Private-Public Partnerships Aim to Tackle COVID-19 Vaccine Inequity, Distribution Disparities

In a session presented at America’s Health Insurance Plans (AHIP’s) National Health Policy Conference, federal health officials and health plan representatives provided updates on the national efforts to combat COVID-19 and highlighted successes of the country’s ongoing vaccine rollout, placing particular emphasis on the role equity plays in distribution.

When it comes to the president’s strategy to fight the pandemic, the administration aims to restore trust, accountability, and a sense of common purpose through the response, explained Bechara Choucair, MD, who serves as vaccines coordinator to the White House COVID Response Team. To successfully implement the administration’s mission, the team has focused on increasing vaccine supply, the number of vaccinators, and the number of places at which individuals can get vaccinated across the country.

“Equity is at the cornerstone of our vaccination strategy,” Choucair stated. “Everything we do, we look at it with that equity lens.” Citing the roughly 1390 federally qualified health centers (FQHCs), throughout the country—which serve around 30 million people—Choucair explained how the administration has prioritized these centers to ensure they receive vaccines for the underserved populations they support. Of the 30 million individuals served at these centers, two-thirds live at or below the federal poverty level, while 60% are ethnic or racial minorities.

During the session, Choucair reiterated the goal of President Joe Biden to have enough vaccine doses available for all adults who wish to receive them by the end of May, and pointed out that over 92 million doses of vaccine have been administered in the United States as of this morning.

Thus far, 23.5% of the US adult population has received at least 1 dose while 60% of individuals over the age of 65 have received at least 1 dose compared with just 8% in late January, he added.

“A successful vaccination program requires a coordinated effort across state, tribal, local and territorial partners, academic partners, commercial partners, provider organizations, insurers, [and] businesses,” said panel member Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases (NCIRD) at the CDC. “But I think especially for COVID-19, the vaccination program requires a whole-of-society effort.”

To help achieve this goal, several stakeholder organizations have partnered with the federal government to ensure vaccine distribution is carried out in an equitable manner. For example, panel member Robert Gluckman, MD, MACP, chief medical officer at Providence Health Plan, also serves as the AHIP liaison to the Advisory Committee on Immunization Practices (ACIP), which offers recommendations to communities to guide vaccine distribution. “The breadth of the stakeholder participation is really strong so multiple perspectives and expertise can be brought forward,” Gluckman said.

In addition, AHIP recently partnered with the Biden administration and the Blue Cross Blue Shield Association to form the Vaccine Community Connectors Initiative. The foundation of this effort (delivering the vaccine to underserved communities) is “arguably the most important population health effort that we will be involved in in our lifetimes,” said William Shrank, MD, the chief medical officer and corporate affairs officer at Humana Inc.

Without an intentional vaccine approach, the same disparities the pandemic has brought to light resulting from longstanding barriers like access, health literacy, engagement, and digital literacy, will only perpetuate, Shrank explained. As a group of health plans, we need to proactively work together to leverage the data we have, the relationships we have with members, the partnerships we have within communities, with retail pharmacies, with health systems to identify the most vulnerable populations, provide outreach, and target resources, Shrank said.

But in addition to providing access to a vaccine, Messonnier stressed the importance of public confidence in the inoculation. On a national level, the CDC is pursuing this goal via the Racial and Ethnic Approaches to Community Health (REACH) program “in which we're supporting hundreds of local and community based organizations to improve COVID-19 vaccination coverage among racial and ethnic groups,” she said. The Retail Federal Pharmacy Program has also been instrumental in this effort.

For health plan members, organizations have been working to address gaps in education and direct outreach to encourage individuals to get the vaccine, Shrank explained. “We've spent a lot of time over the course of the pandemic, making proactive calls, asking our members about the very personal challenges they've been experiencing throughout the pandemic,” he said. “We've tried as hard as we really can to stay close to our members, understand the very, very, very personal challenges they're facing. This effort to engage and educate and encourage our members about the vaccine, we see as a continuation of that effort.”

Combatting misinformation by disseminating reliable information from the CDC, FDA, or local health authorities is essential to achieve the uptake of the vaccine that is necessary, said Gluckman. “An important opportunity for health plans is to understand where their populations may not have been vaccinated yet, and how we can really ramp up our community outreach partnerships to increase the uptake of vaccine…so that vaccine acceptance becomes more widespread than it currently is.”

Despite these efforts, Messonnier pointed out it is still unknown what percentage of individuals would need to be vaccinated to achieve herd immunity for COVID-19. The concept is not a national phenomenon, but rather “it's community by community, which means we need to strive for 100% coverage in every corner of the community,” she said. Although we may have enough vaccines by the end of May, it will take several months until it reaches every corner of every community in the United States. Furthermore, as there are currently no vaccines licensed for children or adolescents, “It's important to think about this as being something that we're going to be dealing with for a long time and to get ourselves ready for the potential need for a longer-term program, like we have with influenza.”