For many across the United States, the early days of the COVID-19 vaccine rollout were chaotic. Local websites to sign up for vaccinations crashed, guidelines around who was eligible for a vaccine and when they could get it was spotty at best, and in some places, ensuring an equitable process was left behind. But in Pima County, Arizona, equity was a core pillar of their vaccine strategy, ensuring that Pima was one of the most successfully vaccinated counties in the state.

Members of Palladium’s Health team in the U.S. and partners from the Pima County Health Department (PCHD) of the state of Arizona recently authored a new journal article that reviews the Health Department's efforts to equitably distribute COVID-19 vaccines. The article “Making Vaccines Equitably Available to All Persons in Pima County, Arizona, 2020–2021” was published within the American Journal of Public Health’s November 2022 issue.

The article and evaluation focused on the Health Department’s vaccination efforts between December of 2020 through August of 2021, specifically on the interventions aimed at ensuring that the vaccine distribution was done in a way that was racially equitable.

As with all counties across the United States, initial vaccine distribution efforts in Pima County were focused on reducing both hospitalisations due to COVID-19 and caseloads in general. PCHD followed the Centers for Disease Control and Prevention (CDC) guidance ensuring that the distribution of vaccine doses was first given to priority population groups. As part of that effort, PCHD engaged in a multi–point of dispensing (POD) approach to vaccine distribution with at-home vaccine distribution and in congregate settings, drive-through and mobile pop-up community sites and more.

“PCHD’s approach to equitable vaccine distribution was rooted in the use of data,” explains Palladium Director of Measurement and Learning, Molly Cannon. “They triangulated data sources, including the Social Vulnerability Index and census track data to ensure their immunisation plan reached those who needed it most – furthermore, they improved data availability through use of county level dashboards and GIS mapping.”

In February of 2021, PCHD specifically focused their efforts on high-risk communities in partnership with community organisations such as schools, law enforcement, local emergency management services, faith-based organisations as well as the leadership of both the Tohono O’odham Nation and the Pascua Yaqui Tribe which share borders with Pima County. PCHD identified these new POD locations aimed at serving high-risk communities based on infection, morbidity, and mortality rates, outbreak, and vaccine uptake data. These outreach efforts were largely successful, vaccine uptake data shows that these efforts correlated with an increase in vaccination within these communities.

PCHD also engaged both a community advisory committee as well as an ethics committee specifically to advise the health department in how to reach historically underserved and underrepresented communities. These committees helped PCHD to ensure that the programs and plans carried out by the health department were responsive to the diverse cultural, and community values of equity and inclusion.

“Equitable distribution of COVID-19 vaccine is not really possible unless members of high-priority groups trust the vaccine and the people delivering it,” notes Ruth Berg, former Palladium Managing Partner and US Health Team Lead.

“As the work in Pima County shows, an essential first step to building that trust is to engage the community in an advisory role.”
The article also highlight’s PCHD’s progress toward its vaccine distribution related goals. PCHD vastly exceeded its initial goal of providing 300,000 single-doses of vaccine March 31st of 2021 by administering 525,000 single doses of vaccine during that time frame. By the end of August of 2021, roughly 63% of the eligible population of Pima County had received one vaccine dose and roughly 55% were fully vaccinated.

Additionally, roughly 85% of those aged 65 years or older were fully vaccinated during that time frame. During the time frame of this evaluation, Pima County was more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake.

However, PCHD’s vaccine rollout was not without difficulty.

The Health Department’s efforts were hampered by the typical factors that often affect public health institutions such as the scale and length of the pandemic response, workforce shortages, and lack of institutional guidance.

Additionally, PCHD faced their own set of unique challenges around the lack of vaccine registration systems, insufficient technology access in the community including internet access and staff capacity, and staff turnover.

Two years later, and PCHD is still implementing its multi-POD approach, specifically to improve vaccine uptake targeting census tracts and zip codes with lower vaccination rates.

Working through county board of supervisor districts, county towns and jurisdictions, and partners, mobile PODs continue to be scheduled at schools, community sites, and non-traditional venues, including barber and tattoo shops.

The County is also continuing to provide at-home vaccinations for people who are unable to leave their homes or live in congregate settings primarily nursing home. “Pima County Health Department’s evidence based equitable vaccine approach may be useful for others,” adds Cannon. “Health Departments around the country can look to Pima County as a guide for future successful vaccination efforts.”

For more, read 'The Yolo Way: How One California County is Addressing COVID-19 and Equity,' check out the full journal article, or contact info@thepalladiumgroup.com.