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Heart of San Joaquin Valley Defines Vaccination Successes for Communities Disproportionately Impacted by COVID-19

Fresno County provides key lessons in bringing vaccines to hard-to-reach areas

Even as state and local health officials race to provide COVID-19 vaccines to as many Californians as possible, one of the key challenges has been making life-saving doses available to less healthy communities, which too often have been disproportionately impacted by the pandemic.

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That’s why health officials have decided to direct more vaccines to Californians in those communities – sending 40% of available vaccines to people living in the Healthy Places Index Quartile 1 (HPIQ1), a subset of the population described as having the lowest household incomes and the poorest health outcomes in the state.

This is especially important in Fresno County where more than 70% of the population is living in HPIQ1. 

While Fresno County encompasses large, sprawling rural areas with unique populations that are at high risk and hardest hit by the pandemic, health officials have seen significant success in making COVID-19 vaccines available especially to its vulnerable residents. By mid-April, the county vaccinated 34% of the population. In their HPIQ1 areas, vaccination rates range from the high 30% to 50% – a remarkable feat considering the challenges that Fresno County faces. 

“The San Joaquin Valley is a unique region with very specific needs so we’ve taken strategic steps to engage those important stakeholders to reach those communities that have been hardest hit by this public health crisis,” said David Luchini, Interim Director of Fresno County Department of Public Health.

The key to their success was learned from the great vaccination rates achieved with employer-led clinics in the food and agriculture industry across the region. Efforts such as bringing small scale vaccine sites to specific groups of people; having 1:1 conversations with trusted community representatives and peers; and education campaigns have all been critical to helping to increase vaccinations.

Less is More

Instead of only focusing on vaccination clinics serving 1,000 or even 500 doses each day, Fresno County is mobilizing smaller teams to reach people living in HPIQ1 communities and creating micro “pop up” clinics offering just 100 doses or less. This approach allows staff to have meaningful conversations with smaller groups and ultimately get more people vaccinated.


“We are working with nearly two dozen community benefit organizations every day, respectfully listening to the needs and the perspectives of community advocates who are on the ground serving these communities year-round,” said Luchini.

Through the Fresno County COVID equity project, the county has worked closely with the local African American Coalition, Disability Equity Project and Immigrant Refugee Coalition to employ members of the communities it seeks to reach through education and outreach about COVID-19. The effort recognizes that this critical public health information is going to be best received by hesitant populations from peers they can relate to and connect with in their own communities. Not only has this led to more vaccinations, but it has also led to meaningful employment for members of the community who otherwise may not have had job opportunities during the pandemic. 

As health officials face as much as 30% of the population with some level of hesitancy to obtaining the vaccine, approaches like those seen in Fresno County will become increasingly important to reaching herd immunity. 

California officials, with the support of the state’s third-party administrator Blue Shield of California, are also supporting this important effort as the state makes more financial resources available to ensure COVID-19 vaccines are made available especially in areas hardest hit by the pandemic.

“This experience working with community-based organizations on COVID-19 is only the first step in continuing long-term collaborations with these organizations on health literacy, upstream public health issues, prevention (and) wellness in communities and neighborhoods that have been negatively impacted by health issues,” said Luchini.