True Community Leaders Often Feel Dismissed By Federal Grants

Another day, another outbreak: after years of battling COVID-19, we now have new targets in the fight against vaccine-preventable diseases. Thirty years after we eradicated wild polio cases in the U.S., a new case emerged in an unvaccinated individual in July. And this year’s monkeypox outbreak is the largest in US history, growing from case counts in the single digits back in May to nearly 19,000 today.

Polio’s reemergence and the proliferation of monkeypox across the US have ushered in a shift in federal officials’ view of public health. Though they pledge to fight each new challenge with urgency, years of underfunding our public health infrastructure have left us, as a nation, woefully unprepared to fight new disease outbreaks.

Beyond the physical infrastructure of vaccine distribution and tracking, our infrastructure is lacking a key component: a culture of immunization.

Each community has its own culture, and no one knows that better than the community-based organizations (CBOs) that serve them. CBOs held up their communities through each wave of COVID-19, with little to no money. When COVID hit, they were the trusted messengers who successfully encouraged PPE, social distancing, and vaccinations once they were available. CBOs were the most effective messengers because they are the groups and individuals who have been listening to their communities for years: working tirelessly to address their challenges and needs and scraping together solutions for their most pressing issues.

CBOs’ status as trusted entities is particularly noteworthy at a time when institutional distrust is deeply entrenched in many communities. Ideally, that distinction would make them a partner of choice for public health efforts aimed at building vaccine confidence, making them eligible for funding opportunities with the potential to make huge impacts in turning the tide of vaccine hesitancy.

Unfortunately, that is not the case – many grant opportunities remain out of reach for small and even mid-sized CBOs. Funding remains scarce and heavily stipulated. Effective grant writing is as much an art as a science, and many smaller nonprofits lack the administrative support and experience to compete for federal grants despite their outsized impact on local issues. The reimbursement model utilized by many grant programs often leaves smaller CBOs at a huge disadvantage. They don’t have the capacity to front time and money that won’t be repaid for several months, and they shouldn’t be expected to. Cumbersome reporting requirements are too complex and time-consuming for small nonprofit staff.

Additionally, federal grant programs developed by the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA) to increase COVID-19 vaccine uptake have done little to find and support nonprofits through one of the greatest crises of our time. Quick, two-to-three-week turnaround times for proposals and short project timelines (ranging from six months to a year) have limited the pool of applicants to organizations with preexisting vaccine outreach programs in place; as a result, these conditions stymied outreach to a broader base of underserved populations. Funds were spent quickly to vaccinate as many people as possible against COVID-19 with little regard to building infrastructure for long-lasting vaccine access and confidence.

Despite these challenges, we believe change is possible – we can transform grant processes so that investments in public health are better allocated to nonprofits on the frontlines of our communities. Our new report, Supporting Community-based Organizations to Reignite a Culture of Immunization, details solutions for increasing equity within grant selection to better support nonprofits. Foremost among our recommendations is the need for funders to transform grant processes by increasing transparency around grantee selection and payment while recalibrating selection criteria and reporting requirements. Our recommendations around seeking partnerships with CBOs are equally important – the public health community must aim for equity if we have any hope of protecting people from preventable diseases across the U.S.

We know how vital CBOs’ role is to public health. The vaccination wins achieved throughout the COVID-19 pandemic were made possible through the dedicated efforts of nonprofits and its cadre of community health workers, and any hope of quelling monkeypox and polio outbreaks for the foreseeable future is also found within these organizations. It’s high time funding reflected recognition of their value – our nation’s health is counting on it.

Amy Pisani is CEO of Vaccinate Your Family, a nonprofit organization committed to reducing the burden of vaccine-preventable diseases across the lifespan.

Venus Ginés is the Founder and President of Día de la Mujer Latina, a nonprofit organization established to promote healthy behaviors within underserved Latinx communities.

Questions and follow-up can be directed to:

Erica DeWald (she/her)

Chief Communication Officer

Venus Ginés, M.A. P/CHWI,
President/Founder, Día de la Mujer Latina® Inc;
(Telehealth Community Navigation Ctr: COVID 19 HOTLINE: 281-801-5285 (Español:281-801-9590)