Best Practices for an Equitable Covid-19 Vaccination Program
Open accessAbstract
Leaders at the VA Puget Sound Health Care System vaccinated Black, Hispanic, and multiracial patients at rates exceeding population averages through outreach efforts that are accessible to other health care organizations.
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Experiences of systemic and institutionalized racism, especially in healthcare, persist as barriers to access to care for racialized and Indigenous communities.
“experiences of systemic and institutionalized racism, especially in healthcare, persist as barriers to access to care(18,53,61).”
From Social inequalities in COVID-19 death by area-level income in 11.2 million people in Ontario, Canada: patterns over time and the mediating role of vaccination. (2026) · cites this paper as [53]
The Challenge section says that understandable mistrust in the medical system undermined Covid-19 vaccine willingness among Black and Hispanic Americans, alongside barriers to vaccine access. It does not identify systemic or institutionalized racism as the cause, establish that it remains a barrier to healthcare access generally, or make that claim about Indigenous communities. The Execution section mentions low vaccination rates among Native American veterans but does not link them to racism. (LLM, conf=0.82)
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Research works printed but not linked: 12
- [1]Dooling K, Marin M, Wallace M, et al. The Advisory Committee on Immunization Practices’ updated interim recommendation for allocation of COVID-19 vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep 2021; 69: 1657- 60 https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm?s_cid=mm695152e2_w 10.15585/mmwr.mm695152e2 33382671 PMC9191902 · DOI
- [2]Lee FC, Adams L, Graves SJ, et al. Counties with high COVID-19 incidence and relatively large racial and ethnic minority populations - United States, April 1-December 22, 2020. MMWR Morb Mortal Wkly Rep 2021; 70: 483- 9 https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e1.htm?s_cid=mm7013e1_w 10.15585/mmwr.mm7013e1 33793463 PMC8022874 · DOI
- [3]Romano SD, Blackstock AJ, Taylor EV, et al. Trends in racial and ethnic disparities in COVID-19 hospitalizations, by region - United States, March-December 2020. MMWR Morb Mortal Wkly Rep 2021; 70: 560- 5 https://www.cdc.gov/mmwr/volumes/70/wr/mm7015e2.htm. 33857068 PMC8344991
- [4]Gold JAW, Rossen LM, Ahmad FB, et al. Race, ethnicity, and age trends in persons who died from COVID-19 - United States, May-August 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1517- 21 https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e1.htm?s_cid=mm6942e1_w 10.15585/mmwr.mm6942e1 33090984 PMC7583501 · DOI
- [7]Gayle H, Foege W, Brown L, Kahn B, eds. Framework for Equitable Allocation of COVID-19 Vaccine. Washington, DC: National Academies Press, 2020. https://www.nap.edu/catalog/25917/framework-for-equitable-allocation-of-covid-19-vaccine. 10.17226/25917 33026758 · DOI
- [8]Webb Hooper M, Nápoles AM, Pérez-Stable EJ. No populations left behind: vaccine hesitancy and equitable diffusion of effective COVID-19 vaccines. J Gen Intern Med 2021; 36: 2130- 3 https://link.springer.com/article/10.1007/s11606-021-06698-5 10.1007/s11606-021-06698-5 33754319 PMC7985226 · DOI
- [12]Tarzian AJ, Geppert CMA. The Veterans Health Administration approach to COVID-19 vaccine allocation-balancing utility and equity. Fed Pract 2021; 38: 52- 4 https://www.mdedge.com/fedprac/article/235663/coronavirus-updates/veterans-health-administration-approach-covid-19-vaccine 10.12788/fp.0093 33716479 PMC7953856 · DOI
- [13]Reddy A, Nelson KM, Wong ES. Primary care spending in the Veterans Health Administration in 2014 and 2018. JAMA Netw Open 2021; 4: e2117533 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782055 10.1001/jamanetworkopen.2021.17533 34279651 PMC8290298 · DOI
- [16]Atkins D, Kilbourne AM, Shulkin D. Moving from discovery to system-wide change: the role of research in a learning health care system: experience from three decades of health systems research in the Veterans Health Administration. Annu Rev Public Health 2017; 38: 467- 87 https://www.annualreviews.org/doi/10.1146/annurev-publhealth-031816-044255 10.1146/annurev-publhealth-031816-044255 28125386 · DOI
- [17]Ismail SJ, Tunis MC, Zhao L, Quach C. Navigating inequities: a roadmap out of the pandemic. BMJ Glob Health 2021; 6: e004087 https://gh.bmj.com/content/6/1/e004087 10.1136/bmjgh-2020-004087 33479019 PMC7825252 · DOI
- [18]Waljee AK, Ryan KA, Krenz CD, et al. Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration. BMC Health Serv Res 2020; 20: 369 https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05211-8. 32357873 PMC7193376 · DOI
- [19]Fihn SD, Francis J, Clancy C, et al. Insights from advanced analytics at the Veterans Health Administration. Health Aff (Millwood) 2014; 33: 1203- 11 https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.0054 10.1377/hlthaff.2014.0054 25006147 · DOI
Cited by
Sorted by citations
Wang, L., Swayze, S., Bodner, K., Calzavara, A., Harrigan, S. P., Siddiqi, A., Baral, S. D., Austin, P. C., Smylie, J., Koh, M., et al. (2026) · American Journal of Epidemiology · doi:10.1093/aje/kwaf051 · Cited by 5 · see citing works
- Authors
- Beste, L. A., Chen, A., Geyer, J., Wilson, M., Schuttner, L., Wheat, C., Rojas, J., Nelson, K., & Reddy, A.
- Affiliations
- University of Washington (US)
- Health Services Research & Development (US)
- ORCID
- Venue
- NEJM Catalyst
- Publisher
- Massachusetts Medical Society
- Published
- 2021-09-15
- Volume
- 2
- Issue
- 10
- ISSN
- 2642-0007 (ISSN-L)
- PMC
- PMC8443122
- OpenAlex
- W3200075708
- Cited by
- 15
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 9
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- NEJM Catalyst (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- COVID-19 vaccination, health equity, vaccination outreach, Black patients, Hispanic patients, Veterans Affairs health care, vaccine access, health disparities
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