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:

  1. Identify best practices and knowledge gaps to inform equitable vaccine distribution
  2. Identify community perceptions, trust and solutions related to a COVID-19 vaccine
  3. 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. 

Anticipated Outputs

Policy briefs; mobile COVID-19 testing unit; bilingual health-promotion documents; literature review; policy memo 

Student Opportunities

Ideally, this project team will include 3 graduate students and 6-8 undergraduate students from a range of disciplines, including clinical health professions, public health, economics, epidemiology, public policy and global health. Students should have interests in implementing actionable community-based services and research and in reducing health disparities. The team leaders seek to prioritize inclusion of underrepresented students. Spanish proficiency is preferred but not necessary.  

The project team will use the Collective Impact Model for effective and inclusive collaboration. Team members will be designated to subgroups, each led by team leaders and a graduate student. Graduate students will have the opportunity to develop skills in project leadership, coordination and management to apply to their future work. One graduate student will provide overall project management for the entire team, including compiling weekly team updates to the class and community members, coordinating discussion topics for weekly class sessions and maintaining overall project timelines and deliverables. Undergraduate students will learn the processes required to conduct rapid literature reviews. 

Both groups will gain skills in policy analysis, community engagement, stakeholder interviews and methods in data-collection and analysis. Students will learn relationship-building skills to identify community partners for collaboration, organize meeting minutes and support focus groups with community members.  

Graduate students will meet weekly with team leaders. Team members will use email, Zoom and other platforms for engagement. The team will engage with contributors as needed during the year and will circulate periodic updates to the entire group.

The meeting time is Thursdays, 5:15 – 6:15 p.m. EST.

The optional summer work for one student will take place during a 10-week period and will require 40 hours/week.

A graduate student will be selected to serve as project manager. 

Timing

Summer 2021 – Spring 2022

  • Summer 2021 (optional): Review North Carolina’s vaccination distribution plan; review community-based mobile testing findings; write policy brief
  • Fall 2021: Submit IRB application; conduct community-based stakeholder engagement; conduct rapid review of literature and policies; present preliminary findings at LATIN-19 meeting
  • Spring 2022: Write community-oriented document for Aim 2, policy memo for Aim 3 and policy briefs

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Community-based Testing and Primary Care to Mitigate COVID-19 Transmission (2020-2021).

 

Image: Airman 1st Class Trinity Packer joins members of the North Carolina National Guard receiving COVID-19 inoculations at NCNG Joint Force Headquarters in Raleigh, Jan. 8, 2021, licensed under CC BY-ND 2.0

Airman 1st Class Trinity Packer joins members of the North Carolina National Guard receiving COVID-19 inoculations.

Team Leaders

  • Andrew Flynn, School of Medicine-Family Medicine and Community Health
  • Gabryel Garcia-Sampson, School of Medicine-Family Medicine and Community Health
  • Viviana Martinez-Bianchi, School of Medicine-Family Medicine and Community Health
  • Gabriela Plasencia, School of Medicine-Family Medicine and Community Health
  • Andrea Thoumi, Margolis Center for Health Policy

/graduate Team Members

  • Priya Alagesan, Medicine MD Second Year
  • Farrah Madanay, Public Policy Studies-PHD
  • Adaobi Onunkwo, Mgt Science and Technology Mgt
  • Courtney Young, Bioethics and Sci Policy - AM

/undergraduate Team Members

  • Afreen Ashraf, Biology (BS), Global Health (AB2)
  • Nikhil Chaudhry
  • Ethan Ho, Biomedical Engineering (BSE)
  • Amy Labrador
  • Caroline Palmer
  • Laura Poma
  • NiQuava Pope, Biology (BS)
  • Anil Prasad, English (AB)
  • Kristen Rigsby, Romance Studies (AB)
  • Etan Zeller MacLean

/yfaculty/staff Team Members

  • Nadine Barrett, School of Medicine-Family Medicine and Community Health
  • Holly Biola, School of Medicine-Medicine:Geriatrics
  • Rushina Cholera, School of Medicine-Pediatrics: Primary Care Pediatrics
  • Oluwadamilola Fayanju, School of Medicine-Surgery
  • Rosa Gonzalez-Guarda, School of Nursing
  • Katie Greene, Margolis Center for Health Policy
  • Tiarney Ritchwood, School of Medicine-Family Medicine and Community Health
  • Mina Silberberg, School of Medicine-Family Medicine and Community Health
  • Nicholas Turner, School of Medicine-Medicine: Infectious Diseases
  • Lavanya Vasudevan, School of Medicine-Family Medicine and Community Health

/zcommunity Team Members

  • LATIN-19
  • African American COVID Taskforce
  • Pablo Friedmann, Durham Public Schools