Hit the sidewalk to vaccinate the underrepresented – and protect everyone

Leonor Garcia held her clipboard close to her chest and tapped the car window with her knuckles. The driver was in one of dozens of cars lined up on a quiet street in Adelanto, California, a small town near the southwestern edge of the Mojave Desert. He waited for the grocery bank to move and lowered the passenger window just enough to hear what Garcia wanted. Then she started on her playing field.

“Good morning! We’re here today to talk about covid-19! Do you have a minute?” she said in Spanish.

After a short conversation, Garcia learned that the man did not have his own internet connection or his own phone, but was 66 years old and wanted to receive the covid vaccine. He had tried to visit a pharmacy in person, but the recordings were all off for the day. Garcia jotted down his name and a friend’s phone number so she could later reach the driver through a mobile vaccination clinic that her organization, the El Sol Neighborhood Educational Center, put together for the remote desert town sometime in April.

Then it went on to the next car. And the next. As the line started moving, she and her health colleague Erika Marroquin jogged up and down the sidewalk, jotting down names, phone numbers, and pre-existing conditions. It was the first mild, sunny day the High Desert region had seen in weeks, and the exercise made her sweat.

Leonor Garcia, El Sol community health worker, speaks to a driver waiting in line for a church food bank on March 17 in Adelanto, California. She and her colleagues not only inform people about the covid vaccines, but also ask if they need help with psychiatric care, food, or rent.(Anna Almendrala / KHN)

In 90 minutes, the grocery bank was ready for the day, and Garcia and Marroquin had spoken to people in 54 cars. They found six people who were eager for the covid vaccine and were immediately eligible for it. Ten more wanted to be put on a waiting list for leftover cans.

The introduction of vaccination in California, as in many states, has been slow and chaotic. More than 5 million of the 24 million adults in the country’s most populous state have been at least partially vaccinated, while another 5.6 million are fully vaccinated. Starting April 15, all adults in California will be able to enroll for a vaccine. The goal is to have enough vaccine available to any adult who so desires by early summer.

However, the country needs to increase the vaccination rate to around 75% to prevent the virus from spreading easily – a level referred to as herd immunity by infectious disease experts. But even this number assumes that the population is homogeneous when it comes to vaccination. For this reason, the state’s ability to stave off further recovery may come from people like Garcia and Marroquin – community health workers and organizers who do time-consuming and tedious work – preventing populations with low vaccination rates in remote or isolated communities from creating a tinderbox for a new covid wave.

“When you have geographic or social pockets of unvaccinated people, herd immunity is really messed up,” said Daniel Salmon, director of the Vaccine Safety Institute at Johns Hopkins University’s Bloomberg School of Public Health.

A sobering example are US measles outbreaks in recent years. State and national vaccine coverage is quite high. “But then you would have these communities where a lot of people would reject vaccines and then measles would be imported and cause an outbreak,” Salmon said. Outbreaks have hit certain Orthodox Jewish communities in New York, Somali immigrants in Minnesota, and affluent areas of Southern California where parents lived against vaccines.

Residents of California’s High Desert region line up at the Centro Cristiano Luz y Esperanza Church in Adelanto to receive their second dose of a covid vaccine at the El Sol vaccination event on March 19. On the left are those who got their first shot at an event in the previous month. The line on the right is full of people hoping for leftover cans. (Anna Almendrala / KHN)

The coronavirus is still widespread in California, albeit at a much lower level than it was two months ago. The virus, especially an increasingly common, more contagious variant, could easily penetrate vulnerable communities with low immunity. In Adelanto, where 29% of the population live in poverty, less than 6% of the adult population were fully vaccinated by March 20.

By March 26, most of the 15.9 million doses of vaccine distributed since December had gone to the healthiest and richest places in the state. Community-based organizations such as nonprofits and churches are demanding more money – and trust – to bring the vaccine the last mile to the people they have served for years.

El Sol’s success in vaccinating blacks, Latinos, and other underrepresented populations debunks the idea these groups don’t get the shot, said Juan Carlos Belliard, vice president of community partnerships at Loma Linda University Health in San Bernardino County. Loma Linda works with El Sol to provide staff and cans for clinics. The people who show up are ready for their vaccine, although some are hesitant, he said.

“They’re not like our middle-class people who literally cry for the vaccine,” Belliard said. “These people are still nervous, but you’ve removed almost all of these other obstacles for them.”

Staff and students at Loma Linda University Health in San Bernardino County lead people into the church hall to be vaccinated at El Sol’s pop-up event. Special paper forms have been created so that users don’t have to type their information into a computer to make an appointment. After the event is over, the hospital’s clinical team manually uploads all data.(Anna Almendrala / KHN)

El Sol community workers received $ 52.7 million in government and philanthropic funds that provided grants to 337 “Trusted Ambassadors” organizations in their communities. The money was given to groups like El Sol, which had a proven record of acquiring shoe leather for voter registration or census surveys.

El Sol received $ 120,000 from the public-private initiative to support his general public outreach and covid education efforts. However, the group was in the dark about whether or not they would receive reimbursement for the mobile vaccination events they organized in San Bernardino County, chief executive Alex Fajardo said.

El Sol hosted a pop-up vaccination event on February 17 at the Centro Cristiano Luz y Esperanza, a church on a dual carriageway in Adelanto, surrounded by desert scrub. Medical workers, students, and vaccines came from Loma Linda University Health, about an hour away, to vaccinate 250 people, and returned a month later to give people their second dose.

Patricia Perez (47) and Rosa Hernandez (69), a mother-daughter couple, were among those who received their vaccines at the Centro Cristiano.

Rosa Hernandez (left) and daughter Patricia Perez received their second dose of Covid vaccine at the El Sol clinic on March 19 and waited the required 15 minutes before returning to Hesperia, California. Hernandez is a cancer survivor and her husband faced a severe case of Covid in June. Fortunately, no one in her household of seven got sick.(Anna Almendrala / KHN)

Perez’s father, who works in a supermarket dairy department, fell ill with Covid in June and was unable to return to work for six months. Nobody else in the seven-person household tested positive, but Rosa Hernandez is a cancer survivor and her daughter was worried about her.

Despite multiple calls to a county phone line, Perez had been unable to find a vaccine for her mother. The family’s internet connection in the nearby town of Hesperia wasn’t that good, and Perez couldn’t really navigate the websites or find information in Spanish, the language she is most comfortable with.

She took the chance when she heard about El Sol’s pop-up event through someone in her church. Perez also managed to snag an extra dose after someone failed to show up for their appointment. Now she and her mother are fully vaccinated, Perez said, and it would not have happened without El Sol.

The group is planning three more vaccination popups in the High Desert region. But future support for his clinics, vaccine reach, and education is dim, Fajardo said.

“What will happen after that?” he said. “If we need you, we’ll pay you. If we don’t need you, ‘Bye-bye.’ “

“That’s a very fair assessment,” said Susan Watson, program director of Together Toward Health at the Public Health Institute, the philanthropic funder behind some of El Sol’s work. “This is an opportunity for people to think about the future and how we do things where community groups don’t necessarily stay outdoors all the time and are only used in an emergency.”

Community Coalition, a South Los Angeles nonprofit that was founded in 1990, also received grants from the public-private partnership to raise awareness of covid vaccines, but no additional funding to deliver vaccines to people. Still, it mobilized employees to knock on doors, text text messages, and email eligible people to attend a two-week pop-up vaccination event in a neighborhood park in early March. 4,487 people received their first dose of vaccine, said group chief officer Corey Matthews.

Dr. Marx Genovez injects a Covid-19 vaccine into Guadalupe Neri.(Anna Almendrala / KHN)

Dr. Mark Ghaly, the secretary of state for health and human services, pledged to allocate more money to groups vaccinating their communities. “This is not a volunteer job,” he told KHN at a press conference. “This is real work and I want to be part of the team that is making this a reality for everyone.”

Barbara Ferrer, director of the Los Angeles County Department of Health, echoed that sentiment. “They were there before the pandemic started, they were there all the time during the pandemic, and they will be here long after the pandemic,” she said.

Whether or not these promises are kept, community groups say they want to be part of the vaccination effort.

“Even if they don’t give us any money, we’ll keep doing the work,” said Fajardo.

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