As Covid-19 Vaccine Demand Dips, Community Health Centers Take the Lead

This story was originally posted by Stateline, an initiative of the Pew Charitable Trusts.

Rob Wohl, a COVID-19 vaccine outreach worker in Northern Virginia, said his best day on the job was when he walked into a white-tablecloth Chinese restaurant in Falls Church, Virginia, in April to see whether he could sign up employees for vaccinations.

He arrived right before the lunch rush, which turned out to be perfect timing. “The manager gets very excited,” Wohl said. “She says, ‘Wait right here.’ She immediately goes and starts grabbing people out of the kitchen—Chinese and Latino workers. Then she calls everyone who was off duty that day and tells them to come in. Suddenly a busboy is interpreting for Spanish speakers, and he says, ‘These guys don’t drive, I’ll bring them over in my van.’”

In less than an hour, Wohl said, 35 at-risk frontline workers were rolling up their sleeves at nearby community health center Neighborhood Health, for a COVID-19 shot they said they’d wanted but didn’t know how to get.

Wohl, a seasoned community organizer who has worked with low-income tenants in Washington, D.C., became Neighborhood Health’s first vaccine outreach worker in March. His territory includes the clinic’s entire reach—the city of Alexandria, and Arlington and Fairfax counties.

Neighborhood Health plans to hire five more outreach professionals with proficiency in Spanish and Amharic, which is spoken by many members of the region’s large Ethiopian community.

Similar on-the-ground campaigns are rolling out nationwide, as community health clinics serve as catalysts for a multitude of local COVID-19 inoculation campaigns. Their mission is to close the gap between the vaccination rates of the nation’s most vulnerable people and the rest of the population.

But nationwide demand for vaccines is sliding—despite a plentiful supply, the number of shots administered declined from a one-day high of 4.2 million shots per day in the beginning of April to an average of 2.4 million shots per day last week. So the Biden administration is calling on community health centers and their local partners, along with private practice physicians, to maintain momentum through the last mile of the marathon effort to defang COVID-19.

In Florida, Ohio, Texas and other states, managers of some mass vaccination sites are preparing to fold up their tents. In the next phase of the vaccine rollout, community health centers, private practice doctors and other medical facilities are expected to become the driving force.

“We’re working with everyone we can,” said Dr. Ron Yee, chief medical officer at the National Association of Community Health Centers. In addition to reaching out to Black and Hispanic communities, local health centers are working to vaccinate people experiencing homelessness, agricultural workers, public housing residents and those who don’t speak English, he said.

Armed with millions of direct-shipped vaccines from the federal government and $6 billion in new grants under the American Rescue Plan enacted in March, the historically underfunded health centers are rallying social welfare agencies, churches, hospitals, schools, local businesses and other trusted community groups to sign up anyone who hasn’t been vaccinated.

Skilled at ground-game strategies, the nation’s more than 1,300 community health centers, which serve more than 30 million patients, already have enlisted local partners to sign up their members for shots at pop-up vaccination sites located within walking distance from where their target populations live and work.

But when that tactic runs its course, likely next month, health centers are preparing to take their campaigns to the streets and rural highways, knocking on doors at public housing complexes, parking mobile clinics outside of grocery stores and sending outreach professionals such as Wohl to find people who haven’t been able to arrange a shot or are on the fence about getting one, Yee said.

In this historic vaccination drive, Yee said, community health centers need to go beyond their patient lists to find people who never have been to a community clinic. Many such newcomers will be young adults in medically underserved neighborhoods who aren’t receiving treatment for chronic conditions and may be ambivalent about getting a COVID-19 vaccine, he said.

Health Disparities

According to the federal Centers for Disease Control and Prevention, Hispanic people have the biggest discrepancy in vaccination rates compared with the White population. The next widest gap is in the Black population.

May 4 data from the CDC indicates that 67% of fully vaccinated people are non-Hispanic White people, who represent 61% of the general population.

In contrast, only 10% of fully vaccinated Americans are Hispanic, despite their 17% representation in the general population. Similarly, only 9% of fully vaccinated people are Black, despite their 12% share of the total population. Less than 5% of vaccinated people are non-Hispanic Asians, a group that makes up close to 6% of the population.

“Federal money and community partnerships likely will help reduce existing racial and ethnic vaccination disparities,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity and a physician at East Baltimore Health Center.

“But it’s going to take a while, if it ever does catch up,” Cooper said. “I can count on one hand the health care metrics where we’ve actually improved. There’s inequity across all of health care. The question is how much inequity.

“For people who are in care and have chronic diseases, community health centers will help close the gap. But there are a bunch of people of color who don’t have any health care. That’s where barber shops, neighborhood pop-ups and churches will make a difference. Not everyone in a community actually goes to a community health center,” Cooper said.

Former community organizer Wohl shares Cooper’s concerns. “Some people are part of an organization, but a lot of people are ‘bowling alone.’ They don’t have a lot of social capital or connections to a formal organization that could refer them. We don’t want those people left out. They’re still in our community,” he said.

Wohl said he’s looking for individuals who can act as informal leaders. “It’s a trick I learned pretty quickly as a community organizer. Actual organic community leaders have the power to move their networks in a way that an outsider never can.

“It can be really hard to persuade someone to get a vaccination if you don’t have any established relationship,” Wohl said. “What works is when a friend says they already got the shot and nothing bad happened. The strongest arguments I can make don’t compare to someone talking to a friend.”

He said he may go back to the Chinese restaurant in Falls Church and talk to José, the busboy who offered rides to people, about spreading the word among his friends and family. “Who knows. He may be in a soccer league. He may belong to a church.”

Equity Experts

Health equity has always been Neighborhood Health’s primary mission, Dr. Basim Khan, its executive director, told Stateline. That’s why the center never advertised its vaccines and never offered online appointment scheduling.

“We asked the staff to work extra hours to make phone calls and text all of our patients,” Khan said. “We realized that with our patient population, requiring online appointments would be a barrier and it would favor people who had the ability to sign up versus those who didn’t.”

Once all of its patients were contacted, Khan said, the health center reached beyond its patient list by partnering with a wide range of other social welfare organizations. So far, the center’s 100-plus partners, which include the Virginia Department of Health, have referred more than 19,000 low-income patients for shots.

In total, Neighborhood Health has delivered 36,000 vaccines. Of those vaccinated, 49% were Hispanic, 24% were Black, 15% were non-Hispanic White and 12% were Asian.

Among the largest community health groups in the country, Neighborhood Health was established in 1994 and provides medical, dental and behavioral health care to nearly 47,000 people. Their patients are predominantly poor, uninsured and Hispanic or Black, and 70% of them speak a language other than English.

Other community health centers have similar demographic profiles and, like Neighborhood Health, are governed by a board of community members. That’s what made federally qualified health centers a natural choice when the Biden administration decided to promote and support equity in its COVID-19 vaccination program, Khan said.

Before President Joe Biden took office, state and county health departments already were coordinating their COVID-19 vaccine programs with community health centers. As the health departments allocated vaccines, the community centers advised them how to communicate with and serve low-income residents, immigrants and other vulnerable populations, said Jennifer Tolbert. Tolbert is the director of state health reform at the Kaiser Family Foundation, which has been tracking community health center vaccination programs.

When Biden offered to ship vaccines directly to community health centers, state health departments did not object, she said. “It didn’t interfere with their authority. It just meant their state would receive more vaccines.”

Earlier in the pandemic, some states provided extra funding, personal protective equipment and other supplies to community health centers to cover the extraordinary cost of battling COVID-19 while shuttering most other medical services that generated income, the national association’s Yee said.

In February, Neighborhood Health was among 250 health centers that the Biden administration chose to participate in its vaccine equity program, which prioritizes underserved communities and populations that have been disproportionately affected by COVID-19.

In March, 700 additional health centers were asked to join the program.

On April 6, Biden visited one of Neighborhood Health’s COVID-19 vaccine clinics at the Virginia Theological Seminary in Alexandria, Virginia.

Lifetime Partnership

Khan said the vaccination sites his health center has set up with community organizations have all been successful and are still going strong, at roughly 5,000 vaccinations per week.

But Khan said he anticipates demand will start dipping by late May, and as the community gets closer to normal life, some of the facilities will open for normal business and won’t be available as vaccination clinics.

At that point, Khan said, Neighborhood Health plans to start administering most COVID-19 vaccines at its 13 medical clinics. Since it began offering vaccines in December, the center has administered only small numbers of shots at its own clinics, because the waiting rooms are not big enough for large groups to wait for 15 minutes after receiving a shot to check for side effects, he explained.

Khan said churches and temples have been among the most rewarding collaborators. Alfred Street Baptist Church, for example, “has been an amazing partner.”

If you ask Lolita Youmans, the church’s administrator, the feeling is mutual.

Founded in 1803, Alfred Street’s largely Black congregation numbers more than 10,000 people, about half of whom live in the local area. The rest remotely attend Sunday services from around the world.

“You can imagine that our church is approached by many people who want to partner with us for many reasons,” said Youmans, a member since 2006. “In my day, there have been some disasters and some that have worked pretty well. But the partnership with Neighborhood Health is by far the most productive and rewarding that I have ever seen.

“I’m optimistic that we can continue our relationship serving underserved people beyond the pandemic, whether it’s food or health care or access to education, jobs or housing.”