As Covid-19 Vaccinations Slow, Safety Net Providers Get Creative

Earlier this year, when Covid-19 vaccines became available, the staff at Highlands Health Clinic were fielding hundreds of phone calls every day.

“So you can imagine, I’m here with this little staff, and it was like, ‘Holy poop,’” recalled Rosalie Danchanko, the executive director at the Pennsylvania-based free clinic, which operates with only five paid staff members and about 65 volunteers across three counties.

To complicate matters, demand and supply were sometimes far apart. At one point, Highlands Health Clinic found out that no vaccine would be available – on a day when hundreds of people were scheduled to receive a second dose.

But things have changed drastically since that point.

According to the Washington Post, national vaccination rates have slowed significantly. In April, an average of 3.3 million doses of Covid-19 vaccine were administered daily. By early June, that number had dropped to about 1 milllion. Vaccination rates vary widely from state to state.

And communities and health centers around the country have gone from being able to get hundreds of vaccines into arms during a single clinic to focusing on creative ways to reach small numbers of people.

Extraordinary measures

“Our community health workers…have gone out even just to vaccinate a group of five or six people,” said Emily Harris, the infectious disease program manager at Chiricahua Community Health Centers in Arizona.

To reach patients in smaller numbers, Chiricahua’s staff members have gone out to local farms – “bringing it right there to them so they can get vaccinated when they show up to work,” Harris said – to reach agricultural workers. They’ve shown up at a local gas station and visited patients in their homes.

And although the one-shot Johnson & Johnson vaccine is a good fit for many of their patients, they’ve also gone out of their way to bring the Pfizer vaccine to their patient populations, so they can reach people ages 12 and up.

They’re not alone in taking a targeted approach. Highlands Health Clinic has gone to churches, senior centers, and local businesses to vaccinate people a handful at a time.

“We’ve had extra shots, and I’ve gone literally into bars and said, ‘Hey, anybody want a shot?’” Danchanko said.

And after a local paper alerted them to the large number of people who were homebound or otherwise unable to go get vaccinated, Highland Health Clinic’s staff began doing home visits – nearly 600 thus far. Sometimes that means hours of driving on dirt roads in remote areas.

Recipients have included a 107-year-old woman. A veteran of Iwo Jima. A child whose severe autism made going to a clinic impossible.

Moments of Opportunity

At this point, many people who want the vaccine haven’t had the opportunity yet, said Orlando Aquino, the patient and community engagement manager at Norwalk Community Health Center in Connecticut. It’s a question of providing opportunities for them.

“Some individuals have to get to work very early and they don’t get home until late. They get caught up in the busyness of their lives,” Aquino said.

For Norwalk, that’s meant holding mobile vaccine clinics – which now include a Direct Relief-donated portable freezer – to places where vulnerable populations, such as day laborers, are likely to be. At one point, “I myself just went up and started talking to individuals – ‘Hey, come up the street and get your vaccine,’” he recalled. “I would walk them all the way to where our medical mobile was.”

That moment of opportunity can be invaluable. A nurse at CARE Clinic in Minnesota went out to a local dairy farm with the Johnson & Johnson vaccine, and ended up convincing a few workers “who were on the fence, but because it was right there, they decided to go ahead and do it,” recalled Julie Malyon, CARE Clinic’s executive director.

Staff at the clinic have also gone to senior living facilities and local businesses, including a hardwood factory and meatpacking plant, to vaccinate individual groups.

Equally important is making the vaccine available to people who come into the clinic for medical or dental care. “We’ll continue to have patients that are coming in that we’ll say, ‘Yes, we can do it right now,’” Malyon said. It’s often a good opportunity to reassure patients – many of whom are concerned about receiving a bill – that their vaccination will be free of charge.

Countering Hesitancy

For some safety net providers, hesitancy is increasingly becoming an issue.

Stephanie Willding, chief executive officer of the Chicago-based clinic CommunityHealth, explained that staff members have seen three separate stages in the vaccination process. First, she said, were people ready and even excited to receive the vaccine. There were so many of those that the schedule at pop-up clinic events would be filled “in an instant.”

Second came people “who needed a few more conversations with a trusted messenger.”

But now, she said, “we find ourselves in a place where folks who have not received the vaccine are those who are extremely hesitant or will never get the vaccines.”

That means spending more time with individual patients, providing educational tools and expressing concerns. One patient needed eight education sessions before he was willing to receive a vaccine.

CommunityHealth staff members have worked to identify several different types of people who haven’t received the vaccine yet, and to develop approaches to make vaccination feel more comfortable for them.

Some can’t afford time off or transportation to a vaccine clinic, or are concerned about side effects keeping them from work. Others have “a historic reason…to distrust the health care system,” Willding said. Some are skeptical about the existence or severity of Covid-19 itself.

“It’s very clear we’re in the times of vaccine hesitancy,” said Harris, of Chiricahua. Patients may have fears about mRNA technology or the newness of the vaccine that can be addressed with education – and personal testimonials.

This kind of work – going to homes, churches, and businesses, holding multiple conversations with patients – can be time-consuming and high-touch. It’s also the kind of work that safety net providers, who are trusted sources of community health care and who maintain strong relationships with other organizations, are particularly skilled at doing.

Or, as Danchanko puts it: “We are the boots on the ground.”

To directly support the safety net in its vaccination efforts, Direct Relief provided $10 million in grants to United States community health centers and $2 million to free and charitable clinics. This vaccine-specific funding was in addition to more general support provided throughout the pandemic.

Most recently, the organization donated more than $50,000 worth of ultracold freezers, intended to safely store the Pfizer vaccine, to seven safety net providers, including Highlands Health Clinic, Norwalk Community Health Center, and Chiricahua Community Health Centers.