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Vaccine Awareness

How Local Health Departments Build Vaccine Confidence and Strengthen Health Equity

Armed with years of vaccination experience and knowledge of their own communities, local health departments will prove valuable for the upcoming COVID-19 vaccinations.

As chief community health strategists, the nation’s nearly 3,000 local health departments lead the front lines of the COVID-19 pandemic response. They are critical to protecting the health, safety, and health equity for millions of people across our country, especially for those at increased risk. As we face a pivotal moment in the pandemic with the development of an effective COVID-19 vaccine, concerning reports about hesitancy among people to get vaccinated have emerged. As vaccine delivery plans are being finalized, local health departments are working tirelessly to build vaccine confidence and ensure equitable uptake of COVID-19 vaccines to help our nation end the pandemic.

Ensuring equity through improved access to immunization services

Local health departments are trusted community partners, playing vital roles in preventing and controlling vaccine-preventable diseases like influenza and measles. Eighty-eight percent of local health departments provide direct clinical immunization services to both adults and children. All of them conduct other essential immunization activities including tracking disease, educating healthcare providers and the public, and developing communication campaigns. Vaccine hesitancy is a threat to confidence in and uptake of vaccines.

Local health departments have reported that vaccine hesitancy within their communities posed significant barriers to increasing vaccine coverage. As COVID-19 has significantly impacted all populations, especially those of color and others at increased risk, local health departments’ in-depth knowledge of health disparities and inequities, coupled with their trusted community relationships, are critical to building trust in, access to, and acceptance of COVID-19 vaccines. This work is incredibly resource-intensive, requiring strong funding, well-trained staff, and a robust infrastructure.

The toll of COVID-19 on local health department immunization programs

As this pandemic persists, local health departments continue to struggle without the necessary resources to support their pandemic response efforts while providing other essential services. Nearly 90 percent of local health departments surveyed in late May indicated that immunization activities were impacted by COVID-19 and immunization staff were reassigned to support the response. Twenty percent indicated needing to redirect funding from immunization budgets to the response.


Nearly two-thirds noted declines in local vaccination coverage rates, which increases community risk for other disease outbreaks. Despite these challenges, many local health departments adopted alternative strategies including conducting virtual immunization education events, home visits, and drive-thru influenza vaccination clinics — while prioritizing those at greater risk.

Mobilizing for COVID-19 vaccination

In preparing for COVID-19 vaccination, local health departments have engaged communities of color, community and faith-based leaders, and partner organizations. They have employed community health workers and community navigators to support outreach, answer questions, lead discussions, and set up vaccination appointments. With extensive knowledge of vaccine science, the social and structural determinants of health, and the needs of their communities, particularly among communities of color and others at increased risk, local health departments provide key data on critical populations that should be prioritized. They disseminate credible information, calm fears, and dispel myths. They also leverage existing community partnerships that extend the reach and success of vaccination efforts.

The people who make up any given local health department are our friends and neighbors. They know what works and what doesn’t in their areas and how to mobilize partners to be successful. While local health departments always seem to find a way to do a lot with a little, it is vital that these agencies have sufficient resources to work with their community in supporting COVID-19 vaccination planning and administration. With the right resources, local health departments can lead the way to ending this pandemic in ways that help eliminate health disparities, improve health equity, and restore the public’s trust in government.

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