Health systems get creative to overcome vaccine barriers

June 15, 2021


When data showed that vaccine rates were low in a neighborhood of mostly Black residents compared to the rest of the mostly white St. Louis suburb of Kirkwood, the Communities Disparities Council of Mercy zeroed in on those residents.

Herman Simmons, left, makes a vaccination appointment for Theopulis Polk at a Chicago laundromat in March. Simmons is a community educator for Saint Anthony Hospital. In a race to boost COVID-19 vaccination rates, the hospital is among many working to overcome mistrust and improve access.
Teresa Crawford/Associated Press

Its members worked with the leaders of the neighborhood group to distribute information on the vaccines' safety and efficacy. Then they set up a block of time on two Saturdays at a Mercy clinic in Kirkwood to give vaccines exclusively to residents of the neighborhood. Along with shots, the 50-odd people who came in for vaccines got free T-shirts.

Mercy's Communities Disparities Council focuses on practical solutions to get people vaccinated.

"Our goal is not to boil the ocean," says Danielle McPherson, the council's diversity officer. "Our goal is to make sure we can get the people who are most in need vaccinated and eradicate this virus as much as possible."

Catholic health systems have joined the nationwide effort to figure out how to get COVID-19 vaccinations to remote or underserved populations and how to persuade skeptics to roll up their sleeves.

Mercy Meacham Park Photo_extra
A worker from Mercy gives a COVID-19 vaccine during a clinic in May set up by the health system specifically for residents of a largely minority neighborhood in Kirkwood, Missouri, a suburb of St. Louis.

The broader effort includes enticements, like a chance to enter lotteries for
$1 million prizes in Ohio and Colorado, giveaways like free donuts, and mass vaccination events. As Catholic Health World went to press, Vice President Kamala Harris was preparing to tour southern and Midwestern states to encourage vaccinations.

For health systems, vaccine outreach efforts include education campaigns using traditional and new media and vaccine clinics in medically underserved communities.

Trinity Health's campaign called "It Starts Here" encourages vaccination among people of color. Black and brown influencers with large followings in 14 underserved communities across the country educate, raise awareness and promote availability of the vaccines in the campaign. The campaign includes $1.1 million in community health grant funding to support local outreach and engagement.

Easing immigrants' access
In Lewiston, Maine, St. Mary's Health System has worked with the New Mainers Public Health Initiative to get the immigrant community vaccinated.

Abdulkerim Said, the nonprofit initiative's founder and executive director, says his group and others that serve the mostly African Muslim migrants first had to overcome a stigma attached to COVID-19 to coax residents to get tested and, if needed, treated for the virus. To encourage vaccination, the New Mainers have had to counter disinformation on social media about the safety of the shots as well as overcome language and transportation issues.

St. Mary's, part of Covenant Health, has helped by providing science-based data and resources. That information has been shared through a variety of means, including text message blasts and social media posts on WhatsApp and TikTok.

Through its affiliate Community Clinical Services, a federally qualified health center, St. Mary's offers vaccines at a site within walking distance for immigrants who live in downtown Lewiston.

The health center also has helped facilitate vaccine events specifically for the immigrant community, such as two that Said's organization set up at local mosques. Said and the mosque leaders got their shots at the events and shared photos of themselves being inoculated on social media.

Workers wait at a registration table at a COVID-19 vaccines event set up by the New Mainers Public Health Initiative in Lewiston, Maine. The nonprofit serves migrants, most of them African Muslims. It is teaming up with health agencies on vaccination campaigns. One of the workers holds a cutout of the face of Dr. Nirav D. Shah, director of the Maine Center for Disease Control and Prevention. He is well known in the state for directing efforts to end the pandemic.

By late May, Said says 45% of those 50 and over in the immigrant community had been vaccinated. Now he and other community leaders are focusing on getting the younger crowd in the mix.

One strategy they have employed is to offer gift cards to entice some local soccer stars to get vaccinated and to share posts about it for their social media followers. "We are using the youth to educate the youth," he says.

Providing reliable information
Stephen M. Costello, executive director for philanthropy for St. Mary's Health System, says as the vaccine rollout expands, hesitancy seems to be a bigger barrier than access. St. Mary's is debunking disinformation about vaccine safety in various languages on social media and sharing information about vaccine clinics, including those run by others.

"If people are making the decision to not get the vaccine based upon incorrect information, then we feel that it's our job to make sure that information is corrected and out there in a format they can understand and use to make an informed decision," he says.

Dr. David Basel is vice president of clinical quality for Avera Medical Group, part of Avera Health, based in Sioux Falls, South Dakota. He says that among the reasons he hears from rural residents for not getting shots is that they don't think the virus will reach their communities. When he gets that argument during his outreach efforts, he counters it with a prairie fire analogy.

"A lot of these communities, if they still have a low vaccination rate, that means there's a lot of dry grass still sitting there waiting for that next round to come through and it only takes a spark in that community to send it up into a prairie fire," he says.

Making vaccination 'fun'
Basel says Avera has given its care providers training on how to educate patients about the vaccine without expressing judgment about their choices. The system has also encouraged providers and patients to post on their personal social media accounts about getting their shots in hopes that they will serve as peer influencers.

The system even has a lengthy post on its website with advice on how to make the vaccination process "fun." Among the tips are that patients reward themselves with a shopping trip or special meal afterward or that they use the process as a chance to practice meditation or mindful breathing.

In addition to vaccine education and advice, Avera is continually expanding vaccine access, Basel says. In three of the four states where Avera operates, vaccine distribution is being handled by public agencies. But in its largest market, South Dakota, the state contracted with health systems to provide the shots.

Avera has used its existing network of hospitals and pharmacies to reach remote areas and is offering shots without appointments at some sites. Basel says the system at first hoped to have vaccine access available within 50 miles for most residents. By mid-May, the system estimated that it and others who were part of the vaccine effort had established access points within 25 miles of almost everyone in the rural state.

The effort got a boost in May when the Food and Drug Administration announced that the Pfizer-BioNTech vaccine could be kept at refrigerator temperatures for 30 days, instead of at constant subzero temperatures that required special freezers. As of early June, the Pfizer vaccine was the only one approved for children 12 and older.

"That's a game changer for us," Basel says of the FDA announcement on safe storage temperatures. "Now we have a lot more ability to get the Pfizer vaccine into rural communities."

Pilot program
PeaceHealth Southwest Medical Center in Vancouver, Washington, has hosted vaccine clinics specifically directed at populations that have obstacles or have shown reluctance to get vaccinated, says Randy Querin, a senior communications specialist.

In early March, a clinic at PeaceHealth Southwest Urgent Care in Vancouver inoculated more than 500 Black, Latino and Pacific Islander community members, in partnership with community organizations. In northwest Washington state, PeaceHealth organized language-specific vaccine clinics for Punjabi- and Hindi-speaking patients and the Latino community.

In Oregon, PeaceHealth is partnering to offer mobile COVID-19 testing and vaccination clinics for vulnerable populations, including the Mam-speaking indigenous Guatemalan community in Cottage Grove.

The system also is expanding outreach to Slavic communities in collaboration with cultural experts, public health departments from six counties and eight health systems in Oregon and Washington, Querin says. Its vaccine education campaign for this community includes the use of various media to share interviews with trusted community members and Russian-speaking clinicians answering questions about the vaccines.

In Longview, Washington, PeaceHealth Medical Group is piloting a program in which primary care physicians ask hesitant patients if they would like information about the vaccine, and then take time to explain the benefits of vaccination. If the patient makes the decision to get vaccinated, the primary care physician handles the injection during the visit.

"Based on early results we believe this will be our model going forward," Querin says.

'Doing the right thing'
McPherson of Mercy helped that system plan its first mobile vaccine clinic in Missouri in Riverview Gardens, a school district in St. Louis County with a large low-income and minority population. She expects others to follow.

Meanwhile, the system is adding to and updating a series of short videos posted on YouTube that feature clinicians, many of them people of color and some speaking in Spanish, answering questions about the vaccines that have been posed by patients. By mid-May the videos had gotten 143,000 views on Facebook alone; of those, 96,000 were from viewers who don't follow Mercy.

McPherson, whose full-time job is director of managed care contracting and payor relations, says Mercy's outreach efforts likely will continue as long as there are still people who are reluctant or unable to get vaccines.

"I feel like our North Star is really doing the right thing," she says. "We know that this is the right thing to do."

Chicago hospital brings the community into its vaccine outreach

Saint Anthony Hospital has taken to the streets to fulfill its mission of getting the community it serves on the west and southwest sides of Chicago vaccinated against COVID-19.

Alberto Raygoza, left, talks with Saint Anthony Hospital outreach worker Patricia Palato at a Chicago grocery store in February. She approached Raygoza as he shopped for produce and made a vaccination appointment for him.
Teresa Crawford/Associated Press

The effort began in February for the independent safety-net hospital that provides care for several low-income neighborhoods with a high concentration of Black, Hispanic and Asian residents plus many people without legal immigration status.

The hospital hired, trained and fields a crew of 80 community educators to laundromats, churches, stores and other places to talk to residents about the importance of getting vaccinated and answer their questions. If the residents are willing to get a shot, the educators immediately phone a call center to set up an appointment. The call center also is staffed by people hired from the community.

When residents arrive at Saint Anthony for their appointments, they are met by patient navigators — again, community residents — who welcome them, register them, escort them to vaccination nurses and then lead them to the chapel for their post-vaccination observation period.

An analysis by the Chicago Tribune found that through April 14, 54% of the vaccines given by Saint Anthony had gone to people residing in high-risk ZIP codes. For some other vaccine providers, that number was as low as 8.4%.


Jim Sifuentes, the hospital's senior vice president for mission and community development, says Saint Anthony's outreach takes away much of the complexity that can discourage people from getting vaccinated.

As the vaccine rollout expands, Saint Anthony is doing even more to assure that those in its service area are inoculated. The hospital has begun to offer pop-up clinics at familiar places where people feel welcome such as schools. In late May it started partnering with community organizations to send workers door to door in some areas to bring vaccines to residents who can't leave their homes to get to the hospital or the pop-up clinics.

Sifuentes says in addition to access challenges, Saint Anthony has had to confront distrust of the medical community by residents, especially those who are African American. The hospital is working with community groups and churches to educate residents and answer their questions.

Sifuentes says the grassroots approach to reaching the community speaks to how well Saint Anthony knows its service area and residents' needs. A Sunday vaccination event in early May at a clinic in a mini-mall in a Latino neighborhood drew more than 200 teenagers. The event was promoted on social media and featured a deejay.

"This didn't just happen," Sifuentes says of the hospital's vaccine effort. "It's our approach to community engagement to begin with. In order to have really successful outcomes in any capacity you have to be in the community."


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