Bridging the Health Equity Gap for COVID-19 Vaccine Uptake in Durham (2021-2022)

Background Patterns of systemic exclusion from health services and networks have a long history in the United States but are increasingly apparent during the COVID-19 pandemic, with structural racism and sociopolitical determinants of health leading to dramatically increased risk of transmission and of morbidity and mortality among Black and Latinx communities. Health systems, including Duke University Health System and local government agencies, have implemented pandemic response efforts within existing health infrastructure that are not equally accessible to all populations. The Biden-Harris team announced plans for equitable and free distribution of the COVID-19 vaccine; however, without a coordinated effort to address these barriers, vaccine drives will also be prone to these patterns of exclusion. Beyond infrastructure and insurance, vaccination itself carries a long history and present distrust among historically marginalized communities of color in the United States. Rooted in real histories of unethical medical experimentation on and exploitation of Black, Indigenous and other people of color, and coupled with modern-day discrimination in healthcare and rampant misinformation, this community distrust is a formidable obstacle to equitable COVID-19 vaccination. Project Description In collaboration with community partners and institutions, this project team aims to make equitable vaccine uptake in Durham County a reality by increasing health equity and equitable access to the COVID-19 vaccination resources, including vaccine information and distribution, and improving the responsiveness of the local health system at the community level for the Latinx and Black communities of Durham County. This year's team will build on experiences from the 2020-2021 team, which focused on equitable COVID-19 testing through community-based mobile testing with community partners. In 2021-2022, the team's three main aims are to: Identify best practices and knowledge gaps to inform equitable vaccine distribution Identify community perceptions, trust and solutions related to a COVID-19 vaccine Assess structural and institutional policies that contribute to systemic exclusion of communities of color Team members will engage with the community to understand structural barriers, negative perceptions to vaccination and community-based solutions and use policy analysis to further understand barriers and solutions identified by the community. Key outputs from these aims include a bilingual document to increase health information in the community for improved informed decision-making, a document on mistrust and misinformation for healthcare institutions and a policy memo that identifies policy barriers.