PHILADELPHIA— On Dec. 16, 2020, the future brightened an hour before the sun rose at Pennsylvania Hospital. At 6:15 a.m., Eric Young, RN, BSN, an emergency department nurse, received the first-ever dose of the COVID-19 vaccine administered by Penn Medicine. That moment set off a cascade of more than 350,000 COVID-19 shots over the last year, with 200,000 administered in Philadelphia itself, providing a welcomed measure of security to Philadelphia residents, even as the threat of the coronavirus and its variants remain.
The two mRNA vaccines are built on technology developed by Penn Medicine scientists, an effort which has been honored with numerous global prizes. The year's vaccine deployment efforts link Penn Medicine's discovery science to community outreach.
"Our primary mission has been getting shots into as many arms as possible to protect our workforce and our community, and we built infrastructure to keep equitable distribution at the center of the effort," said University of Pennsylvania Health System CEO Kevin B. Mahoney. "We've known that the virus has struck hardest in communities of color, so we have focused on giving everyone the opportunity to protect themselves, their loved ones, and their neighbors. It has been a core tenet of our outreach from the beginning and remains critical as we move forward."
Twelve months into the vaccination effort, the focus on health equity has led to tangible results, as Penn Medicine distributed more vaccine doses in Philadelphia than any other health system or nonprofit, with its ratios of vaccinations close to the city's racial and ethnic make-up. Roughly one in 20 people vaccinated in Philadelphia received their shot from a Penn Medicine provider.
"Before the first dose was even available, we were planning to address inequities that plagued the COVID response around the country," said PJ Brennan, MD, chief medical officer of the University of Pennsylvania Health System. "It started with improving access and communication within our workforce, then quickly moved into reaching our communities in ways that reduced barriers to vaccination. As proud as we are of the past year, our commitment has to stay strong as we enter the second year of vaccination amid new worries about virus transmission."
In a city where Black residents had the highest rates of infection, hospitalization, and death, Penn Medicine's work provides insight for pursuing vaccine equity. Of the vaccines administered in Philadelphia so far by Penn Medicine, 38 percent (roughly 77,000 doses) went to Black patients. And according to city figures, 42 percent of all shots administered to Black patients in Philadelphia came from Penn Medicine. Just one entity, a commercial pharmacy, provided more. Penn Medicine also provided more than 12,000 shots to the city's Asian-American residents, a number just behind a collection of commercial pharmacies and FEMA's centralized mass-vaccine operation.
The Playbook
After hosting its first community vaccine clinic in mid-February 2021 at a church in West Philadelphia, Penn Medicine stood up dozens more at schools, recreation centers, and even professional sporting events. It followed a playbook for equity that leaders at Penn Medicine developed and published in NEJM Catalyst in hopes of providing tools to other health systems and communities, chiefly "meeting people where they are" with the vaccine instead of employing a single, static vaccination site that might be difficult for some to reach. Additionally, clinic sign-ups followed a "low/no-tech" approach, leaning on text messaging and traditional phone banking to ensure those without internet access or who had language barriers were easily able to obtain appointments.
All the while, Penn Medicine worked closely with local, trusted community leaders and "super-referrers" to help improve vaccine uptake, a challenge amid distrust of health care sowed by historic abuses of racial and ethnic groups, as well as sustained online disinformation during the pandemic. A team of canvassers also went door-to-door to answer questions, bust myths and encourage clinic signups.
Suburban and Rural Reach
Similar efforts have rippled across Penn Medicine's entire service area. Combined, Lancaster General Health, Chester County Hospital, and Princeton Health have distributed almost 160,000 COVID vaccine doses in their communities. Lancaster General Health also spearheaded a coalition that included other health systems and the county government to host a mass vaccination clinic, Vaccinate Lancaster, at a shopping mall. Through that effort, an additional 238,000 doses were administered, including nearly 10,000 doses to Black patients and 24,000 to Latinx patients.
Community partnerships made an impact, one event at a time. A Chester County Hospital-staffed clinic at Tabernacle Baptist Church, for instance, vaccinated 320 people, and another 200 individuals got shots at a food distribution site serving Hispanic migrant farmers in the area's mushroom farms. At Penn Medicine Princeton Health in New Jersey, outreach conducted with local municipalities, food pantries and other non-profits provided more opportunities for underserved individuals to be vaccinated.
The Challenge Ahead
With cases of the virus surging again, especially in areas with low vaccination rates, leaders are looking to yet more creative approaches. Among the new strategies employed by Penn Medicine is a transition from mass clinics in the early part of 2021 to smaller, hyper-local clinics held everywhere from fast food restaurants to the parking lot of a hardware store. These clinics can potentially vaccinate more than 1,000 people but also chip away at the area's unvaccinated population by giving shots to even just a handful of people at a time. Staffed by members of Penn Medicine's department of Family Medicine and Community Health, the clinics and their supplies are portable enough to be transported by just a single SUV or van.
"This phase of the vaccination campaign is a marathon, not a sprint," said Heather Klusaritz, PhD, director of Community Health Services for the Penn Medicine Center for Health Equity Advancement. "Increasing vaccination takes a continuous presence in the community. Answering questions, providing support, and making ourselves available is critical to helping those who have not yet been vaccinated feel comfortable saying yes to a vaccine."
With vaccines now approved for children 5 and up, the health system has re-centered its efforts on vaccinating youth, including school-based clinics, especially in underserved areas. To date, Penn Medicine has hosted clinics at 21 different schools across Philadelphia, including one that administered roughly 800 shots. Lancaster General Health hosted a series of clinics this fall specifically for newly eligible elementary school-aged children, building on an ongoing clinic partnership for clinics with the School District of Lancaster. And Princeton Health staff have visited 17 different schools across three New Jersey counties to vaccinate K-12 students.
"We continue to engage with our communities about the critical importance of vaccination and to increase vaccination rates for the safety and protection of all of us," said Michael Ripchinski, MD, chief clinical officer of Lancaster General Health. "The recent rise in cases is yet another reminder of the importance of taking simple, proven precautions: Wear a mask, social distance and wash your hands, avoid large gatherings, and, most of all, please get vaccinated, or a booster if you qualify, to protect you and your loved ones."
