants emerge. First, engaging community and government partnerships established before COVID-19 enabled our team to quickly build infrastructure focused on COVID-19 vaccine education and health equity. Second, medical distrust runs deep in the Baltimore community, as it does in many other cities, which was an important contributor to COVID-19 vaccine hesitancy. However, communities were very interested and receptive to updating their perspectives through new information learned from trusted sources including diverse providers, who were often requested, and community members providing their direct experience with the COVID-19 vaccine. Third, community partnerships, education events, and open dialogues between the community and medical faculty using multicultural media venues reached many community members and facilitated informed decisionmaking by providing accurate information. An equitable COVID-19 vaccine policy requires attention to access to vaccines and access to sound educational information using nontraditional approaches to delivering care outside of the healthcare setting. Due to the ever-changing nature of the pandemic, consistent innovation will be critical to address COVID-19 not only in Baltimore but throughout the country. While we are able to document the reach of our work with respect to the numbers of individuals touched through media campaigns and outreach, a limitation of our public health implementation strategy across the city is that we do not have a direct means to assess the effectiveness of the campaign with respect to a comparison group. However, through numerous community COVID-19 sessions, we received direct feedback that the ability to get questions answered directly from providers and seeing trusted messengers in campaigns helped individuals overcome vaccine hesitancy and medical distrust. Recent data in this area have shown that interventions to decrease vaccine hesitancy should be multipronged, engage with the community, and provide consistent and comprehensive messages delivered by trusted resources, which is what our work aimed to accomplish.11 Additionally, our focused efforts in the Latinx community, for example, likely contributed to the fully vaccinated rate being 60.8% in Baltimore versus 55.0% in the United States.41,42

Finally, the most important lesson learned from this experience is that to achieve health equity for the most vulnerable populations, we need a continued focus on delivering care to communities outside of our traditional venues; this lesson has been affirmed by other studies on COVID-19.43,44 We need to advocate for financial and personnel resources to transition the infrastructure created for COVID-19 community education and vaccine distribution into a permanent component of health system clinical operations to deliver preventive care and treatment for non-COVID-19 diseases to vulnerable communities. This will also enable us to translate lessons learned about healthcare delivery and education during the COVID-19 pandemic to chronic disease management where healthcare inequities have existed for decades. The comorbidities that put minoritized communities at risk for poor COVID-19 outcomes—diabetes, obesity, chronic lung disease, cardiovascular disease—were present before the pandemic and will still be present when the pandemic has subsided. We now have a comprehensive approach to effectively reach these communities and achieve health equity.

Conclusion

The COVID-19 Vaccine Equity Community Education and Outreach Initiative mobilized partnerships with faith and community leaders, local and state government representatives, and community-based organizations to help address health disparities that emerged during the COVID-19 pandemic. The use of web-based educational content, culturally adapted media campaigns, community and faith education outreach, youth-focused initiatives, and equity-focused mobile vaccine clinics provided the community with accurate information and access to healthcare, with the goal of improving health disparities. To achieve health equity, we must advocate for personnel and financial resources that can sustain an infrastructure that can combat the health disparities we see across disease states.

Acknowledgments

The authors would like to thank the Community COVID-19 Vaccine Education Stakeholder Group; Baltimore City Public-Private Partnership members; the COVID-19 Internal Stakeholder Group; Joni Hollifield of HeartSmiles, and the Heartbeats; staff of the Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity; staff of the Office of Government and Community Affairs; leadership of the Urban Health Institute and Center for Health Equity; staff of the Brancati Center for the Advancement of Community Care; staff of Johns Hopkins Medicine Marketing and Communications; staff of the Johns Hopkins Center for Communication Programs; leadership of Centro SOL (Center for Salud/Health and Opportunities for Latinos); and the vice provost for Diversity and Inclusion. Support for these efforts was provided by Johns Hopkins University and Johns Hopkins Medicine. Additional support was provided to the primary author by the Johns Hopkins University Center for AIDS Research (1P30AI094189) and the National Institutes of Health National Institute on Drug Abuse (2R01DA013806). Community testing was supported in part by grants from the National Institute on Drug Abuse (3R01DA045556-04S1) as a part of the RADx-UP program. Availability of data and material: The data that support the findings of this study are available from the corresponding author upon request.

References

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