State Strategies for Leveraging Local Partnerships for Equitable Distribution of COVID-19 Vaccines

COVID-19 Update

Editor’s Note: As the United States enters its seventh month of the COVID-19 vaccine rollout, available data show distribution efforts have not produced equitable outcomes.1 In a new “Expert Perspectives”—prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program in partnership with Health Equity Solutions and Families USA—Manatt Health shares key strategies that state leaders and their community partners can use to address inequities, leveraging policy, data and financing levers to drive access and vaccine adoption among Black, Indigenous and people of color (BIPOC). Key strategies are summarized below. Click here to access a free copy of the full “Expert Perspectives” including real-world state examples.

Across states, Black and Latino(a) people have received smaller shares of COVID-19 vaccines compared to their shares of the total population, despite experiencing disproportionately higher rates of COVID-19 cases, hospitalizations and deaths.2, 3, 4, 5 In recent months, eligibility for the COVID-19 vaccine has broadened to include all adults and adolescents aged 12 years or older.6 With open eligibility and adequate levels of vaccine supply, state leaders can use their political will, as well as administrative, policy and funding levers, to support community partners in improving access points; addressing structural barriers to vaccination; and establishing rapid data collection and evaluation efforts to track, refine and scale equitable COVID-19 vaccine distribution solutions.

Improving Local Access and Addressing Structural Barriers to Vaccination

Key strategies to support local access rely on financing and building partnerships with local leaders, businesses and community-based organizations who have established trust in the community, understand the best points of access and have a proven track record of addressing underlying barriers in the community.

  • Strategy 1: Increase points of access where people work, live and engage. Increasing equitable COVID-19 vaccine access for BIPOC involves establishing trusted and convenient administration sites for the COVID-19 vaccine. Sites should be set up in a way that engages community trust, including in a convenient space in the community (e.g., local library, church), with community leaders actively involved in design, communication and administration opportunities. Sites can be staffed by local community-based organization partners, firefighters, emergency medical services providers, community health workers and other trusted community service providers. Employing vaccinators who are considered community leaders or champions can also help build trust among BIPOC. For sites staffed by national guard, military personnel or police, staff should dress in civilian clothes to avoid intimidating community members.
  • Strategy 2: Address structural barriers to vaccination. In addition to increasing points of access in local communities, states can support COVID-19 vaccination efforts by addressing the structural barriers to vaccination, such as lack of transportation, paid time off and childcare supports. To address transportation barriers, states can partner with local public transportation agencies to offer complimentary rides to and from vaccination sites or with community-based organizations to help community members take advantage of the Biden administration’s agreement with Lyft and Uber to offer free rides to and from vaccination sites.

    Lack of paid time off is also a prevalent barrier preventing individuals from receiving the COVID-19 vaccine. In survey data from April 2021, nearly two-thirds of unvaccinated Latino(a) adults and over half of unvaccinated Black adults reported concerns about potentially missing work due to side effects from the COVID-19 vaccine.7 State leaders can use their “bully pulpit” to encourage or incentivize employers to provide paid time off for vaccination appointments and to recover from COVID-19 vaccine symptoms. They also can lead by example by instituting this policy for state employees.
  • Strategy 3. Offer vaccination incentives that empower individuals and alleviate barriers to vaccine access. Several states are establishing incentives to encourage individuals to take up the vaccine, and these approaches can be effective if they are non-coercive and address barriers to vaccine access and systemic inequities. Incentives that resonate with the community (such as transportation vouchers; paid leave; free state university, community college or trade school credits) can serve as an opportunity for states to both increase take-up in the short-term and to build trust in and access to the health system moving forward.

Building Trust and Scaling Efforts at the Local Level

Additional state strategies rely on community engagement and investment to bolster vaccine confidence and enhance data sharing.

  • Strategy 4. Partner with and fund community-based organizations to build trust, conduct targeted outreach, and combat misinformation and safety concerns. While access is a primary barrier to COVID-19 vaccination efforts, issues of vaccine confidence and the spread of misinformation remain a concern that states will need to continue to address. Meaningfully engaging, learning from and supporting local efforts to provide consistent messaging via trusted sources is a key tool for promoting confidence in the efficacy and safety of the COVID-19 vaccine and in understanding barriers in those communities. States can also provide flexible sources of funding to localities or local organizations that can be applied to address identified local challenges to vaccination. Similarly, states can consider ways to streamline and simplify their funding applications and distribution systems to improve local organizations’ access to funding.
  • Strategy 5. Establish rapid data collection and evaluation efforts to track, refine and scale equitable COVID-19 vaccine distribution solutions. A major challenge for states, providers and communities has been tracking COVID-19 vaccine administration data, disaggregated for key subpopulations, such as gender, race and ethnicity, and geography, and monitoring this data in a timely manner to inform vaccine distribution strategy and community investment. As of the end of April 2021, 44 states are reporting doses administered by age, 40 states are reporting doses administered by gender and 46 states are reporting vaccine doses administered by race. However, only 21 states reported information about how the administration of vaccine doses by race and ethnicity compares to the state’s underlying population distribution.8 Rapid data collection efforts, in addition to building a long-term data infrastructure that focuses on equity, are vital to understanding gaps and opportunities at the neighborhood or county level. In addition to quantitative data, states can supplement data collection with qualitative information gathered through direct community outreach and engagement.


Across these short-term strategies to increase equitable distribution of the COVID-19 vaccine, success relies on partnerships with local leaders and community-based organizations who are working on the ground to support vaccination efforts. State efforts to mobilize cross-sector solutions, build durable partnerships with communities and streamline grant funding approaches for local organizations can support these short-term strategies. At the same time, building infrastructure and relationships and identifying policies or regulations that perpetuate inequities will help states address long-standing systemic inequities in their public health infrastructure.

1 Ndugga, Nambi, et al. Latest Data on COVID-19 Vaccinations Race/Ethnicity. Kaiser Family Foundation. May 12, 2021. Available at:

2 Ibid.

3 Ibid.

4 Hughes, Michelle, et al. County-Level COVID-19 Vaccination Coverage and Social Vulnerability—United States, December 14, 2020–March 1, 2021. Centers for Disease Control and Prevention. March 26, 2021. Available at:

5 Lopez L, Hart LH, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021;325(8):719–720. doi:10.1001/jama.2020.26443.

6 FDA News Release. FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic. May 10, 2021. Available at:

7 Artiga, S. and Hamel, L. How Employer Actions Could Facilitate Equity in COVID-19 Vaccinations. Kaiser Family Foundation. May 17, 2021. Available at:

8 Zylla, E, et al. Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations. State Health and Value Strategies. April 26, 2021. Available at:



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