Live. Magazine

In January of 2022, there were many reasons for hope in the battle against the coronavirus pandemic. Over 50 percent of the US population had received at least one vaccine dose, and several treatments were available. But the fatality rates for Black, Hispanic and other ethnic communities were still disproportionately high – and so was vaccine hesitancy.

The Center for Global Health Innovation (CGHI), a US-based nonprofit focused on global health equity, was one of many organizations around the country working to close this gap in vaccination rates. They had just won funding from the US Health Resources and Services Administration, including support from Pastor King, for their own vaccine access initiative, and they selected Stephanie Adams to lead the project, which also included measuring how this hyperlocal focus would increase trust.

“My team had close to 10 million US dollars to spend to increase vaccine access in about eight months and there was no time to wait,” said Stephanie Adams, who transitioned from her career in patent law into public health in 2020 to help address the immense death toll in underserved and under-resourced communities. “But the public health sector had realized that traditional approaches didn’t work, and we all needed to try something new to achieve this.”

The general idea was that to boost vaccine rates in underserved regions, individual communities needed individual solutions – down to specific neighborhoods or even church congregations. Besides that, the idea was also to strengthen trust in the healthcare system, which Adams was tasked to measure too.

“The grant gave us the funding to prove that sustained hyperlocal engagement through trusted leaders and community health workers could increase vaccination rates, and inherently trust too,” said Adams. “And it was incredibly successful, which we were able to prove with our data.”

Now Adams is applying these same strategies to save lives again – this time from another leading killer in the United States: cardiovascular disease. She is part of the team behind the Engage with Heart program, which is partnering with communities to co-create solutions aimed at improving heart health in Baltimore, Maryland, and maybe eventually across the United States.

Groundswell of enthusiasm

Even before the pandemic, the idea of hyperlocal engagement had been emerging around the world. But the funding hadn’t been available to test the approach on a larger scale, or for a longer duration.

During the first two years of the pandemic, the CGHI had pursued a variety of projects that paved the way for this type of engagement. This included growing a network of over 400 trusted community and faith leaders around the country.

This network was the starting point for Adams and her team, and their first step was to reach out to help these trusted leaders better understand the science and technology behind the coronavirus infection, the necessary health interventions and the vaccines.

“We were committed to letting them know that we were not coming at this heavy-handed, but from a place of compassion, concern, and empathy,” said Adams. “Historically, previous engagement efforts had held focus groups and similar activities where they gathered information and data from the community, but they didn’t bring anything in return – what’s really important in these projects is that you bring something to the community.”

Beyond their scientific expertise, what Adams and her team brought was the funding and resources to recruit and train about 125 new community health workers to cover the targeted communities in the seven states included in the grant. Adams and her team also brought their own eagerness to listen to the leaders’ and recruits’ expertise about what strategies would work best in their communities.

The recruitment process was handled almost exclusively by the CGHI’s network of community leaders, many of whom joined the project as regional coordinators. In fact, no job postings were ever needed – the network already knew who in their communities would be the best fit for these new positions.

“What surprised us most was this groundswell of enthusiasm and the willingness of people in these communities, who already had busy lives, to stop what they were doing and take on this role,” said Adams. “We were astonished that we were able to hire 90 percent of the community health workers within six weeks of the project launch.”

Throughout the project, Adams’s team offered continuous support and regular brainstorming meetings about how to overcome local challenges and create more effective outreach activities. These included webinars, vaccine clinics, flyers, social media posts, events at faith-based organizations, door-to-door outreach, and attendance at community events, such as high school football games.

“In some places it was really conducted like a grassroots political campaign,” said Adams.

Adams also noted how important it was that the project offered part-time work so that recruits didn’t have to leave their current jobs, and also that the project offered flexible work schedules.

“This was essential, and we didn’t really think about it in the beginning, but you need to interact with the community when the community is around,” said Adams. “And that’s not during nine-to-five work or school hours, that’s in the evenings and on the weekend.”

Saving lives and building trust

Thanks to nation-wide efforts like the CGHI’s work, vaccination rates among the Hispanic population surpassed those of the white population in early 2022. Rates among the Black population came close to equal later that year. Fatality rates as a whole dropped for all groups and the gap between groups nearly vanished.

Numerous publications from the Rockefeller Foundation, Kaiser Family Foundation and others have since highlighted the critical role that community health workers played in this success. Although the CGHI project was only designed to collect limited data about vaccination rates and long-term follow-up, the project did gather over 27000 reports and surveys that gave key insights into other outcomes, like increasing trust.

These included over 14500 reports from community health workers about each interaction or outreach they coordinated. In addition to detailing the type of activity, as well as who and how many people participated, the reports also included subjective questions about whether the worker thought that the activity improved trust and reduced barriers to getting vaccinated.

Beyond this worker feedback, over 13000 community members agreed to complete a voluntary survey, which was offered after they received a vaccination or booster dose.

In total, the reports indicated over 750000 interactions with community members across all the project locations. The reports and surveys revealed that over 80 percent of respondents thought that the activities helped build trust and provided successful education about the coronavirus and vaccines. Nearly as many (77 percent) said that the outreach removed barriers to healthcare as well.

The results also showed that the most common forms of engagement were door-to-door outreach, events at faith-based organizations, flyers, and social media posts. Regarding effectiveness, the feedback suggested that first-time in-person interactions were the most likely to result in a person receiving the vaccine. Follow-ups were unlikely to convince people if they weren’t persuaded the first time.

“That result was surprising because some people thought that it was long-held beliefs that were preventing people from getting vaccinated,” said Adams. “But now there’s a lot of data saying that the majority of people were open to being convinced if approached the right way, and that the best way to convince someone to get vaccinated is to have a friend or family member urge them.”

“Our results show that a trusted community health worker can be a proxy for that friendly voice.”

Moving to heart health

“It’s unbelievable how time and time again, from Arizona to Detroit to the Rio Grande Valley to the city of Baltimore, the results of using this model have been resoundingly positive,” said Adams.

Another surprise during the project was the extremely high retention rate – only 2 percent of the workers left their roles. Also, when the project received a five-month extension, 100 percent of the workers whom the team invited to continue agreed to extend their roles.

Although their work during the pandemic was largely successful, the CGHI’s interactions with these communities also brought into focus other longstanding inequities – namely that these communities suffered from many other chronic and fatal illnesses that had never received as much support and attention as the pandemic. Among these, cardiovascular disease has been the number one killer in many communities.

“It was a massive criticism that we heard during the pandemic. People told us that they have been dying of heart disease for 30 years and that no one had ever stood by them to help,” said Adams.

“So now we’re really excited to be able to say, we heard you and now we’re back to help with heart disease too.”

Adams left the CGHI in 2023 to work for the High Impact Network of Responsible Innovators, one of the partners of the Engage with Heart program. Her role there is to do much the same as she did during the pandemic – except that now her teams are working to improve heart health.

Like her previous project, the Engage with Heart program is coordinating a range of activities including events and shared healthy meals, increased access to health screening, and education about cardiovascular disease and the preventive benefits of nutrition and exercise. Also as before, these are all designed and achieved in close partnership with the communities themselves.

“We’ve seen that this model extends to really any community and any health disparity – there’s a network that’s out there waiting to be tapped,” said Adams. “Once we can support that network, it’s amazing to see how quickly we can form those trusted partnerships to address our shared goals of making their communities healthier.”