When Sun Life Family Health Center got their hands on precious vaccine doses, things happened fast.

Community members were calling the Arizona health center nonstop. Appointment slots filled as soon as they opened them. Soon, they were vaccinating about 2,500 people per week.

All that came with added expenses, including paying overtime and hiring more staff.

“We’re figuring out how we’re going to break even later,” said family nurse practitioner Bessie Burk.

The health center serves a wide and diverse area, ranging from suburban areas just outside Phoenix to small, remote communities of farmers, miners, agricultural workers, and people experiencing homelessness.

Reaching those more remote patients is an additional challenge, one that brings with it increased staffing costs, refrigeration and equipment costs, and other considerations that come with “spending a few hours vaccinating 100 people, then returning four weeks later,” Burk said.

Sun Life isn’t alone. As health centers across the country swing into gear, vaccinating hundreds or thousands of patients a week, they’re feeling the effects – many of them financial.

The costs of staffing vaccine clinics and mobile outreach efforts, taking painstaking care of vaccines, and doing the nitty-gritty, high-touch work of fighting vaccine misinformation and hesitancy are considerable for safety net providers already operating on narrow budgets.

Health centers will receive private insurance reimbursement – if their patients have private insurance, which many don’t – and extensive government support. But to navigate the challenges of vaccination, they’re relying on their well-honed ingenuity…and the occasional leap of faith.

To support health centers in vaccinating the country’s most vulnerable individuals and communities, Direct Relief is distributing $10 million to health centers across the country. The money will be used to cover increased staffing and equipment costs, conduct vital outreach, and get the vaccine to hard-to-reach patients, among other things.

Countering hesitancy…and filling in paperwork

At Brockton Neighborhood Health Center in Massachusetts, CEO Sue Joss said that help from the National Guard, which sent ten people to vaccinate the community, has been essential.

But even with the assistance, scheduling vaccine appointments has required all hands on deck – even those of some health care providers, like dentists.

And countering vaccine hesitancy in the community has required the dedicated attention of ambassador nurses, who have gone on the local radio, held town halls, and met one-on-one with a number of patients to correct inaccuracies and answer questions. “That type of outreach is very time consuming and labor intensive,” Joss said.

Dr. Wilhelmina Lewis, chief executive officer of Florida Community Health Centers, sees a similar need in her community. “There’s definitely a lot of misunderstanding and misinformation and vaccine hesitancy to a degree that has been disturbing and challenging to combat.” She’s fielded concerns about the vaccines affecting DNA and whether the vaccines are an opportunity to conduct experiments on people.

In addition, she said, the vaccination itself is easy enough, but the paperwork around it can be time-consuming – and thus expensive. To complicate matters, many of the health center’s patients don’t speak English or have low health literacy. Filling in forms and making sure there’s a reliable record of the vaccination can take half an hour per person, she said.

Lewis noted that her health center – like many others – already operates on thin margins and helps patients find food, legal resources, and other needs. “Add a pandemic on top of it, and you have the people who are doing some of the hardest work for some of the most challenging populations for a really long time,” she said. It’s no wonder that staff members are tired.

Reaching communities

At Northeast Valley Health Corporation, a health center in California’s San Fernando Valley, director of health education Debra Rosen is focused on reaching their patient population, which is widespread, primarily Latinx, and includes a number of patients experiencing homelessness.

For Rosen, as for Lewis, one of the biggest challenges of getting patients vaccinated has been the complex registration work required. A vaccination takes a few moments, but making sure that a patient is accounted for in the system is a time-consuming process.

And it’s essential that the staff members working with patients speak their language and are culturally competent. Rosen explained that Northeast Valley Health Corporation will use their Direct Relief funding to offset the salary and benefits of bilingual, culturally competent staff members who can work effectively with the larger community.

Community Health Center of Southeast Kansas knows something about reaching out to the community. Already serving what chief executive officer Krista Postoi described as the “poorest and least healthy section of the state of Kansas,” the health center employs a nurse practitioner to visit older and disabled patients, along with anyone else who can’t make it to a clinic.

So when a Covid-19 vaccine became available, it made sense that the health center – in addition to vaccinating high volumes of patients at clinic locations – would target older and disabled adults for vaccinations as well. The health center plans to spend part of its Direct Relief funding on outreach to people who need the vaccine but for whom getting to a clinic would pose a hardship.

“There’s no shortage of folks who are stuck at home in rural America,” Postoi said.

At the same time, they’ve had a “tsunami of folks” – Postoi’s words – who wanted a vaccine appointment, straining both their staffing resources and their online systems. They’ve been paying a lot of overtime, Postoi said.

“We’re not really in a financial position to do that. We’re still bouncing back from the down months,” she explained.

The health center is used to Covid-19 bringing ever-new challenges – at one point, unable to get a full supply of PPE, the health center placed a large order for plastic raincoats and instructed staff members to wear them backward.

But when it comes to vaccination and testing, they’ve managed the surrounding community’s most vulnerable. “We’ve actually brought vaccine to a county that everyone thought would be the last to get it,” Postoi said. “We’ve been the first.”