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149. Turning the Hospital Inside Out: Expanding Access to COVID-19 Vaccinations for Underserved Adolescents Using Mobile Outreach

      Purpose

      There exist clear disparities in COVID-19 vaccination rates for adolescents and young adults in Massachusetts and across the United States. Massachusetts Department of Public Health data demonstrates that where social vulnerability is high in our communities, COVID vaccination rates for adolescents and young adults staggers. With community engagement as the backbone, we implemented a low-barrier, mobile walk-in COVID-19 vaccination unit using a community health van in the greater Boston area from May 2021 to present to help address disparities in vaccination for this vulnerable population.

      Methods

      From May 20, 2021 to August 18, 2021, using a double equity model, we situated the mobile COVID-19 vaccination unit in Chelsea, Everett, Revere, all communities with high social vulnerability index and a disproportionately high burden of COVID-19 illness. We chose sites in concert with local partners based on the volume of foot traffic and proximity to public parks, beaches, and community-based services that attract adolescent and young adult populations. Our mobile clinic was run at youth events and community run sports programs. Publicity around the vaccination efforts was youth focused. Community partners who had long standing relationships and partnerships with youth in the area helped guide our efforts. We collected demographic and clinical data for mobile vaccination services, including participant age, sex, race/ethnicity, insurance status, and zip code. We use participant zip code to estimate median salary and social vulnerability index. We used the online Massachusetts Department of Public Health COVID-19 Vaccination Dashboard (link) as the data source on the general vaccinated population in Massachusetts as well as to assess disparities in adolescent vaccination rates. We report continuous variables as median (interquartile ranges) and categorical variables as frequencies (percentages). We use Wilcoxon rank sum testing to compare the sociodemographic characteristics of persons vaccinated through the mobile COVID-19 vaccination unit with the general vaccinated population in the three target cities and in the general vaccinated population in Massachusetts.

      Results

      From May 20, 2021, to August 18, 2021, the mobile MGH Kraft COVID-19 vaccination unit administered 937 doses of Pfizer vaccine. About ninety percent of participants returned to complete their second dose. The median (IQR) age of participants were 20 (14- 40) years, 477 (51%) were males, 768 (82%) were non-white, and 580 (62%) were Hispanic.

      Conclusions

      A mobile COVID-19 vaccination unit, implemented with community and stakeholder engagement and support, has the potential to improve vaccine access among racial/ethnic adolescent minorities and medically underserved adolescent populations. Compared to the overall population of the target cities, participants in the mobile vaccination unit were younger, more likely to be male, and more likely to have non-commercial insurance. Compared to the remainder of the vaccinated population of Massachusetts, participants in the mobile vaccination unit were younger and more likely to be male, non-white, and covered with non-commercial insurance. This prototypical model shows that when you bring services to the community, meet adolescents where they are, literally, you decrease so many barriers and increase equity.

      Sources of Support

      NIH Rapid Acceleration of Diagnostics grant, Mass General Brigham, Mass General Hospital Kraft Center for Community Health.