Health and Housing in St. Louis

Intra-Governmental Partnerships to Reach City of St. Louis Housing Authority Residents

In St. Louis, like in many places across the U.S., low-income communities and communities of color have disproportionately shouldered the burden of COVID-19 sickness and death and now face inequities in COVID-19 vaccination efforts. Data from a January 2021 survey revealed that of 17,000 individuals who registered their interest in receiving the COVID-19 vaccine, less than 3,000 were from under-resourced and low-income neighborhoods such as North St. Louis.

Leaders like Dr. Fredrick Echols with the City of St. Louis Department of Health were determined to demonstrate the need to proactively engage and outreach to communities most disproportionately impacted by the COVID-19 pandemic. Dr. Echols has also worked to counter dominant narratives of vaccine hesitancy among communities of color, especially Black communities. With the strategic engagement of the Alana Green, Executive Director of the St. Louis Housing Authority, and staff from their Resident Initiatives Team, they were able to reach Housing Authority residents by phone and assist them in setting up appointments to receive their COVID-19 vaccine. Engaging the Housing Authority as a trusted partner and messenger for this community resulted in the ability to vaccinate over 300 seniors in just one clinic effort,  roughly 98% of whom identified as Black/African American! An invite only follow-up vaccination clinic with Housing Authority residents resulted in a 96.3% return ratefor the second dose of COVID vaccinations. The partnership between the Health Department and Housing Authority has yielded other promising benefits to housing authority residents, including food distribution, distribution of personal protective equipment, COVID-19 testing and now the COVID-19 vaccine. This partnership serves as a promising model for intra-governmental partnerships to reach disproportionately impacted community members in vaccine distribution and administration.

Key Partners

  • Dr. Fredrick Echols, Director, City of St. Louis Department of Health
  • Alana Green, Executive Director, St. Louis Housing Authority

Key Funding Mechanisms

  • In-kind staffing support from the St. Louis Housing Authority


  • The Emergency Preparedness program conducted a site survey to map out the area and plan for site flow and to address any mobility issues. There was a specific focus on making the space conducive for older individuals and ensuring that everyone received a quality experience.
  • The departments worked to increase access and remove potential barriers by only using the first floor of facilities and avoiding stairwells and elevators; partners worked closely with transportation providers to shuttle people to the event.
  • Department leaders acknowledge past injustices and harms perpetrated by hospitals and healthcare over decades to create strong foundations of trust with the community.
  • The Housing Authority’s strong relationship with tenants, cultivated over time through engagement with their Elderly and Disabled Coordinator and their Resident Initiatives Team, increased receptiveness and responsiveness from tenants.
  • All Health Department staff undergo mandatory sensitivity, awareness, and anti-racism training through the People’s Institute, in order to understand how they can change systems and trajectories in their own roles.
  • Representation matters. It was important for residents to see themselves reflected and represented in the staff and leadership present and administering vaccines during the vaccine clinic.
  • Partnering with community-based organizations (CBOs) such as International Institute and Casa de Salud to reach out to non-English speaking and immigrant communities is an important strategy for ongoing efforts to advance equity in vaccine distribution.
  • The Housing Authority will continue to support senior clients by helping their residents register online and answer questions over the phone. The department also plans to disseminate vaccine education information through partner tenant associations.
  • The Health Department is working with systems level partners to identify uninsured individuals that are diagnosed or need to be quarantined and connecting them with a medical partner.

Key Takeaways

  • Government agencies can serve as trusted messengers and partners if staff and leadership have worked to develop ongoing, trusted relationships with the communities they serve.
  • Engaging staff that have frequent interactions and have built trusted relationships with tenants, opened doors to communicating and working with community members and housing authority clients.
  • Leadership that is reflective of the communities being served, can also help to build trust and increase vaccine acceptance.
  • Data can be used to inform and motivate elected leaders to embrace an equitable response to COVID-19 vaccine distribution.
  • Providing equity training to all staff can prepare a department for rapid racial equity responses with an eye toward long-term systemic and policy changes; in St. Louis, Health Department staff received racial equity training from the People’s Institute to better prepare the department to advance equity internally and in partnership with the communities they serve.