Better Together: Implementation of a Public Health Learning Community During the COVID-19 Pandemic

Abstract

The Centers for Disease Control and Prevention’s Partnering for Vaccine Equity program was developed during the COVID-19 public health emergency to fund more than 500 community-based organizations working to improve vaccine equity. Organizations were supported by a virtual learning community where members received tailored learning content, peer-to-peer learning opportunities, and resources that facilitated deployment of vaccine-related programming during a dynamic pandemic. Process evaluation metrics indicate successful implementation of the learning community. The virtual learning community model can be duplicated to address other public health issues. (Am J Public Health. 2025;115(4):469–472. https://doi.org/10.2105/AJPH.2024.307965)

When COVID-19 vaccinations became available in the United States under emergency use authorization, an estimated 343 845 people had already died from COVID-19 in the country.¹ Longstanding racial, ethnic, and socioeconomic inequities; differential access to a trustworthy health care system; and unequal exposure to the virus for essential workers who are disproportionally people of color raised concerns about the equitable distribution of vaccines, even before they were available.^2,3

INTERVENTION AND IMPLEMENTATION

In summer 2020, the Centers for Disease Control and Prevention (CDC) convened a diverse group of leaders to discuss strategies for ensuring that vaccines reached racial and ethnic minoritized populations. Based on this session, the Partnering for Vaccine Equity (P4VE) program was established to equip community-based organizations with knowledge and resources that could be dispersed locally.⁴ These organizations used P4VE funding to plan and host community outreach events and vaccine clinics, train trusted messengers, develop educational materials and communication campaigns, and evaluate and disseminate best practices. They were supported by a learning community infrastructure that had three main objectives: (1) connect members to subject matter experts for tailored learning content, (2) provide forums for members to share knowledge with each other, and (3) build a set of resources to support longer-term vaccine equity efforts.

The P4VE learning community was supported by a team of Urban Institute researchers that served as its group learning manager. All organizations with P4VE funding were considered members. Four primary components facilitated collective learning opportunities (Table 1). The group learning manager hosted virtual learning events in various formats including webinars (45-minute presentations by subject matter experts with a question-and-answer segment), capacity-building workshops (90-minute sessions for learning a technical skill), coworking sessions (two-hour sessions to work virtually on a common task, with subject matter experts available for individual assistance), and “ask the expert” office hours (sessions with 10-minute time slots for one-on-one technical assistance). Webinars covered topics such as vaccine science and understanding vaccine hesitancy, and workshops focused on topics such as optimizing social media and motivational interviewing.

TABLE 1—

Objectives of the Partnering for Vaccine Equity Learning Community and Corresponding Program Activities

	Events: Virtual Group Learning Events Hosted in Various Formats (e.g., Webinars, Workshops, Coworking Sessions, Office Hours)	Web Site: Online Platform That Included Searchable Member Directory, Discussion Board, Events Calendar, Resource Library	Communities of Practice: Forum for Peer-to-Peer Information Sharing With Other Organizations Who Served the Same Priority Population	Promising Practices: Subgrants Provided to 18 Organizations to Implement Tailored Strategies to Advance Vaccine Equity and Uptake
Objective 1: Connect members to subject matter experts for tailored learning content.	√			√
Objective 2: Provide forums for members to share knowledge and expertise with each other.	√	√	√	√
Objective 3: Build a set of resources to support longer-term vaccine equity efforts.	√			√

The second component, Communities of Practice (COP) groups, gave members a forum for peer-to-peer information sharing. Learning community members determined the three COP groups that were formed, based on the common priority populations they served: (1) African American/African Diaspora, (2) Hispanic/Latinx, and (3) Asian American, Native Hawaiian, Pacific Islander, American Indian, and Alaska Native.

The third component of the P4VE learning community was the members-only Community Connector Web site. It included a searchable peer directory, group discussion board, events calendar, and a library of materials from past events and resources such as toolkits and fact sheets. The final component was the Promising Practices initiative under which Urban Institute provided $25,000 subgrants to 18 P4VE-funded organizations to develop, implement, and evaluate the effectiveness of a promising practice in one of three areas: (1) media-based outreach, (2) community-based outreach, and (3) vaccine events and partnerships.⁵

PLACE, TIME, AND PERSONS

The CDC contracted with the Urban Institute to manage the P4VE Learning Community from April 2021 through April 2024. The virtual P4VE learning community supported information sharing among more than 500 community-based organizations throughout the United States who received P4VE funding from the CDC, and participation was voluntary. The societal reliance on technology, especially virtual meetings, that increased during the pandemic supported application of an online learning community structure that was available to people in various geographies, minimized training costs, and permitted inclusion of members with diverse perspectives and resource-limited organizations.

PURPOSE

Vaccines were a critical component of the COVID-19 pandemic response, and distribution needed to occur quickly and equitably to combat the raging, highly infectious virus. Previous literature demonstrates the effectiveness of community-based organizations in implementing public health programming in local areas of influence.^6,7 These organizations understand local culture including assets and obstacles (e.g., transportation, work environments, health care facilities) for accessing health-promoting resources (e.g., testing, vaccinations). Therefore, they are well-positioned to design and implement culturally and linguistically appropriate programming that can play a critical role in affecting health behaviors (e.g., vaccine uptake) of the community members they serve.

Numerous initiatives focus on increasing vaccination among racially and ethnically minoritized populations, but programmatic efforts often miss opportunities to build in collaboration that facilitates efficient use of resources. The P4VE Learning Community fostered an information-sharing network for organizations focused on vaccine equity to enhance their collective societal impact, and this coordination supported a time-sensitive response to the COVID-19 pandemic.

EVALUATION AND ADVERSE EFFECTS

More than 500 organizations, representing 52 US states and territories, were part of the P4VE partner network. This included 404 nonprofits (nonmedical associations), 64 federally qualified health centers (FQHCs), 34 health departments, 16 community health centers (non-FQHCs), 16 universities, 11 nonprofit medical associations, six social media partners, and two city governments.⁴

The Urban Institute conducted a process evaluation of learning community activities as part of quarterly and annual reporting to the CDC; performance indicators were based on self-reported data from the group learning team and P4VE-funded organizations. These indicators demonstrated that the learning community was a valuable component of the P4VE program and helped its members conduct program activities. The learning community team hosted a total of 149 learning events, and, for each reporting period, on average at least 95% of event attendees agreed or strongly agreed that they learned something during the event that enhanced their P4VE program work.

The COP groups served as a space for learning community members to build relationships for peer-to-peer information sharing. According to COP facilitators, members engaged in timely discussions such as cultural influence on the perception of vaccines, messaging for new variants, and managing changing funding allotments. In total, 129 people joined the African American/African Diaspora group, 100 people joined Hispanic/Latinx group, and 50 people joined the Asian American, Native Hawaiian, Pacific Islander, American Indian, Alaska Native group. The Community Connector Web site was used for communication and asynchronous learning. There were 1014 logins, 1969 resources downloaded, and 1985 total discussion posts. The Promising Practices initiative provided an opportunity for organizations to test an initiative that addressed vaccine equity within a cohort structure and with group-learning team support on implementation and evaluation. All 18 organizations completed the six-month performance period and submitted data evaluating their efforts as well as final reports. The success of this component of the learning community has been previously described.⁵

In total, between the program’s launch and April 2024, P4VE funded organizations and their partners trained 410 000 trusted messengers to conduct community outreach, engaged more than 4 million people at promotional events, reached 572 000 clinicians, launched 674 educational campaigns in 45 languages, and administered 2.4 million COVID-19 and influenza vaccines.⁸

SUSTAINABILITY

The COVID-19 pandemic created the opportunity to establish a network of organizations to make a tangible public health impact, and several factors make P4VE sustainable. The organizations that comprised the learning community are committed to the people their work serves. In fact, most organizations were engaging in health-promoting activities before joining the P4VE learning community and were selected for funding because they were already well-connected to the communities the initiative prioritized. Feedback survey results indicate learning community participation helped members connect and learn from other organizations with similar missions and priority populations, making their programming more efficient. Secondly, the group learning team developed a large repository that includes hundreds of resources such as recorded webinars, fact sheets, and social media materials that can be used to guide future programmatic efforts. They also developed protocols (e.g., online event planning, implementing a subgrant program) to guide learning community operations that can be used as a foundation for ongoing and new programs. Finally, COP members made relationships with other organizations that can be sustained.

PUBLIC HEALTH SIGNIFICANCE

Community-based organizations that possess knowledge of the local culture and have community trust are well-positioned to address public health issues. A network that facilitates strategy sharing can enhance productivity and impact. While the P4VE learning community was implemented during the COVID-19 public health emergency, the network can be employed to address longstanding health inequities. For example, the National Institutes of Health’s Community Engagement Alliance program (NIH-CEAL), which had similar goals to P4VE at its inception, is leveraging the partnerships built during the COVID-19 pandemic to understand long COVID and other chronic diseases as well as the social, structural, and environmental factors that lead to health inequities.⁹ Like NIH-CEAL, the P4VE Learning Community provides evidence of (1) the power of community-level efforts to have a positive impact on the health of residents when properly resourced and (2) the strength of operating in a network of organizations with aligned goals.

In addition to vaccinations, there are well-documented inequities in social determinants such as food access, transportation, education quality, job opportunities, and myriad health outcomes including cancer, diabetes, and cardiovascular disease that organizations of varying sizes can work within a network to efficiently address. The relationships and strategies established by P4VE learning community members to promote the rapid uptake of the COVID-19 vaccine can be sustained and expanded to address a wider range of vaccinations, long COVID, and other diseases that have persistent inequities.