What Are Foundations Doing To Help Understand And Diminish The Barriers To People Getting Available COVID-19 Vaccines?

The widespread demand for the COVID-19 vaccine in the United States was widely anticipated. And appointment systems have been overwhelmed, and long lines have been seen at many mass vaccination sites around the country. Although the first vaccine was administered in mid-December 2020, by April 4, only 18.5 percent of US residents had been fully vaccinated, with wide variations across states.

The slow roll-out for the COVID-19 vaccine in many places has various explanations—not the least of which is confusion about when and how to access the vaccine. Significant but less visible barriers include concerns about the efficacy of the vaccine, distrust of media sources, and fear connected to historic patterns of racism related to medical experimentation. These are often being captured under the umbrella term of “vaccine hesitancy.”

Starting in December 2020, the Kaiser Family Foundation COVID-19 Vaccine Monitor project has issued reports on the willingness of people to receive the COVID-19 vaccine if it is available. While the overall number of vaccine-hesitant people declined over the first months of reporting, the percentage of rural residents who say that they will definitely not get a vaccine has remained relatively constant: as of April 9, 2021, the percentage was 20 percent.


In fall 2020, Missouri Foundation for Health supported data gathering to better understand Missourians’ feelings and perceptions about the anticipated COVID-19 vaccines. Data were collected statewide and focused on rural residents, including rural Black and Hispanic adults. The results, released in March 2021, highlighted the concerns of Black and Hispanic participants around the rapidity of vaccine development, access (that is, where will they get it?), and conflicting information coming from many official and unofficial information sources. Effective messaging by community and health leaders should focus on the need to get “back to normal,” to protect one’s family, and to provide protection for the whole community.


March 2021 also marked the release of the first request for proposals (RFP) from the Colorado funders supporting the Together We Protect—Colorado’s COVID-19 Vaccine Equity Fund. Foundations participating in the fund include Caring for Colorado Foundation, the Colorado Health Foundation, Community First Foundation, Delta Dental of Colorado Foundation, El Pomar Foundation, the Denver Foundation, the Vera and Joseph Dresner Foundation, Kaiser Permanente, the Latino Community Foundation of Colorado, Next50 Initiative, Rocky Mountain Health Foundation, and Rose Community Foundation. When the RFP was released in March, $3 million had been pledged with an intent to raise additional funds for at least a second round of grant making (deadline for submitting proposals for the second round is April 28, 2021). The Colorado Vaccine Equity Task Force, made up of community advocates and health care professionals from around the state, is responsible for the funding decisions.

Colleen Church, chief strategy officer and vice president of philanthropy at Caring for Colorado Foundation, indicated that while establishment of the fund came quickly in January and February 2021, Colorado funders were showing interest in focusing on the vaccine needs of those facing structural and information barriers well before that. “This effort came together very quickly to respond to an urgent community imperative to ensure equitable access to COVID-19 vaccines,” she told me in a telephone call. And “the funder group is committed to the long game, so the Fund will adapt over time to emerging needs.” Church added, “While categories for grant funding are broadly defined to allow for local innovation, it’s anticipated that the Fund will support on-the-ground strategies like community health workers, transportation, and technology support, as well as locally tailored outreach campaigns as examples.” Rural Colorado will definitely be a focus.

Washington State

At the same time, a group of funders in Washington State, along with corporate supporters and individual donors, under the umbrella of All In WA, have started the All In WA Vaccine Equity Initiative, which raised $15 million (and leveraged an additional $15 million in federal funding) initially for grant making to community-based organizations focused on immigrants, farmworkers, meat-packing plant employees, and people of color. The funds are initially supporting enhanced registration systems, transportation to vaccine clinics, and mobile and pop-up clinic sites.

New York City Area

In April 2021 the New York Community Trust approved $1 million in grants to counter misinformation, to use science-based messaging to encourage people to get vaccinated, and to improve access. For example, the trust funded efforts to determine specific community concerns about vaccine safety and the creation of customized vaccine advocacy campaigns for hard-to-reach populations, such as immigrants, people experiencing homelessness, and people who were formerly incarcerated.


The I Got the Shot campaign is a partnership of the Foundation for a Healthy Kentucky and the Kentucky Nurses Association to respond to concerns voiced by Black populations about getting a COVID-19 vaccine. To develop the campaign, the foundation created an advisory group of community representatives to discuss cultural sensitivities and appropriate messaging. One advisory group member, Vivian Lasley-Bibbs, served in two capacities: as foundation board chair and as director of the Office of Health Equity in the Kentucky Department for Public Health.

This statewide foundation is now encouraging partners throughout the commonwealth to share campaign materials and tailor them to their own use. For example, a weekend anchor for WPSD-TV in Paducah, Kentucky, who is Black, filmed her own response to a question for the campaign, and the station is now airing that as a public service announcement along with the videos shared by the Foundation for a Healthy Kentucky.

Ben Chandler, president and CEO, Foundation for a Healthy Kentucky, commented in an e-mail:

If your experience with health care hasn’t always proven to be helpful to you and your loved ones, you’re naturally going to have concerns about the Covid-19 vaccines. Health advocates can’t just brush these concerns aside. People need answers. The spokespersons in this campaign are trusted messengers in their communities who are helping to provide those answers.


While the groups of people who are vaccine hesitant, vaccine resistant, or just needing support to help them get immunized have been long anticipated, funder response has been relatively slow. Part of the complexity for funders is the lack of ready-made funding models and a paucity of relationships with the kinds of community advocacy groups that can easily mobilize some of the populations most likely to be missed in the COVID-19 vaccine campaigns. Recent discussions have begun to focus on emulating successful efforts for mobilizing US Census response and Affordable Care Act enrollment. Unfortunately, it may be well into the summer of 2021 before we know which tactics appear to be showing promise.

This article originally appeared on the Health Affairs blog in April 2021
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