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Editor’s Note: The following contributed article was written by Dr. Ron Yee, MBA, FAAFP, and Chief Medical Officer of the National Association of Community Health Centers, or NACHC. Direct Relief is a longstanding partner of NACHC, which represents more than 1,400 community health centers across the United States.
In late October, with approval from the Food and Drug Administration and the Centers for Disease Control and Prevention on the horizon, the Biden administration announced its plans for distribution of the Covid-19 vaccine to the 5-11-year-old age group. The CDC gave its final authorization and pediatric inoculations are progressing, one small arm at a time.
Figuring prominently in the administration’s blueprint for vaccinating this newly eligible population as quickly, efficiently, and equitably as possible are the nation’s 1,400 community health centers, also known as federally qualified health centers, which serve 8 million of the nation’s most vulnerable children – those who stand to benefit most from the protection afforded by the Covid-19 vaccine.
Health centers have been offering quality, comprehensive, low-barrier primary care and ancillary services, such as in-house pharmacies, radiology, and behavioral health care to America’s most at-risk patients for 55 years. Nearly 80% of patients at health centers are either publicly insured (through Medicaid or Medicare) or uninsured, and over 91% have incomes below 200% of the federal poverty level – currently $53,000 annually for a family of four. Health center patients provide America’s food, transportation, home health services, and beyond – they are our essential workers who face higher risk of Covid-19 exposure due to public-facing roles. Some are unhoused – on the street, doubled up with family, or living in transitional congregate housing, which also heightens their risk of infection.
Since December of 2020, health centers have administered 16 million vaccinations to adults and adolescents. With virtually all health centers offering Covid-19 testing, they were able to nimbly transition their testing infrastructure – community-based outreach sites as well as those co-located in clinics – to administer vaccines while continuing to provide testing. Health centers pride themselves on offering easy-to-access, walk-in services at convenient times for community members who may have work schedules, family obligations, or transportation issues that are difficult to navigate.
One such community health center system is Beaufort-Jasper-Hampton Comprehensive Health Services, a network of health centers serving three counties occupying the (largely rural) southern tip of South Carolina. With nine medical centers providing an array of multidisciplinary medical, dental, and social support services, BJHCHS has succeeded in vaccinating over 14,000 patients in a state and local region with comparatively low vaccination rates overall.
In addition, BJHCHS operates nine school-based health centers – all located in low-income, Title 1 schools – and one mobile clinic visiting various school sites. Between their school-based health services and two freestanding clinics boasting large pediatric practices, BJHCHS serves approximately 4,500 pediatric patients.
These children are disproportionately affected by “diseases of poverty” such as asthma and obesity – the latter afflicts 30-40% of BJHCHS’s pediatric patients – as well as other chronic conditions that heighten their risk of hospitalization and death due to Covid-19. The higher prevalence of chronic disease among poorer children makes it all the more pressing to get them vaccinated.
Like other health centers around the country, BJHCHS’s success in vaccinating a socioeconomically stressed, high-risk community means their services in vaccinating underprivileged children will be vital.
The majority of BJHCHS’s pediatric patients are children of color – around 50% Black and 25% Latino. Communities of color in South Carolina have been particularly hard hit by Covid-19, with Hispanic residents nearly 50% more likely to contract the virus than white residents. Black South Carolinians have contracted Covid-19 at a 13% higher rate than their white counterparts and have been almost 75% more likely to be hospitalized and nearly 30% more likely to die, according to the most recent available state-level data. Not only are children of color more likely to be exposed to the virus in their homes, they are more likely to live in multi-generational households where they risk spreading it to older family members at higher risk for severe disease.
Notably, although BJHCHS is located in an area of the country where Covid-19 vaccine hesitancy has been well-documented, providers say they’ve encountered little such hesitancy among their patients. When patients have expressed hesitancy, it has typically been overcome by simply answering questions and sticking to the science. Once their concerns are addressed, providers say, patients are usually more than willing to get vaccinated.
BJHCHS attributes this to the high level of trust they’ve established over 50 years of service in the community, trust that is solidified by the demographic congruence between health center staff and patients (“We look like them,” says Chief Operating Officer Gloria Warner) and the fact that they reside in the same communities.
The strength of this trusted relationship is why BJHCHS and other health centers like it are perfectly positioned to vaccinate kids, especially those at higher risk of both contracting Covid-19 and living in families that are more vulnerable to the health and socioeconomic fallout that a pandemic can bring.
Reports from the ground indicate that patients’ concerns about safety and long-term effects are likely to be more acute when it’s their kids, not themselves, who are getting vaccinated. This makes families’ access to information from a trusted source that can simultaneously provide robust, low-barrier access to vaccines all the more critical.
Health centers strive to “meet families where they’re at” by providing walk-in vaccinations, community outreach, pop-up sites, and evening and weekend accessibility. This approach serves to strengthen clinics’ credibility with a population that is – to put it nicely – often unaccustomed to accessible, quality care. That’s why the role of health centers in vaccinating kids, especially those from low-income families, is central to protecting not only their health but that of their communities, while forming a critical piece of the puzzle which, once assembled, will move us closer to ending the pandemic.