With All Eyes on COVID Vaccination Rates, Funders Nationwide Battle Hesitancy and Inequity
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Vaccination site in covina, california. Ringo Chiu/shutterstock
Late last year, when the COVID-19 vaccine rollout was just beginning, the term “vaccine hesitancy” wasn’t a big part of the mainstream conversation. People were worried about supply, distribution and the challenges of freezing the Pfizer vaccine. Local governments made plans for vaccination priority groups, and early efforts to promote equity focused on getting the vaccine to essential workers and populations most impacted by the pandemic.
But in the philanthropic community, many funders anticipated the problem of vaccine hesitancy in the United States, and recognized that vaccination equity was a multilayered, complex problem that wasn’t just about access to clinics, transportation, information and broadband, but also lack of trust in the government and the healthcare system. In Chicago, a group of funders that included the Chicago Community Trust, the Joyce Foundation and the United Way had been working together on community access to COVID-19 treatment and testing in collaboration with the City of Chicago. With that program up and running, in the late summer of 2020, the group reconvened to talk about the vaccine.
“We started to build this coalition of people that met every Tuesday at noon to discuss what we were learning about vaccines,” says Gayla Brockman, CEO of the Michael Reese Health Trust. “We knew some people would be resistant, and we knew there would be access problems in Black, brown, and Indigenous communities, including many who are essential workers.”
The growing coalition contacted the state of Illinois about their plans, and soon enough, a group of private funders, city and state officials, and leaders of community-based organizations (CBOs) were all attending the Tuesday meetings. They decided to raise money around vaccine outreach, with the intent to fund hyperlocal organizations that wouldn’t necessarily have the infrastructure to apply for the big public dollars that everyone assumed were forthcoming from the Biden administration.
Today, this group forms the basis of the Chicagoland Vaccination Partnership, which is incubated at Michael Reese Health Trust, managed by Partners in Health, and supported by funders ranging from national legacy foundations like the Rockefeller Foundation to Chicago-based foundations like the Polk Bros. Foundation. The partnership has raised over $3 million and is growing.
The Chicagoland effort is managed by the U.S. Public Health Accompaniment Unit, a new grant program launched last year by Partners in Health, a Boston-based international healthcare nonprofit. The new program came together in 2020 with an initial seed investment from the Audacious Project, a funding initiative housed by the organization behind TED Talks. With the new program, Partners in Health is applying its decades of experience in international public health to battle COVID within the United States.
The Chicagoland Vaccination Partnership is also a founding member of the Biden administration’s COVID-19 Community Corp, which has enabled a higher level of coordination with public health initiatives at the state and county levels. The partnership’s Tuesday meetings are still in session, and they often include representatives from philanthropy as well as healthcare, academia, community-based organizations (CBOs), health departments and faith-based organizations.
Max Clermont, the senior project lead at Partners in Health’s U.S. Accompaniment Unit, says that with these diverse public-private partnerships, Partners in Health hopes to “expand the definition of public health work among funders to include CBOs that are trusted by their communities, but not traditionally thought of as public health organizations.” As an example, he describes a Chicago grantee that runs a food pantry and youth boxing program. The organization is now using its presence in the community to help administer vaccinations and provide vaccine information. “This model can be expanded beyond COVID-19 to connect people with a wider set of public health resources,” Clermont says.
Coalitions and partnerships, with public health funders at the helm
Data from the CDC suggests that the vast majority of COVID deaths and hospitalizations are now among the unvaccinated, yet recent polling shows that 41% of Republicans and 25% of 18- to 39-year-olds say that they probably or definitely don’t plan to get vaccinated. Vaccination rates have plateaued or declined among certain populations, and the total U.S. vaccination rate has fallen behind other developed countries.
As vaccination becomes increasingly essential in winning the larger fight against COVID, funders are preparing for long-haul coalition work. The story of the Chicagoland Vaccination Partnership is emblematic of the types of coalitions that have popped up all over the country: Community-focused foundations with experience in public health philanthropy are acting as hubs for rapidly growing coalitions composed of both private- and public-sector participants.
In Houston, that hub is the Episcopal Health Foundation (EHF), which has $1.3 billion in assets and strong ties with both national foundations and community-based healthcare organizations throughout the state. According to Elena Marks, president and CEO of EHF, conversations among healthcare grantmakers turned to vaccines at the end of 2020.
“We knew there would be a lot of money out there from the government and from health systems,” she says, “but we were concerned about the groups who would not be reached or persuaded by the government or the healthcare delivery system, and how to get to this population. So we set up a fund.”
This fund became the Your Shot Texas campaign, a state-wide effort to provide grant dollars to “outreach efforts and activities that may not qualify for public resources but offer a promising approach at increasing vaccine confidence and uptake.” Your Shot Texas has raised over $2 million to date from EHF, Methodist Healthcare Ministries, the Meadows Foundation, Arnold Ventures and several other private funders and foundations. It is administered by the Greater Houston Community Foundation.
“We managed to bring lots of funders together to do something big and quick and impactful,” Marks says. “This is one of the things that philanthropy is good at, if we want to be.” According to Marks, the philanthropic community in Texas was better-equipped to meet the COVID vaccination challenge thanks to work they’d already put into building coalitions to reach Texan communities during the 2020 Census, as well as community-based efforts related to Hurricane Harvey recovery in 2017.
In California, Together Toward Health follows a similar model, with a veteran healthcare nonprofit—in this case, the Public Health Institute—administering a pooled fund that provides rapid, flexible grants to hyper-local community organizations throughout the state. The program started in 2020 with a broad COVID response mandate, and in 2021, the primary focus has become vaccination. The coalition has raised over $30 million from 18 funders, including The California Endowment, the Blue Shield of California Foundation and the Ballmer Group.
Mary Pittman, president and CEO at the Public Health Institute, says that a colleague at The California Endowment contacted her about providing fiscal sponsorship and operational support for the emerging coalition. The funders understood the importance of the institute’s long-standing relationships with both public health officials and community-based organizations. Similar to the efforts in Texas and Chicago, Pittman says that Together Toward Health focuses its grantmaking on “CBOs that are not generally eligible for grants because of their size,” and working within “the communities most impacted by the pandemic.”
Philanthropic coalitions are following this hyper-local approach to vaccination outreach across the United States, often with support from an assortment of local funders and national foundations. In Washington, All In WA’s Vaccine Equity Initiative is a public-private partnership supported by larger foundations, such as the Bill & Melinda Gates Foundation, as well as individual donors and corporations, like Starbucks, that are based in Washington.
A number of national foundations are emerging as resources for these state- and city-based efforts. The Rockefeller Foundation’s Equity-First Vaccination Initiative launched in April with a $20 million commitment to improve vaccination rates in communities of color that have been disproportionately impacted by the pandemic. The Robert Wood Johnson Foundation has committed over $10 million to grants related to vaccination equity and uptake in the U.S., and the W.K. Kellogg Foundation is funding a variety of equitable vaccination efforts in cities across the country.
Many of the mega-grants related to vaccines are focused less on the United States and more on vaccination distribution efforts in the international context. This includes the Bill & Melinda Gates Foundation’s $50 million grant to GAVI, the Vaccine Alliance, Google’s $150 million commitment to vaccination distribution and education programs, and the Mastercard Foundation’s $1.3 billion deployment to support vaccination efforts in Africa.
With ample federal funding, philanthropy plays a unique role
In March, the Biden administration committed $10 billion to expanding access to vaccines and increasing vaccine confidence. Much of this funding goes directly to state and county governments, health departments, pharmacies and healthcare providers. The plan includes a $3 billion investment in the COVID-19 Community Corps, which partners with trusted messengers and community organizations.
With this influx, philanthropic funders were given some breathing room. They could now strategically focus attention on areas where government funding would be less impactful. The Your Shot Texas campaign, for example, isn’t providing grants to health clinics because they are already receiving federal funds. “And there are people who aren’t trusting of the health system, so it wouldn’t do any good if a healthcare person is reaching out to them,” Marks says.
Historically a weakness for the sector, in recent years, philanthropy has placed a larger focus on partnering with community-based organizations that provide essential services to historically underserved populations. A set of funders honed this ability during their efforts to engage communities in the latest U.S. Census, among other recent engagements. The philanthropic sector thus has a unique opportunity to partner with the “trusted messengers” that the Biden administration repeatedly cites as the best strategy for achieving vaccination equity.
“Even the most well-intentioned approaches to increase access to COVID-19 vaccines can encounter unexpected challenges if they are not generated by the community, for the community,” Estelle Willie, the director of Health Policy and Communications at the Rockefeller Foundation, explained in an email to Inside Philanthropy. Community partners understand what works best in their own community. Financial incentives, for example, work great in some populations, but backfire in others. Community-based organizations are able to gauge more sensitively whether it’s access problems, trust problems, or both driving low vaccination rates within a particular community.
“For many people, the driving factor isn’t reluctance, it’s about access,” Willie says, adding that this is especially true among people of color. An April survey that Rockefeller co-funded found that among people of color, 72% said that they wanted the vaccine, but 63% said they weren’t sure how to get it.
The Sierra Health Foundation, a long-standing Sacramento-based philanthropy, is one of the funders of the Together Toward Health partnership in California. Chet Hewitt, Sierra’s CEO, says that collaborative philanthropy’s ability to leverage its relationships with smaller community-based organizations and connect them with public health efforts has been “incredibly helpful” to the U.S. COVID response. CBOs and trusted messengers speak the language of the community (often literally), are culturally competent, and might employ different tactics than the typical public health toolkit.
“Many of these partnerships were ramped up when we knew we had to get people counted [for the U.S. Census],” Hewitt says. “We had some families who maybe lived in a garage. Who might be more reticent to show up in a public place. Who might not have the ability to sign online.” Now that these same people require outreach for vaccination efforts, partnerships with CBOs and community leaders are already in place.
Another area where philanthropy plays a critical role is research and information sharing. The Rockefeller Foundation committed $13.5 million to “data-driven public health interventions’’ to combat misinformation and disinformation, particularly vis-a-vis vaccines. Another collaborative research effort, the Covid States Project, supports research into COVID and social behaviors at Harvard Medical School, Northwestern and other universities. The project is funded by the Knight Foundation, the Russell Sage Foundation and the Peter G. Peterson Foundation in collaboration with the National Science Foundation. The project’s most recent report found that public support for vaccine mandates has grown across “nearly all partisan and demographic subgroups.”
Corporations including Microsoft, Google and Pfizer are likewise funding research into vaccination uptake and equitable access. In June, Facebook and Merck pledged $20 million apiece to the Alliance for Advancing Health Online, a joint partnership with the CDC Foundation, the World Bank and the World Health Organization to provide research into using “behavioral science, social media and digital platforms to build confidence in and access to vaccines.”
Dr. Julie Morita, executive vice president at the Robert Wood Johnson Foundation, says that with ample federal funding for COVID vaccination equity, philanthropy has turned its attention to research and assessment rather than only scrambling to address immediate healthcare needs, as was the case in 2020. Moving forward, she believes philanthropy will play an important role in improving research into public health inequities in general, as well as efforts to better prepare for future public health crises.
“We can see that public health data was sorely lacking [at the beginning of the pandemic],” Morita says. “Even just the fact that we didn’t know who was sick by race, ethnicity, geography.” In terms of vaccination, Morita says that researching misinformation and figuring out which pro-vaccination messages work, and in which communities, is becoming a core funding focus within the philanthropic community.
In general, Morita says that with the vaccination push, the public-private partnerships between health officials and the private sector have been “truly remarkable.” Morita has special insight here—before her foundation work, she led the Chicago Department of Public Health as its commissioner.
“With the national foundations as well as the community foundations engaging with public health responses, and with the current federal administration really seeking out the philanthropic sector to address this challenge, it really has been unprecedented,” she said
The open lines of communication between philanthropic funders and public officials means that everyone knows what everyone else is doing, so philanthropists can assess where the gaps are. According to Morita, many did not fully anticipate the problem of low vaccination rates among political conservatives and white Evangelical Christians. But thanks to Biden administration efforts, there is funding for state and local organizations to reach this population. At the same time, efforts to increase vaccination rates among conservative populations are guided by new research—funded, in part, by the philanthropic sector—into the spread of misinformation.
Several funders that spoke with Inside Philanthropy believe that the public health challenges experienced during COVID reveal the deep inequities of the U.S. healthcare system, and also underscore the importance of community inclusion and engagement in the search for solutions.
“Clearly the public health infrastructure in this country really needs to be rebuilt,” says Hewitt, of the Sierra Health Foundation. “And I think it’s important to understand that these issues around [vaccination] equity and hesitancy are not over.”
