Governors, public health officials and experts in health disparities are confronting these issues, sometimes called social determinants of health, as they finalize their vaccine rollout plans for both rural and urban underserved areas.

President-elect Joe Biden, who has already appointed a coronavirus adviser to focus specifically on race and health, has promised a more cohesive national approach to the coronavirus, although states will retain their traditional strong role in vaccination.

Experts said a good starting point in planning an equitable immunization campaign is making sure the affected communities have a voice in decision-making about when and where vaccines will be accessible — and for states to include in their plans places where people already are used to getting care, where there is trust, familiarity and convenience.

One part of their emerging strategy is to make vaccines available at coronavirus testing centers in every county and have at least some shots available in early evening when people are coming off work.

New York Gov. Andrew Cuomo recently announced a similar statewide Covid-19 Equity Task Force to “break down barriers to vaccination and ensure equitable distribution” as more coronavirus vaccine doses arrive.

So state and county officials are thinking about making the shots available in places like churches, offices, mobile vans, county public health clinics, federally qualified health centers, community colleges, grocery stores, as well as some doctors’ offices — and having at least some options in hours that are not 9 a.m. to 5 p.m., said Blaire Bryant, associate legislative director for health at the National Association of Counties.

But Bryant also pointed out that given the enormous strains on the underfunded and overstretched public health workforce — which is doing an unprecedented massive vaccination campaign while trying to control an unprecedented pandemic — there are tensions and tradeoffs in figuring out where to locate the vaccines.

And some are staffed by community health workers, who live in those neighborhoods, are often multilingual and have a reservoir of patient trust.

“Community health workers are going to be key” to both trust-building and vaccination, said Lisa Cooper, a Johns Hopkins University physician and professor who directs both the school’s Center for Health Equity and its Urban Health Institute.


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