UMD Report: Complex Challenges Slowed Prince George’s COVID Vaccine Response

Prince George’s County’s lagging COVID-19 vaccination rate stems from complex organizational challenges and alienation from the health care system among many people of color, coupled with a lack of access, according to a new report from the University of Maryland’s School of Public Health.

Produced by the Maryland Center for Health Equity (M-CHE) for the CommuniVax coalition, a national research initiative led by the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, the report found that addressing this urgent problem will require more clinics, better communication and additional health care workers.

“We had health disparities before COVID, and we will have health disparities after COVID,” said Professor Sandra C. Quinn, who with M-CHE Director and Professor Stephen B. Thomas leads the CommuniVax team. “But how can we make sure that the health infrastructure and surveillance systems that were created to address COVID don’t go away? How can we make it sustainable?”

Prince George’s County, whose population is 62% African American and 20% Latino, has a long history of disparities in chronic diseases, HIV, infant mortality and unequal access to health care. Throughout the pandemic, Prince George’s has led Maryland in COVID-19 cases, hospitalizations and deaths. Although, as of Sept. 17, 70% of county residents were fully vaccinated, significant proportions, particularly of the African American population, have not been and remain at grave risk from the Delta and future variants.

One reason for the gap, the report found, was a disjointed rollout for the vaccine in winter and early spring. It cited the state’s rapidly changing eligibility requirements, limited supply, changing information, and a total reliance on frequently changing computerized systems to access vaccine appointments. The location of vaccine sites created transportation challenges, as did their hours of operation.

The report also criticized vaccine hesitancy as a “simplistic and inaccurate representation of residents’ attitudes and experiences.” It noted vaccine hesitancy can exist only when there is actual access to vaccines, and that hesitancy doesn’t mean anti-vax. Many participants reported that they had questions and concerns, and struggled to find digestible information and answers. Others discussed the history of mistrust of health care, not solely because of notorious unauthorized medical experiments on Black people, but because they experienced bias and discrimination in their own encounters with health care systems.

The researchers called for a holistic and sustainable approach to address health disparities, bolster the county’s health and human services capacity and set a course for the county to recover from the pandemic. Their key recommendations are to:

Use COVID-19 vaccination campaigns as the foundation for long-term health promotion efforts: Barbershops, hair salons, churches and other community sites that were enlisted to reach people to get a COVID-19 vaccine should be maintained as ongoing partners with the county’s four large hospital systems, local pharmacies and the Prince George’s Health Department. “We want to take advantage of the hyperlocal, authentic relationships to keep communities engaged today and into the future,” said Thomas, who has been working with barbershops and salons to provide space for COVID-19 vaccine clinics.

Humanize delivery and communication strategies for COVID-19 vaccines: While vaccine sites seemed to be everywhere for a time, the locations and available times were not always communicated appropriately to those who needed it most, including those with low literacy, low English proficiency or limited access to technology. The CommuniVax team urged the county health department to partner with UMD experts in languages, health literacy and communications and community engagement approaches to expand access.

Invest in a strong, properly staffed public health infrastructure: The report strongly advised greater investment in the county’s health and human services resources, including increased and appropriate staffing for risk communication, health literacy, community engagement, and public health preparedness and response. It urged Prince George’s to consider models in other Maryland counties and create an independent board of health that is separate from the county council and includes experts in all areas of public health.

Strengthen the health system as the backbone for equity, resilience and recovery: The research team suggested that the county build on the work of the Prince George’s Forward task force and collaborate with government, community-based and faith-based organizations and university and health care partners to support and fund a program that increases the number of community health workers who can apply their influence for social good. The team also recommended that the county engage all aspects of government and county services to recover from the pandemic and to create a “recovery and resilience commission” to help integrate the efforts on all fronts related to health promotion, disaster recovery and economic development, among other issues.

The report will be shared with county leaders, health care systems and the Maryland General Assembly over the coming weeks and at a CommuniVax Report Back webinar on Sept. 28.