Taking a shot at inequities in emergency response: COVID-19 pandemic spurs ongoing healthcare and community partnership to promote equity for children facing disaster.

Abstract

Evidence shows that responses to health crises often worsen existing disparities. As the approval of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine for people 12 years and older became imminent in the spring of 2021, our institution sought to meet the urgent need to vaccinate the young people in our community facing inequities in pandemic response. In this report, we describe our institution's approach to responding to a rapidly emerging public health need and how we continue to leverage this framework to respond equitably to subsequent local health crises. We recognized that groups of children who had been most impacted by the detrimental effects of the pandemic would also face significant barriers to accessing coronavirus disease 2019 (COVID-19) vaccines. To identify this at-risk cohort, we partnered with our public health department and the school district to use data to identify the zone improvement plan (ZIP) codes with the lowest adult SARS-CoV-2 vaccination rates, schools most often closed due to COVID-19 outbreaks, and schools with the highest percentage of students undervaccinated against routine childhood diseases. We then partnered with our local school district and community organizations who were similarly committed to serving the children of our community (including museums, faith centers, and the zoo, among others), to develop and promote 50 COVID-19 vaccine clinic locations that were positioned to maximize access for populations of children at greatest need. Through these efforts, we administered 10,792 vaccinations to 6,981 unique patients. Of these, 8,503 were in Philadelphia with over one-third (37 percent) of vaccines given to people from our target ZIP codes, and non-White individuals represented 73 percent of the vaccine recipients. Key lessons included utilizing available data to select where care delivery sites would be positioned, integrating with other responding organizations to coordinate efforts and avoid overlap, providing care to the whole family (not just children) when able, and developing a robust monitoring structure with iterative change to maximize impact for our target populations. Key challenges included navigating the balance between low attendance clinics in high-risk areas or areas that were difficult to access while striving to be resource-efficient and maximize our impact on vulnerable populations. In conclusion, recognition of the potential for disaster response to worsen existing disparities in healthcare should lead managers to include a specific focus on equity in their planning. Our experience demonstrates that coordinated, intentional response can successfully minimize disaster impact on our most vulnerable populations.