D.C. Community Leaders Say Personal Outreach Is Key To Herd Immunity "Locating a clinic in an underserved area is not enough," one community health leader says.
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D.C. Community Leaders Say Personal Outreach Is Key To Herd Immunity

Locals get coronavirus vaccines at a location run by Neighborhood Health, a federally qualified health center in Northern Virginia. Tyrone Turner/WAMU/DCist hide caption

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Tyrone Turner/WAMU/DCist

Michael Pope is fully vaccinated, but he's still worried about the pandemic. He's been following the deadly surge of the coronavirus in India. And while the Southwest D.C. resident, 57, got his second shot at the Entertainment and Sports Arena site on a recent Monday morning, he's not sure things are going so well with the vaccine rollout.

"I'm wondering, are we really going to subdue this thing? I mean, really subdue it," he said. "I have friends who are saying they're not going to take a shot due to various reasons."

Scientists and public health experts share Pope's concerns. Many are now questioning whether herd immunity — a point where about 80% of people are vaccinated — is even attainable anymore. In the D.C. region, the vaccine is more accessible than it's ever been, with no appointments needed at many mass vaccination sites and ample supplies of shots at several local pharmacies. But demand seems to be slowing: In D.C., Maryland, and Virginia, the number of first doses administered began trending downward between mid-and late April, even though only about half of residents in all three jurisdictions have received at least one vaccine dose.

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To get the momentum back up, local health departments are getting more creative with outreach — offering incentives like free beer and D.C. United tickets at vaccine sites, and organizing more pop-up and mobile vaccination opportunities for immigrant, Black, and Latino communities. Community organizers, labor leaders, and community health leaders say this kind of work — taking the vaccine directly to the communities that have been most affected by the virus — needs to continue and expand.

Herd immunity can only happen if more people decide to, or are able to be, vaccinated. And organizers say that means getting small but crucial details right: Making a concerted effort to understand and address residents' questions and concerns about the shot, and presenting people with solutions so that they can spread the word to unvaccinated people they know. It's slow, resource-intensive work, with long hours spent in one-on-one conversations, door-knocking efforts, and other techniques of grassroots organizing that don't always come naturally for local governments. And the work demands already-depleted energy reserves from the people and organizations who have spent the last 14 months helping their communities survive.

Personal outreach — even peer pressure from friends — did the trick for other D.C. residents who got their shots alongside Pope at the Entertainment and Sports Arena.

"At first, I was totally against getting the vaccine. I was scared. I didn't know what to expect," says Victoria Bracey, 31, of Southeast D.C. "But once everybody that already had got it... told me how they was doing, it made me want to go get it. So I think it's a good choice."

Leaders at local community health centers have also tried to spur more situations like this, where people influence those around them to take the vaccine.

"You can't talk to every church. You can't talk to every group. But it does happen one at a time, and hopefully then those people that you talk to become credible messengers and then they start spreading the word," says Dr. Tollie Elliott, the Chief Medical Officer of Mary's Center, which has been administering the vaccine to its largely low-income, Black, and Latino patients.

But Elliott says there's another important piece to this process: genuinely acknowledging people's concerns about the vaccine, instead of judging them.

"You hear a lot about vaccine hesitancy and a lot of other concerns, but it almost seems as if it's kind of like victim-blaming," Elliott says. "Instead of blaming people for why they don't want to get the vaccine, try to find out why they don't want to get the vaccine ... it's just a part of doing your due diligence and educating them and then showing grace if they choose not to get it."

Researchers have found that no racial group or political group is monolithic in attitudes about the COVID-19 vaccine, and a majority of people across demographic groups are at least "somewhat open" to taking it. The polling firm Civiqs finds that nationally, the percentage of people who say they're a hard no when it comes to the vaccine has remained steady at about 23%, while the percentage of people who are unsure about the vaccine has declined as more people have gotten their shots.

In the D.C. region, health experts and organizers who have been directly engaged in the vaccine rollout believe there's still room to boost vaccination rates by dedicating resources to Black and Brown communities that the health care system has struggled to reach. While racial and ethnic disparities in vaccinations narrowed throughout the spring in D.C., vaccination rates are still the lowest in the majority-Black wards east of the Anacostia river. Limited data from Maryland and Virginia also show that rural, more conservative counties are lagging behind urban and suburban areas in vaccination rates — and racial disparities in vaccinations are narrowing but still persistent.

Michael and Caroline Pope pose outside of the Entertainment and Sports Arena after their second shots. Margaret Barthel/WAMU/DCist hide caption

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Margaret Barthel/WAMU/DCist

Pope, who is Black, says many men his age in his social circle are hesitant to get the vaccine, a fear he traces back to the history of the American medical establishment's neglect and maltreatment of Black people.

"I don't take pleasure in bringing up what I'm bringing up," Pope says. "They just don't trust. They believe that things just aren't on the up and up and maybe they [scientists] want to try something in the Black community to see what the results would be without informing us honestly."

Confronted with others' concerns about the vaccine, Pope's wife Caroline says she talks to people about how the virus is continuing to affect her loved ones.

"I have a family member who has it and is in the hospital with it," she says. "We just have to pray and trust scientists, like when we get our flu shots, our vaccinations for school. It's the same thing."

Some community leaders worry that concerns about the vaccines are being exacerbated by misinformation online.

"I think a lot of folks are getting wrong information from social media," says Jaime Contreras, the Vice President of SEIU 32BJ, a union representing janitors, airport workers, and security officers in the region. "So our job has been to give them the correct information and have trusted sources, not just a union rep, but also doctors who look like them, who speak like them."

Contreras, says the union has been hosting Zoom calls with members for this purpose — though overall, he says members of his majority-Black and Brown union have been excited about the vaccine and are eager to take it.

The union members who haven't taken the vaccine yet have a variety of reasons, he says. Some members who have already had the virus and recovered from it don't initially understand why they should still take the shot. Others feel that since so many other people are getting the vaccine, it's alright for them to wait. In other cases, people just have questions that relate to their own personal medical experience.

"People who are pregnant have questions," Contreras says. "You know, [they] have certain allergies. The general information that a doctor can explain to a worker in their language better than I can — I think that is extremely important."

Contreras says he'll continue to hold those calls, because "until everybody gets vaccinated, it's going to be hard to get back to normal": 2,100 union members remain laid off from their jobs.

Basim Khan at a Neighborhood Health-run vaccine site in a closed pet supply store in the Arlandria neighborhood in Northern Virginia. Tyrone Turner/WAMU/DCist hide caption

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Tyrone Turner/WAMU/DCist

Primary care doctors say it's critical that interactions with hesitant patients be individualized and respectful — an initial "no" can turn into a "yes" later on.

"I've had some people who flatly refused [the vaccine], but I provided whatever information I could. I was not judgmental," says Dr. Basim Khan, a primary care physician who leads Neighborhood Health, a federally qualified health center in Northern Virginia which currently runs seven vaccine clinics and is vaccinating about 5,000 people per week. "I realized a few weeks later, without knowing, that they'd signed up for a vaccine appointment."

Khan says doing what he calls "this difficult work one-on-one" is what will make the difference as the vaccine rollout progresses, especially now that supply of shots is no longer an issue.

"Locating a clinic in an underserved area is not enough. You actually have to find ways to reach out to the communities and to engage with them," he says. "At this stage, though, where the supply and demand equation has changed, I think one has to do even more."

To Khan, doing "even more" means keeping vaccine sites open at convenient times, standing up mobile and pop-up vaccination sites, and getting vaccines to primary care doctors' offices.

Grassroots organizers are used to working in this kind of individualized way — addressing people's personal needs in order to advance a larger cause. It's what Daniel del Pielago, the Organizing Director of Empower DC, calls "working in the minutiae" — for example, making sure that a resident of public housing has the childcare they need to so that they can attend a meeting, or arranging a ride for a resident so that they can testify before the D.C. Council. Now, the challenges of boosting vaccination rates are forcing local governments and health departments to take a page out of the book of grassroots organizing as well, by going directly to people to help them get the vaccine.

In D.C., Mayor Muriel Bowser joined with 1,000 volunteers to knock on 12,000 doors in the District to share information about the vaccine and how to get one.

"They literally went to people's homes," says Elliott. "That's a lot of work, a lot of volunteers. But, you know, short of going to the homes, you have to go into the communities." For Elliott, this has involved partnering with groups that serve, for example, Indigenous Mayan people in the region who speak languages that aren't represented in most media or government communications.

In Montgomery County, door0to-door outreach by trusted case workers from Identity Youth, a nonprofit organization serving mostly Latinx youth and their families, helped to increase testing rates among Latinx residents earlier in the pandemic. Identity modeled that strategy on its U.S. Census outreach efforts last year, and some leaders want to try to replicate it again to get more Latinx youth to take the vaccine.

"We had youth ambassadors helping us get into their own neighborhoods and refer people to case management and then to vaccinations and testing, etc.," says Diego Uriburu, the Identity Youth executive director. "So now we're trying to deploy these young people to begin to do outreach about vaccinations."

The ambassadors, Uriburu says, can help people get past barriers to getting the shot. They might help set up Uber rides to vaccination sites, for example, or document the reasons why some people remain hesitant. This hones Identity's specific understanding of the sources of hesitancy. Uriburu envisions setting up focus groups with hesitant youth to help workshop solutions. Then they'll go back and do it all over, time after time.

"We'll do it again and again and again," he says.

Uriburu says he's been pleased with how responsive and collaborative county leadership has been in trying to serve immigrant and marginalized communities through the pandemic. But even with strong government support, he worries about the capacity of his staff to continue and scale their vaccine work, on top of everything else they are doing to help some of the hardest-hit communities in the county recover from the pandemic.

"My colleagues at Identity, we have asked them to put their shoulder in and to work hard," Uriburu says. "They're working at a rhythm that is unsustainable."

More and more vaccine clinics across the region are offering shots to walk-ups as well as scheduled appointments, as vaccine supplies surpass demand for shots. Tyrone Turner/WAMU/DCist hide caption

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Tyrone Turner/WAMU/DCist

And through the resource-intensive work that local governments are doing to boost vaccine access for the most marginalized, some point to a twinge of resentment, too.

Del Pielago says he recently spoke to a D.C. public housing resident he organizes with who hasn't received a shot — even though she tried to get an appointment as soon as she was eligible, when demand for the vaccine was far greater than supply and D.C. appointments were difficult to secure. That experience, he said, soured the entire process for her.

"[She] said, 'Yeah, a couple of months ago I tried to get a vaccine, and I said I was a frontline worker, and they denied me. And now they're reaching out to me, asking me to come get it,'" del Pielago says. "And, you know, she was feeling not comfortable with that. That wasn't sitting right with her that at one point when she proactively tried to seek out the vaccine, she was denied."

The D.C. Housing Authority worked with DC Health and hospitals to bring the vaccine directly to senior public housing buildings — an effort del Pielago says deserves praise. But, he adds, the agency didn't bring the vaccine to every single one of its buildings — and its successes with the vaccine exist against a larger backdrop of neglect for residents' health.

"Folks are taking a risk just living in these deplorable homes," he says, referencing the Housing Authority's ongoing struggle to repair an immense backlog of maintenance issues — and its failure to fix lead paint hazards on time in many of its apartments.

Elliott points out that the push to get Black and Latino residents access to health care in the form of vaccines, while incredibly important, also raises questions about motivation. The need for more and better health care has long-existed for Black people and immigrants in the D.C. region, but a concerted effort to bridge the gap is in some cases only arriving now.

"The imperative to reach out to these communities is because the rest of the world — or the rest of everybody else's activities — were put to a halt, " Elliott says. "If it didn't impact everybody, [do you] really think that this would be this massive event?"

This story is from DCist.com, the local news website of WAMU.

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