A Tale Of Three Cities: Lessons Learned From COVID-19 Vaccine Mobile Clinics
A Tale Of Three Cities:
Lessons Learned From COVID-19 Vaccine Mobile Clinics
Written by: Jasmine Y. Gale, Ali Khan MD, MPP, Nida Al-Ramahi MHA , David Velasquez, Suhas Gondi, and Alister Martin, MD, MPP
Editor: Emily C. Cleveland Manchanda, MD, MPH
The COVID-19 pandemic laid bare persistent inequities in U.S. health care. Historically marginalized groups, including Black and Latinx populations, had significantly higher rates of COVID-19 infection, hospitalization, and mortality compared to white populations, a consequence of decades of structural racism. Among the many factors underpinning these disparities was the distribution of public health resources. State-run COVID-19 testing centers, for example, were predominantly located in majority white communities, despite minority communities experiencing a disproportionate burden of the pandemic. Similar inequities have affected COVID-19 vaccine distribution; people of color have demonstrably worse access to vaccination centers than their white counterparts, and remain vaccinated at significantly lower rates throughout the U.S. To combat these disparities, three independent groups (led by the authors of this writing) in Boston, Philadelphia, and Chicago created hyper-localized COVID-19 vaccine mobile clinics. Here we describe cross-cutting lessons from our experiences in the hope that our learnings can be applied to other COVID-19 vaccine outreach efforts and to equity-focused mobile health clinics more broadly.
GOTVax, A Grassroots Campaign in Greater Boston
GOTVax is a Boston-based initiative that applies get-out-the-vote tactics to increase COVID-19 vaccination rates in communities of color. This group works with physicians, students, community-based organizations, electoral campaign staff, public housing managers, community health centers, and a supply chain company to bring COVID-19 vaccines to communities of color. GOTVax conducts three rounds of outreach--text messaging, phone calls, and door knocking--to register community members for a vaccine slot. So far, GOTVax has delivered 6800 vaccines via pop-up clinics in the Greater Boston area; over 80 percent of those vaccinated have been people of color.
Various lessons have emerged from the GOTVax campaign. First, while organizers expected significant hesitancy, they rapidly learned that access barriers were more important drivers of low vaccination rates. These barriers – faced disproportionately by people of color in low-income neighborhoods – included lack of technology, unreliable transportation, limited physical mobility, and language gaps. While GOTVax volunteers encountered some hesitancy during door-knocking and other forms of canvassing, the number of these interactions was limited. Second, leveraging political campaign strategies for vaccine outreach was highly effective. Old-fashioned door knocking proved critical to reaching older adults, people with disabilities, and people of color who suffer from the digital divide. Using relational organizing to encourage people to personally engage unvaccinated friends and family shortly after receiving their shot – a strategy crafted based on the well-studied practice of vote tripling – helped expand GOTVax’s impact in the communities it served. Third, GOTVax noticed the tremendous value of developing community partnerships. Leveraging trusted community messengers, such as unions, nonprofits, and local news outlets, allowed for culturally and linguistically appropriate vaccine education, which in turn bolstered clinic attendance. Having a diverse, multilingual volunteer base that included health professionals of color further promoted trust between GOTVax and the community. Finally, GOTVax recognized the importance of fostering team cohesion through occasional social events. These events allowed volunteers to develop meaningful relationships with one another that built the foundation of an understanding support network.
Oak Street Health, an Innovative Primary Care Practice in Chicago
Oak Street Health is a national network of value-based primary care centers focused on managing the care of over 110,000 Medicare beneficiaries. Headquartered in Chicago, Oak Street cares for nearly 50,000 Medicare beneficiaries across 21 centers in its hometown and in Chicagoland – nearly all of whom reside in majority Black/Latinx communities with high social/community vulnerability index (SVI) scores and disproportionately high rates of COVID-19 cases and deaths. Near the peak of the pandemic, Oak Street Health partnered with the city of Chicago, Cook County and other county health departments, public health officials, community-based organizations (CBOs), health systems, and civic partnerships such as Protect Chicago Plus and the Chicago Vaccine Corps to vaccinate residents within and outside of their network.
To do so, Oak Street Health deployed a proactive, multi-channel engagement strategy to register those residents, using Internet-based, text-based, telephonic and mobile team outreach to canvas hard-hit communities of color, register them for vaccinations and provide on-the-spot scheduling into Oak Street’s multiple community vaccination clinics. Those hyperlocal clinics – based in easily accessible community centers at hours convenient for and desired by local residents, including evening and weekend hours – ranged from church-based to Oak Street center-based to mobile units delivering care in public housing and senior living facilities. Through deep partnerships with over 50 community-based organizations, Oak Street leveraged trusted channels and messengers alike to amplify registration efforts, as exemplified in their work in the Belmont-Cragin neighborhood on Chicago’s Northwest Side. There, as part of Protect Chicago Plus, Oak Street led a community coalition that vaccinated nearly 10,000 residents of Chicago’s neighborhood hit hardest by COVID-19 in just eight weekends. So far, Oak Street Health has administered over 250,000 vaccines across 12 states, with over 150,000 administered in Chicago and greater Chicagoland. Of these, over 85% of vaccines went to communities of color with medium to high levels of social vulnerability.
Although Oak Street Health is a much larger, well-established organization than GOTVax, its key takeaways are complimentary. When registering community members for the COVID-19 vaccine, Oak Street Health noticed that traditional sign-up processes—those requiring internet access and digital literacy—impeded access to the COVID-19 vaccines. Simplifying the scheduling and registration process through the deployment of both analog (community canvassing and telephonic outreach) and digital (Web-based and text-based) methods of registration became instrumental to their success. Similar to GOTVax, Oak Street Health also found that developing a network of trusted community partners helped address some of the structural barriers that affect its target population. They formed critical partnerships with a mix of prominent CBOs, interfaith partners, local governmental partners (such as city aldermen and state legislators), cross-sector governmental partners (such as Chicago Public Schools and local housing authorities), local businesses, other community health providers and higher education institutions. Oak Street equipped each partner with tools to conduct simplified outreach and immediately schedule vaccine appointments for anyone in their networks – removing the need for additional hand-offs or extraneous steps to secure that appointment. Finally, the scale of Oak Street vaccine operations required expanding its workforce. Temporarily lowering barriers to volunteering and streamlining the onboarding process (e.g., not requiring proof of a recent TB test, obtaining enhanced flexibility on active clinical licensure requirements, etc.) helped Oak Street rapidly secure a workforce of over 500 volunteers to meet the labor needs of its vaccine operation.
Mercy & Penn Medicine and The Community #VaccineCollaborative in Philadelphia
In contrast to GOTVax and Oak Street Health, the #VaccineCollaborative is a multi-health system community-partnered COVID-19 vaccination team operating in Philadelphia neighborhoods. This group is primarily composed of Penn Medicine (a large academic medical center), Mercy Catholic Medical Center (a community teaching hospital), and Black community faith leaders. Together, the #VaccineCollaborative stands up mobile clinics throughout the heart of Black neighborhoods. They leverage a low-tech, hybrid automated text message and phone-based intake platform. Their pre-clinic process includes engaging with Black community faith leaders in discussions around the COVID-19 vaccine. These faith leaders received a COVID-19 vaccine at the organization’s first clinic as a visible demonstration of vaccine endorsement. They later operated as trusted messengers by holding informational sessions with churchgoers. So far, the Mercy & Penn Medicine and the Community #VaccineCollaborative have administered 7500 vaccines to community members, 85 percent of whom were Black.
Similar to GOTVax and Oak Street Health, this multi-health system community partnership recognized the importance of low-tech solutions. They deployed an accessible sign-up process that could be accessed through text messaging and automated phone calls. Local partnerships were again a central part: engaging Black community faith leaders with a deep understanding of community desires and preferences were essential to building trust between large health systems and the community. One salient concern for organizers in this initiative was the mental health of their workers, many of whom had been frontline workers or otherwise personally affected by the initial waves of COVID-19. The #VaccineCollaborative took particular care to design volunteer shift schedules to minimize burnout and promote wellness (e.g., avoiding back-to-back shifts).
Collective Lessons From The Field
Although different in scale and form, GOTVax, Oak Street Health, and Philadelphia’s #VaccineCollaborative each sought to overcome vaccination barriers in communities of color. Several cross-cutting themes emerged. Each group reports that access to the COVID-19 vaccine remains a critical issue, and implementing low-tech scheduling and registration systems helps address limited access. The importance of engaging community leaders and partners--from faith leaders to clinicians--to bridge the information and trust gaps was a universal finding. Lastly, each group highlighted the importance of taking care of their own workers. This ranged from lowering barriers to volunteerism to preventing burnout once volunteers began working. Regardless of the group--a grassroots organization, primary care practice, or academic medical center--these collective lessons may aid advocates, policymakers, and clinicians in their work to advance health equity and end the COVID-19 pandemic through targeted vaccine outreach in the hardest hit communities.