Cities

Lessons from the Vaccine Rollout: Harnessing Proximity in Healthcare

New Yorkers wait in line outside Yankee Stadium to get their vaccinations. | Photographer: Steve Sanchez Photos | Source: Shutterstock

In the beginning, there were stadium sites.

America’s vaccine rollout kicked off with the repurposing of sports stadiums and their parking lots for walk-up and drive-through inoculations.

In New York City, mass vaccination sites, some piloting 24-hour schedules, were launched at Yankee Stadium in the Bronx, Citi Field in Queens, Manhattan’s Javits Center, and the Brooklyn Army Terminal. Los Angeles turned to Dodger Stadium. Miami utilized Marlins Park.

Nor was America the only nation to leverage a venue’s large size for a rollout location. Europeans headed to soccer stadiums and museums to get their shots. And in southern England, providers inside 800-year-old Salisbury Cathedral administered the Pfizer vaccine to British seniors while the church organist played Bach compositions and Broadway showtunes.

Salisbury Church in southern England—one of the many unique vaccination sites around the world. | Photographer: Nussar | Source: Shutterstock

But mega-venues, by and large, served those who could readily access the sites. To vaccinate people in non-urban regions, healthcare providers had to improvise alternative strategies.

Take southwestern Colorado, where Cortez-based Southwest Health System deployed “vaccine swat teams.” Its members traversed a sprawling, rugged service area to deliver doses to long-term care facilities and vaccinate the homebound and unhoused. Meanwhile, up in rural Alaska, tribal healthcare providers used bush planes, water taxis, and sleds hitched to snowmobiles to access patients, even giving Alaskans shots on a remote airstrip.

Citizen initiative marked an effort in Ruidoso, New Mexico, a mountain village of 8,000. The Fabulous Ladies Book Club, a group of working mothers, helped establish a pop-up vaccine site in a wellness spa. Logging up to 50 hours weekly, the women fielded hotline questions, assisted with appointments, and shoveled snow. In three short weeks, they helped 2,400-plus residents—roughly a third of the town’s adults, many of them seniors—get vaccinated.

New Mexico Leads the Way

New Mexico, as it happens, is a rollout exemplar. Throughout the spring, it had fully vaccinated more of its eligible population than any other state. As of June 9, it led the nation in terms of doses dispensed, with 94.79 percent of its available vaccine utilized. The state’s success comes despite the fact that it’s financially under-resourced, has the nation’s third-highest poverty rate, and ranks near the bottom in hospital beds per capita, one measure of healthcare provision.

So how did New Mexico do it?

Effective political leadership, robust state and local collaboration, and a vaccine urgency born of past public health struggles tell part of the story.

With vulnerable Latino and Native American populations making up 60 percent of state residents, New Mexico’s leaders knew they couldn’t afford rollout stumbles. A smart choice of technology partner aided the effort. In a state without local health agencies, the Department of Health hired a small Albuquerque software firm, Real Time Solutions, to design a statewide appointment and notification network. Instead of the crazy-quilt of scheduling platforms that impeded rollout in some other states, New Mexico residents logged onto a single, user-friendly portal in a centralized system.

Reaching the Unvaccinated

If vaccine supply and swift dispensation were the big challenges in phase one of America’s rollout, the focus now shifts to those who have yet to be dosed.

Slightly more than half of the total U.S. population has received at least one dose—a major milestone. But that leaves the other half—close to 156 million people.

To reach the resistant, the fearful, and the unmotivated, trust campaigns and incentive programs have proliferated. On June 2, the Biden Administration announced a “national month of action” in pursuit of an ambitious goal: To have 70 percent of American adults vaccinated in part or in full by July 4. White House partnerships with the private sector have resulted in incentives such as a CVS-run sweepstakes to win Super Bowl tickets, Xboxes distributed by Microsoft, and $5 online vouchers from Anheuser-Busch that can be redeemed for beer or another beverage.

Vice-President Kamala Harris is slated to go on a national tour, with an emphasis on lagging Southern states, to promote vaccinations. The tour, called “We Can Do This,” extends an April campaign of the same name that enlisted celebrities, athletes, community leaders, and religious figures to vouch for vaccines. And in response to data like a Quinnipiac poll finding 45 percent of Republicans might skip getting dosed, the first installment of “We Can Do This” recruited NASCAR as a partner and purchased ads on country music channel CMT.

Ohio governor Mike DeWine, in mid-May, famously announced that five immunized Ohioans, chosen by lottery, would each receive a whopping $1 million. Maryland and New York State quickly followed with lotteries of their own, and were joined by Colorado and all three West Coast states. Meanwhile, Maine offered fishing licenses and West Virginia hunting rifles.

Do vaccine “carrots” work? They do, says Professor Noel Brewer at the University of North Carolina, who analyzes human behavior from a public health perspective. He cites studies showing an eight percent average increase in getting people to “yes” when incentives exist.

On the trust front, states, municipalities, even individual physicians are doing their own public messaging. New Mexico’s “Trusted Voices” initiative features church leaders and other community figures. In tiny De Queen, Arkansas, Dr. Jason Lofton, a family doctor and county health officer, launched a series of local talks and posted Facebook Live videos attesting to vaccine safety and efficacy. In one video, he is shown receiving his second shot.

Politics-based vaccine resistance, something faced by Lofton in De Queen, is not easy to overcome. One of the brighter rollout stories has been the embrace of vaccines by tribal communities, from Navajo Nation in the Southwest to North Carolina’s Eastern Band of Cherokee Indians. Experts credit a communal ethic, reverence for elders, wise leadership, and health-system centralizing. But the news isn’t uniformly good, and ideology is part of the problem. In Osage County in northeastern Oklahoma, where Republican politics dominate, vaccine acceptance, even among members of the Osage Nation, has suffered.

Osage Nation member Shannon Shaw Duty, editor of the Osage News, wrote a powerful Washington Post column detailing her community’s vaccine hesitancy. The tribal health center, she says, is actively addressing the problem with “reservation billboards, print, TV, and online ads announcing vaccine events, and social media updates and videos.” However, Shaw Duty adds, “Our elected tribal leaders have not conducted a campaign to address hesitancy.”

The Vaccine Hunters of Epicenter-NYC

A new term arose in early 2021—“vaccine hunters.” These are citizens dedicated to helping others secure a COVID-19 shot. In the New York borough of Queens, a 200-strong team of such volunteers arose organically, and as rollout stories go, this one shines forth.

S. Mitra Kalita, an experienced journalist on a mission to get Queens, New York, vaccinated. | Photographer: Greg Kessler

The group emerged under the leadership of journalist S. Mitra Kalita, whose extensive media background includes stints as senior vice president at CNN Digital and managing editor at the Los Angeles Times. Cofounder of Epicenter-NYC, a pandemic newsletter launched in July 2020, Kalita also writes a column on the workplace and COVID-19 economy for Fortune magazine.

The effort to help Queens residents get vaccinated began with Kalita and a couple staffers, following her own experience trying to book appointments for her parents. But thanks to word of mouth and social media, it wasn’t long before many dozens of New Yorkers were donating digital skills, foreign-language ability, problem-solving creativity, and time.

Tirelessly working their electronic devices, the volunteers helped elderly Chinese speakers, Latino restaurant workers with jammed schedules, immigrant taxi drivers, and people without computers or the time to slot-surf, lock down precious vaccine appointments.

And the group didn’t stop there. The volunteers also arranged transportation for people, helped others secure time off from work, handled paperwork, determined ease of site access for those with disabilities and the infirm, and in some cases even made it possible for Queens residents to get their shots alongside those they trusted most, like their family members and caregivers.

In late March, Epicenter-NYC published an influential online report detailing the digital, logistical, informational, and schedule challenges faced by New York vaccine seekers, while offering ideas to improve the city’s rollout. The report assembled valuable data and observations from the volunteers, and garnered attention from city officials and public health experts.

Though a diverse group of people, these volunteers had one thing in common—they shared Kalita’s sense of urgency, given the stakes for the city’s vulnerable and understanding that mass vaccinations, as Kalita puts it, were “the way we get to the other side of this crisis.”

As May began, Epicenter-NYC had booked a remarkable 5,000-plus vaccine appointments.

“It’s rare in life,” Kalita says, “when you have an opportunity to assemble a team like that—people who didn’t know each other and came together, all driven by the best of intentions. It’s made me think about how you unlock the good in people and apply it to desperate situations.”

Is there an aspect of New York’s rollout she would change, if she could?

“I’d be setting up way more community pop-up sites in places where people gather,” says Kalita, “instead of expecting people to get to a facility like a stadium. The truth about space in New York is that it’s hard to find, so mega-sites tend to be in less convenient places.”

Then she mentions a location, one she knows well: Diversity Plaza in Jackson Heights, which serves thousands of residents in her dense and vibrant multicultural neighborhood.

“I’d open a pop-up site there,” Kalita says, “on a Sunday at the end of restaurant workers’ shifts. These workers tend to have Monday and Tuesday off. So if anyone experienced side-effects from the shots, they’d be home, and wouldn’t have to ask for time off from their jobs.”

The Value of Proximity

The Biden Administration itself has pivoted to a focus on local, targeted outreach, emphasizing rural areas, Republican-leaning regions, and minority communities, such as the Latino population, where vaccine misinformation is proving an obstacle, especially among men.

On May 4, the White House announced increased federal support for neighborhood pop-up clinics, community-based vaccination sites, and mobile vaccine units. And in early June came the launch of “Shots at the Shop,” an initiative recruiting Black-owned barbershops and hair salons to operate as centers of trust messaging and even as hosts of pop-up vaccination sites.

Cities, too, are shifting away from big venues. In Milwaukee, the health department has been organizing one-day walk-in clinics at churches, taverns, and nonprofits familiar to local residents. And for four hours last month, even the Black Historical Society became a vaccine site.

The Sean Penn–founded humanitarian organization CORE (Community Organized Relief Effort) recognized early on the value of neighborhood-based approaches. Along with handling logistics at the Dodger Stadium drive-through vaccination site, CORE also sent mobile testing units—vans and trailer-pulling pickups driven by members of the Los Angeles Fire Department—to Latino and Black neighborhoods in East L.A., Watts, South Central, and elsewhere.

A line of cars full of people waiting to get their vaccination at the Dodger Stadium site. | Photographer: Ringo Chiu | Source: Shutterstock

And now, in partnership with provider Carbon Health, CORE is offering operational support to mobile vaccination units and community clinics in L.A., Chicago, and Atlanta.

All told, CORE has helped vaccinate more than 1.5 million Americans.

San Francisco-based Carbon Health has also partnered with REEF Health, a division of Miami-based technology and real estate firm REEF, which oversees more than 4,500 physical locations—parking lots and parking structures—that together create potential neighborhood hubs located within five minutes of 70 percent of North America’s population. Repurposing of many REEF sites is underway, with the land serving as anchors for neighborhood kitchens, sustainable last-mile delivery, vertical farms to supply local produce, and locations for community healthcare.

A 3-D rendering of a REEF Health site, an example of proximity in healthcare.

REEF and Carbon Health share a vision—reducing barriers to healthcare, not least in underserved and economically disadvantaged urban neighborhoods. One way to do this is to “bring healthcare to the block” by establishing micro-clinics, with REEF providing the property and logistics.

Going forward, these micro-clinics can be places to vaccinate kids and administer COVID-19 booster shots, as well as offer flu shots, pediatric and women’s healthcare, opioid addiction care, and more. Geographic inaccessibility disincentivizes those seeking healthcare, especially in marginalized neighborhoods where transportation and scheduling challenges are significant obstacles. Here, healthcare can be right down the street or around the nearest corner.

Author of the book Life After Favre, Phil Hanrahan is a Milwaukee-based writer and editor working on a book sharing the story of a pioneering art college in rural Ireland.

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