SMC Health COVID-19 Plan & Metrics
Newly available safe and effective vaccines are one of the most important ways to end the COVID-19 pandemic. Access to these vaccines must be equitable.
The COVID-19 pandemic has worsened pre-existing disparities affecting low-income residents and communities of color in San Mateo County. For example, members of the Latinx community represent 24% of population, but 41.6% of COVID-19 cases as of June 2021. Full recovery from COVID-19 requires we do everything we can to address not only the public health impacts, but economic recovery, community infrastructure, education and child care. While we know addressing these inequities fully is a long-term effort, we must start now with a pandemic response that targets the most impacted communities with tailored, culturally responsive approaches to overcome vaccination barriers.
Our Ultimate Measure of Success
How will we know if we are making progress? California requires each county to reduce overrepresentation of low-income and/or minority groups in its COVID-19 positive cases. The way this is measured is by comparing rates of positive cases in different neighborhoods (or census areas) using a data set called the Healthy Places Index . With the introduction of vaccines, we expect the State will establish new metrics to assure the equitable distribution of vaccines. If we are successful, there will be no difference in rates of COVID-19 cases or vaccinations between different communities within San Mateo County.
How are we doing?
For additional detail, please see our data dashboards which outline the vaccination rates in various communities here
San Mateo County Equity Principles to Guide our Vaccination Effort
Safety, equity and transparency: We are committed to being transparent, careful, and above all equitable in providing COVID-19 vaccines to everyone who needs and requests vaccination. While the federal and state governments directly guide and supply many vaccinations through large health care systems and pharmacies, County Health coordinates vaccinations for those not already connected to vaccines and provide a safety net assuring no one is left behind. Our focus is to increase accessibility for low-income residents and communities of color and partner with trusted members of these communities to understand and remove barriers.
We are using these principles to guide our effort :
- Provide transparency in the science, data, and vaccination process.
- Prioritize those that shoulder the most risk.
- Acknowledge explicitly the negative and painful history of health care in the US in communities of color and current health inequities that have led to distrust in healthcare, research, and government.
- Engage our community to better understand their concerns and needs and respond as much as possible.
- Communicate effectively in culturally sensitive ways through trusted partners.
- Overcome as many barriers to accessing the vaccine as possible – geographic, linguistic, cultural, physical, technological, documentation, mistrust, and more.
- Learn and improve as we go.
More about our vaccine equity work here
Our Vaccine Plan: Two strategies to stop spread and reduce inequities
San Mateo County Health’s pandemic response plan involves custom approaches for different at-risk community groups. The work to ensure equitable distribution of vaccine builds on strategies we have used throughout the pandemic and will be informed by the newly expanded Vaccine Communication Equity Working Group comprised of over 100 members and convened as part of the San Mateo County Recovery Initiative.
The very complex and dynamic vaccine roll out is changing every day. County Health plays a key coordination role between the federal and state government and our community. The federal government approves and creates guidance which the state of California further details. The State then gives vaccine doses to counties and large multi-county health care organizations like Kaiser, Sutter/Palo Alto Medical Foundation, Dignity/Sequoia and AHMC/Seton Medical. County Health supports smaller health care organizations to sign up to be vaccinators and gives doses to them to vaccinate patients, prioritizing underserved groups. Additionally, we act as a safety net by arranging vaccine access for residents who cannot access it through their employer or healthcare provider. County Health monitors data to be sure there are no disparities in access within our community.
Strategy 1: Improve communication to build trust, engagement and participation in vaccine efforts
Our first strategy addresses multiple concerns, namely:
- Distrust of government, research, and health care as a result of painful and shameful history of health experimentation on people of color
- Current health inequities in healthcare and beyond
- Safety concerns
- Confidentiality and immigration status concerns
- Linguistic barriers
- Knowing when and how to receive vaccine, especially for those who are not digitally connected
What we are working on:
Engagement: The San Mateo County Recovery Initiative Vaccine Communication Equity Working Group allows for an ongoing dialog between the County and our most impacted communities. This group allows us to better understand the needs and concerns of our communities and get direct feedback on our plans. It also helps community partners get up to date information about the vaccine roll out at all levels to be able to share that knowledge with the communities they represent and serve. Community leaders can use this forum to share feedback with the State on their prioritization and planning efforts through a partnership set up with the California Pan Ethnic Health Network – a statewide health equity advocacy organization that serves on the State Community Advisory Committee.
In addition, our Health Equity Initiatives supported through San Mateo County Health’s Office of Diversity and Equity continue to provide vaccine discussion forums to serve as venues for two-way engagement between the County and impacted communities.
Communication: With the assistance of the SMC Recovery Initiative Vaccine Communication Equity Working Group, residents of the most impacted neighborhoods will receive accurate and effective information about the COVID-19 vaccine, the vaccination process, and how to stay healthy before and after vaccination by focusing on other protective behaviors. This group develops COVID-19 vaccine communication and outreach plans specifically designed for the most vulnerable communities in San Mateo County and provides feedback on the countywide vaccine communications plan. To ensure consistent, accurate, and timely information these communication efforts align with other efforts at federal, state, and local levels.
The vaccine communication approach is built on our existing strategies by continuing to:
- Provide targeted, culturally and linguistically appropriate communications to reinforce core messaging
- Maintain public data dashboards and in-language resource information
- Facilitate conversations with at-risk communities and impacted groups
- Develop partnerships with trusted messengers, community leaders and key sectors (business, education, child care) to promote health equity as the vaccine roll out
The County will continually acknowledge the mistrust in our communities of color because of current and past health inequities they have experienced, as we work to overcome them. In addition to County communication strategies, we are engaged with all large local health care organizations to better coordinate communications.
Partnership: The most significant way we will move the needle is by partnering with trusted community-based organizations in our most impacted communities. Leaders in these communities have built trust over many years, understand effective outreach strategies, and will be important messengers once they have confidence in the vaccine and vaccination process themselves.
Through the Office of Community Affairs, the County partners with over 30 organizations providing vaccine information to our most vulnerable neighborhoods. We also host nine Health Equity Initiatives to ensure dialogue in racial/ethnic, LGBTQ+, and spirituality affinity groups about the vaccine. We plan to expand partnerships to support trusted messengers in their outreach, as we learn directly from their expertise and community learnings.
The State is has a notification and scheduling system called MyTurn allowing all California residents to learn if they are eligible to receive a vaccine, and if not yet eligible, to register to be notified by text or e-mail when it is their turn.
Given that many of our hard to reach residents do not have access to or use technology, we are enlisting local partners, leaders and media to publicize key updates.
- Where/How: Many San Mateo County residents will receive vaccination from their health care provider or local pharmacy.
How we will know how we are doing:
|# of interactive vaccine related community sessions||Average 3 per month||April: 7 Sessions|
|# of population-specific messaging and outreach campaigns||
5 ethnically/linguistically targeted campaigns
6 geographically targeted campaigns
|38 in May|
|# of resourced partnerships with community based organization to support vaccine outreach||30+ partnerships||30+|
Strategy 2: Enhance targeted vaccination strategies to ensure equitable distribution to at-risk communities
Our second strategy addresses additional barriers that include:
- Geographic distance, physical limitations, and lack of access to transportation
- Access for people who are homebound or reside in congregate care settings
- Access to technology for scheduling, accessibility and proving eligibility
What we are working on:
Community-based strategies: Building on lessons from our efforts to ensure access to COVID-19 testing, our vaccination plan includes working with local partners to identify vaccination sites in vulnerable neighborhoods. Our plans involve working with local partners like pharmacies, community clinic sites, and vendors willing to establish mobile neighborhood-focused locations. In addition, our Mobile Health Van and Street and Field Medical Teams actively engage our homeless and farmworker population for vaccination.
Congregate care strategies: Older and disabled adults living in congregate care facilities of all types have been among those San Mateo County residents most impacted by the pandemic. The federal Centers for Disease Control has contracted with Walgreens and CVS to provide on-site vaccination for the majority of long-term care facilities. This program is well underway in San Mateo County, and County Health has arranged with Safeway Pharmacy to help this effort in our community.
High-volume countywide strategies: In order to reach our goal to vaccinate 90% of adult San Mateo County residents (557,100 people) by the end of June 2021 with two doses of a vaccine, we will need 185,700 vaccinations per month, or more than 6,190 per day. To meet this ambitious goal, all health care systems and pharmacies in San Mateo County will need to pull out all the stops.
We expect to need at least one mass vaccination site that can vaccinate thousands of people each day. While large vaccination sites will not be right for everyone, one or more sites will greatly expedite our progress in vaccinating residents. The County organized pilot events at San Mateo County Event Center in January that demonstrated what is possible, and large systems (Sutter/PAMF and Kaiser) are actively pursuing mass vaccination sites to serve their patients/members. We hope to be able to allow patients of smaller systems to these mass vaccination options. We are exploring arrangements with other entities to create this capacity.
Accessibility to registration and appointment-setting: Many members of our community lack access to internet connectivity and/or devices, cannot use online systems that are not offered in their language, experience challenges navigating web resources, and/or are not comfortable sharing personal information online. The County prioritizes access and will work to make registration to any County-led vaccination process as easy as possible to navigate, require the least personal information and documentation necessary, be available in languages other than English, and offer alternatives to online registration where possible.
How we will know how we are doing:
|# of alternatives to online vaccine registration methods supported by the County||2-3||3|
|# of community-based vaccination strategies as alternatives to high-volume sites||3||3|
Please see our vaccine related data dashboards here