"Placing community in the driver's seat": Key strategies and critical enablers of an equitable place-based COVID-19 vaccination response.

Abstract

Addressing health inequities requires both national and local-level action. In the case of COVID-19, locally-led place-based programs were instrumental in addressing vaccination inequities that resulted from implementation gaps in national and state-level universal COVID-19 vaccination programs. To prepare for future pandemics, understanding which local strategies are effective and the conditions that enable their effectiveness is crucial. We conducted a case study using qualitative interviews (n = 22) and document analysis to identify key strategies employed to increase vaccination uptake among priority populations in a regional community in Victoria, Australia, and the conditions perceived to enable or constrain the success of those strategies. Interviewees included Aboriginal and migrant community members (n = 12) and representatives from organisations that designed and implemented the COVID-19 vaccination program (n = 10). Strategies perceived to be effective by local migrant and Aboriginal communities included the location of outreach clinics (places considered physically, cultural and political accessible and safe), communication via trusted community leaders, practical supports such as translation services and transport, and empowering community in clinical interactions. Conditions perceived to influence program implementation and outcomes related to four themes: (i) shared vision and strong bonds of local partners, (ii) placing community in the driver's seat, (iii) rebalancing power through leadership grit and guts, and (iv) equity-enabling service and funding models. Our study supports strengthening of national and state government investment and engagement with local partnerships to place equity and community at the centre of future pandemic and public health responses.