By Rachel Crumpler

On Dec. 14, 2020, Katie Passaretti, medical director of infection prevention at Atrium Health, became the first person in North Carolina to be vaccinated for COVID-19.

Now, one and a half years later, more than 16.9 million COVID shots have been administered in the state, according to the N.C. Department of Health and Human Services vaccinations dashboard.

To get to this point, it’s taken a mighty effort by the state’s public health personnel — along with community health workers and volunteers — working tirelessly to make vaccines accessible. It’s taken mass vaccination clinics such as the federally supported one at Four Seasons Town Centre in Greensboro to smaller community vaccination events at churches, grocery stores and local fire departments. It’s taken public Q&As with medical experts and one-on-one conversations with physicians and other trusted messengers to break through vaccine hesitancy. It’s taken addressing transportation and language barriers. 

All that work paid off. 

In contrast to other states, North Carolina has almost eliminated the gap between Black and white vaccination rates across all age groups. The state’s efforts have also led vaccination rates to be higher for Hispanic populations than non-Hispanic populations. 

People around the country are taking notice, even the White House. 

In June, representatives from the White House Office of Science and Technology Policy made a special trip to Macedonia New Life Church in Raleigh to hear more details about the state’s COVID response. Last week, Kody Kinsley, secretary of N.C. DHHS, attended the White House’s Summit on the Future of COVID-19 Vaccines to speak on a panel about advancing vaccine equity.

How did North Carolina manage to become a leader in this space? 

North Carolina’s recipe for success: data-driven decision-making and community partnerships.

“North Carolina committed to building a vaccine registry where race and ethnicity and other demographic data was non-negotiable,” Kinsley said during the White House vaccine equity panel on July 26.

“We had to have that information and then we compared the visibility of that information to leverage, frankly, our providers in making sure that we can hold them accountable to vaccinate on par with the folks that they’re serving in their community. 

“And at the same time pair that with community-based organizations that could leverage the trust that they had long had.”

Using data to embed equity

While vaccine rollout may have started bumpy, the state prioritized equity with efficiency early in its distribution plans. 

For North Carolina, data was fundamental in shaping COVID response strategies to minimize disparities. Officials knew they needed data to know where to go and what to improve. 

However, the state didn’t initially have real-time data to see any potential gaps and disparities. This led the state to build a vaccinations dashboard that includes important demographic information to give officials — and the public — needed visibility. North Carolina became one of the first states nationwide to release statewide race and ethnicity data for COVID vaccines. 

The racial and ethnic information, as well as geographic data by census tract and ZIP code, informed equity-based vaccine allocations early in the vaccine rollout.

For example, the state provided additional doses to counties with providers that showed a focus on serving populations with higher COVID burden. That included such groups as seniors 65 years and older, people living in poverty identified by census tract, and counties with high rates of unvaccinated people from historically marginalized communities. Focused efforts were also made to reach underserved communities including migrant farmworkers, meat and poultry processing workers and unhoused populations. 

“How do we leverage data and information to make sure we are intentional about our resources to try to overcome disparity?” Kinsley said during the White House staff visit to North Carolina in June about the state’s thought process.

Data was critical in identifying vaccine gaps across the state and, for a time, there was a weekly rhythm to it. 

N.C. DHHS would analyze updated data each week to identify priority census tracts by criteria such as percent vaccinated and social vulnerability index scores. The scores were determined using 15 census variables such as poverty, lack of vehicle access and crowded housing — factors that could indicate areas that most likely need support. 

For the top 10 identified census tracts, generally areas with a population size between 1,200 and 8,000 people, state officials would consult with local health departments and community-based organizations to determine a plan for targeted outreach and deploy resources needed to vaccinate residents in the area.

Irreplaceable trusted messengers

While data helped form a vaccine distribution plan centered around equity, implementing it was only possible with the help of trusted community partners. 

“We have invested so much money in community-based organizations that are doing on-the-ground work to leverage trust to establish routine and stable communication channels,” Kinsley said last week.

One such investment is Healthier Together, a public-private partnership the state DHHS launched with the NC Counts Coalition in March 2021 to increase COVID vaccinations among individuals who are Black, American Indian, Latino and from other historically marginalized populations across the state. The partnership focuses on building trust and providing education and outreach to eliminate barriers to vaccination. From May 2021 to April 2022, Healthier Together led 522 vaccine events across the state, administering more than 11,400 shots. 

Another influential multi-sector group, LATIN-19, comprised of over 700 participants representing health care systems, public health departments and community-based organizations, spread word of the safe vaccinations in the Latino community to alleviate mistrust and disparities.

Wake and other counties also relied on community partners, such as faith-based leaders and Black Greek sororities and fraternities, to narrow vaccine gaps. Lechelle Wardell, community outreach and engagement manager at Wake County Health & Human Services who has served the county for 26 years, said community events made all the difference in reaching historically marginalized populations disproportionately affected by COVID.

“It was really just taking [vaccines] to where people felt safe, where they were located and where they didn’t feel like it was the government or a distrusted system that was giving it,” Wardell said.

Holding vaccination clinics at convenient, trusted sites in people’s own communities — such as churches — immediately led to results. Wardell said people were more comfortable coming to these places, and in fact, she saw people flock there whereas they were unwilling or unable to go to mass vaccination sites. 

Senior Pastor Joe Stevenson eagerly volunteered Macedonia New Life Church, a predominantly African American congregation, as a host site for several vaccine clinics — clinics that were readily received by his congregation all because the trust was already there.

“They trust the church, they trust their pastor, they trust their physicians,” Stevenson said. “So if you put it in the community where people of color, minorities live, then they’ll walk to the church, they’ll call their cousins and call their uncles, their grandmothers and bring their family to the church.” 

As he helped set up the church as a vaccination site, he remembers holding about 300 vials of the Moderna vaccine in his hands. That moment further moved him to go to the pulpit before his congregation of about 600 and tell them, “I held what the world is looking for. This is going to save lives.”

A trusted messenger like Stevenson encouraging vaccination often had more impact than a health official. 

“We’ve got to get the conversations about vaccination coming less from people like me and more coming from trusted resources,” Kinsley said last week at the White House. “I think that’s what really matters.”

Centering equity

Data and community partnerships are the backbone of North Carolina’s efforts to embed equity in its COVID vaccine distribution. The two elements will continue to be crucial when tackling other disparities.

“It’s what we should be doing to address all inequities that we’re seeing,” Wardell said. “We’ve got to build relationships. We’ve got to get out where people are. We’ve got to shift our policies, our practices and our procedures to help communities feel safe and more comfortable in interacting with us.”

Kinsley echoed Wardell’s sentiment. 

“We’re in complex disease management and it’s going to take every tool and an equitable approach with every single tool,” Kinsley said last week at the White House. “I think that’s the best thing we can really do to continue to center equity.”

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