We Need an Equitable Vaccine Rollout

Focusing on implementation can achieve better public health outcomes
close up image of a person with gloved hands injecting a vaccine into someone's upper arm

By all accounts, the development of the COVID-19 vaccines will be remembered as one of the greatest successes in modern medical history. The record-breaking development speed and efficacy statistics far exceed what medical experts could have hoped for a year ago. Unfortunately, these successes haven’t been replicated in the US vaccine rollout, which has been fraught with challenges in last-mile implementation delivery.

State and local health departments have been left to fend for themselves across a varied and inconsistent landscape of vaccine supply, solution providers, and federal support in the midst of a presidential transition. As a result, they have struggled heavily to deploy vaccines in an equitable and just manner with systems that are efficient, easy-to-use, and treat people with dignity and respect.

Indeed, stories abound of difficult appointment websites that require seniors to spend 30+ minutes meticulously filling out online forms or violate disability rights lawsphone lines with half-day wait times, and inconsistent vaccination outcomes that heavily skew towards more affluent neighborhoods with predominantly white populations. The vaccines are here, and they work—but they are not reaching the people they most urgently need to. This goes to show that delivery is of utmost importance in the achievement of equitable outcomes, especially in times when people are suffering and in great need.

The good news is that we know that this is possible, and that services can be designed very quickly to be fastsimple, and effective, with underlying processes and systems that support best-in-class emergency responses. In order for this to happen, however, governments must fundamentally shift how last-mile delivery is treated. Delivery may be the last step in the process, but it needs to be considered before we take the first.

Measuring what matters should be part of every service—like participation gaps and access rates, especially through the lens of racial equity. Ensuring services are designed to reach all who need them, prioritizing the most vulnerable, such as the lowest-income or non-English speakers . People with lived experience should be centered in the design and creation of services—with input before and during design and creation, not as an afterthought—in order for the people delivering the service to truly understand the needs of people accessing the service.

Public servants should be empowered to work flexibly. In many cases, county health departments opted to use off-the-shelf solutions like Eventbrite for vaccine sign-ups. This was fast, practical, and easy-to-use. While not a perfect solution, it was a “good-enough” solution that met emergency needs. On the flip side, other county health departments were compelled to go through onerous contracting and procurement processes and forced to adopt difficult-to-use solutions that were deployed months after, with frustrating user experiences that led many who wanted vaccines to be unable to get through the appointment process. Similarly, many health departments were not able to add enough call center support capacity to handle the surge in call volumes of people asking for help; largely due to policies and processes that precluded them from working quickly with flexibility.

There are promising signs that we are turning a corner in the vaccine rollout, both in supply and in better considerations for delivery methods. By ensuring that equity is at the core of government service delivery, and empowering the hard-working public servants who are trying to help as many as people as possible during a time of crisis, governments can significantly improve outcomes during these trying times—and be better prepared to address our next national emergency.

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