Closing the COVID vaccine gap: Small clinics at churches and apartment buildings reach vulnerable residents

Joanne Bennet eagerly slipped off the blue jacket covering her right arm so a nurse could inject a dose of COVID-19 vaccine. Bennet was all smiles, despite a dislike of needles, sitting in a chair in a community room of her own apartment building.

"It'll be nice to get back to a little bit of normal after being incarcerated," said the 68-year-old resident of Bolton North apartments in Midtown Baltimore. "I call it incarcerated, but it was really me spending the past year in my apartment."

Four months after vaccinations began, everyone in Maryland age 16 and older is eligible, and tens of thousands of people are getting shots daily at mass vaccination sites, pharmacies and elsewhere.

Some like Bennet qualified weeks ago because of their age or health condition, but still hadn't been vaccinated for reasons public health officials are struggling to understand and address. Such lapses not only threaten the lives of some most at risk from the virus, but potentially are delaying the pandemic's end.

So health and government leaders have begun targeting pockets of underserved older adults, African Americans, non-English speakers and the disabled. They are running small clinics in apartment buildings and churches and using mobile vans. They're even going door-to-door.

"We're about that strategic, on-the-ground tactical operation, getting shots in arms in people where they are," said Maryland National Guard Brig. Gen. Janeen Birckhead, who heads the state's Vaccine Equity Task Force.

The tactics in some ways mirror early efforts, when vaccinators went to nursing homes to stem the tide of hospitalizations and deaths from COVID-19. Close to 80% of older adults now have gotten at least one dose of vaccine.

But those efforts weren't aimed at the homebound or others living outside institutions. And mass vaccination efforts often aren't reaching minority groups. White people in Maryland are still getting vaccinated at a much higher rate than Black people. Latino Marylanders, about 10% of the population, have received under 6% of the immunizations.

In places prioritizing equity, the disparities are less severe. Baltimore City, which Gov. Larry Hogan once blasted for its vaccine distribution, has vaccinated a higher proportion of Black people than nearly every other county, according to state data.

Equity has been such an issue nationally that a group of Yale University professors recently proposed holding clinics at Dollar General stores because they "would greatly decrease the distance to vaccines for both low-income and minority households." These vaccination efforts are not just challenging, but also more labor-intensive and expensive.

State and federal regulators are beginning to step up their efforts to reach groups who haven't been served. Ten Maryland hospital systems have applied to a recently created state program funded with $12 million raised from patient billing. And local health departments will get the bulk of $54 million allotted to Maryland to help distribute vaccines to underserved populations from the recent COVID relief bill.

Some health departments say there is work to be done before they schedule clinics. National surveys show hesitancy remains a problem, though more so now among rural Republican men than African Americans.

Health workers in conservative Harford County, for example, said they have maintained consistent messaging on social media in an attempt to eliminate the skepticism they say derives from misinformation. Others are relying on church leaders, family doctors and other trusted community leaders to allay concerns about vaccinations or specific vaccines.

Dr. Michael Kiritsy directs a vaccine outreach program for LifeBridge Health, parent of Sinai Hospital in Baltimore. He sends vaccination teams to places identified by local health departments, down to specific apartment buildings, including Bennet's Bolton North. They vaccinate anywhere from a few to a few hundred people a day—reaching much smaller numbers than the thousands at mass clinics.

Some recipients are without transportation, computers or the wherewithal to get and keep an appointment, while others are unsure they want to be vaccinated and haven't tried.

"Many of these people certainly would have qualified for vaccination earlier, but they faced a variety of barriers," Kiritsy said. "We reach out and bring vaccine to them."

Bolton North apartments

The seniors who live in this apartment building on West Mount Royal Avenue are mostly Black and Korean. Many don't speak English or drive, and some have health conditions, issues that make it important but difficult to be vaccinated.

Gina Stritch, resident services coordinator, called around for help. LifeBridge Health responded with staff and coolers of the Moderna vaccine for about 100 residents.

A Korean-speaking oncology nurse, Young Kim, volunteered to do the vaccinations because she felt the residents would be more comfortable, especially if they had questions. She gently reassured a nervous Bennet as she plunged a needle into her arm, though Bennet said there was no question of getting vaccinated.

"I got vaccines in the '50s for polio and all that," Bennet said. "I prayed on it."

She did have some stipulations. She did not want Johnson & Johnson's one-dose vaccine, with lower reported efficacy than the two-dose Pfizer/BioNTech and Moderna vaccines. And no long lines. She'd already turned down an appointment her doctor offered at a clinic in Columbia for that reason.

"With my asthma, I wasn't going to wait," she said.

Regina Williams, 76, said she hadn't gotten a vaccine yet because her doctors hadn't yet offered her one, despite qualifying because of her age.

She said the in-house clinic at Bolton North also worked out better because she was able to assist her neighbor. Williams arrived arm-in-arm with the woman and they were vaccinated one after the other.

"My family made me stay with my daughter for 3 months, and I only got to go on the porch and in the yard," Williams said. "It'll be a relief to be more social."

Bilingual Christian Church of Baltimore

At the Bilingual Christian Church of Baltimore, Bishop Angel Nuñez spent Friday night racing around the facility, where a vaccination clinic, boxed meal giveaway and hiring event were underway.

Nuñez worked with leaders on the state's Vaccine Equity Task Force to hold the clinic at the East Baltimore church, where 120 people preregistered for appointments and others walked up hoping for extra doses. To Nuñez's distress, some had to be turned away.

The charismatic church leader had worked with parishioners to find people in need of vaccines, then worked to register them. He also called fellow bishops and pastors of other Spanish-speaking churches so they could get shots and pass the word.

The process was taxing, Nuñez said—but worth it.

"I'm seeing hope in the eyes of the people," he said. "I'm happy I'm seeing the results."

Luz Candelaria, a grandmother to eight, contracted the coronavirus in June. She had problems finding a vaccine online and through her doctor's office, despite qualifying for a shot months ago.

She found this appointment through her daughter, a church member. Others she knows have been out-of-luck or frustrated by long commutes necessary for two separate vaccine trips.

Candelaria lives nearby and will be back for a second Moderna dose in May.

Such community vaccination clinics run by the task force are delivering about 7,000 doses a week, officials said.

Despite the church's success at drawing people in, Dr. Dana S. Simpler, the site's head clinician, said she looked forward to offering doses in her office. There she could address concerns in more resistant patients.

"Sometimes I can't talk them out of" their objections, she said, "but most times I can."

Southern Baptist Church

The people lined up outside Southern Baptist Church in East Baltimore last Saturday morning wrapped around the building onto North Chester Street. Johns Hopkins Medicine and the Baltimore City Health Department had signed up about 400 people for immunizations ahead of time but left the door open for walk-ups.

Within hours, they anticipated giving 600 shots.

Leroy Key, 59, had been at home just down the street when a friend, who was one of the 4,000-plus members of the church, texted him about no-appointment vaccinations. Key had signed up at the mass vaccination site at M&T Bank Stadium but was having second thoughts. The vaccine is still new, he said, "that's what makes me apprehensive."

But Key hadn't been able to hold his latest grandchild born just two months ago and, if he gets his second dose on time, that could happen for the first time on his 60th birthday.

Less than two hours after receiving the text message, he rolled up the sleeve on his gray collared shirt.

"The only thing driving it is my grandchildren," he said.

For some the decision came down to opportunity, and for others it was the messenger: Bishop Donte Hickman Sr., who had been advocating for church-based clinics almost since vaccines arrived in December.

He heard from congregants what health and government officials are finally understanding: Vaccine hesitancy wasn't keeping certain African Americans from being vaccinated, access was.

"When science and doctors can't be trusted, people have always looked to the community of faith, their churches, to find the right and trusted answer," Hickman said.

Bernard Segar thanked God, and the reverends and the pastors who "brought it to attention."

Segar, 56, heard about the Southern Baptist clinic from friends after believing the odds were low of getting an appointment through the state's system, originally only online. Segar said he's "illiterate to the internet," but here he could get critical protection for himself and his 81-year-old mother.

Segar moved through the line quickly from sign-up to shot to a 15-minute observation period, which Segar spent in a church pew.

"I'm going to let some other people know, too," he said.

That word-of-mouth advertising may help the city achieve its goal of vaccinating 80% of residents—with many people inoculated at sites other than large vaccination clinics.

"You might not have the kind of schedule where you can plan something in advance," said Dr. Katie J. O'Conor, Hopkins' director of community vaccination clinics. "Maybe you didn't hear about it, maybe you don't even have a phone.

"And maybe you just happened to hang out around here, and if you see this happening, we can get you vaccinated."

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