Barnett Harris has been talking about the COVID-19 vaccine for months — to his friends, his colleagues at Pittsburgh Mercy and to the individuals who roll through the clinics he helps set up across Pittsburgh.

In the process, he’s gotten shots into the arms of people who otherwise would’ve been hesitant. But if you ask him, he’s not convincing anybody to get the vaccine — he says he does more listening than talking. In communities where pockets of misinformation and mistrust about the vaccine remain, he offers the facts, and more importantly, one-on-one conversations.

“It comes down to people needing to be heard,” said Harris, a senior manager for community engagement at Pittsburgh Mercy.

This community-centered approach to vaccine distribution has helped advance the rollout in otherwise underserved neighborhoods. Now, with over 52% of the county fully vaccinated, those same methods may become essential to reaching the elusive goal of herd immunity. 

Allegheny County’s vaccine rollout has slowed from its peak in mid-April, when an average of over 15,000 residents received a vaccination every day. Since then, that number has fallen steadily to about 1,000. The same is true on the state level, with fewer than 15,000 Pennsylvanians per day getting an injection compared to over 100,000 per day in late March and early April. That slowdown has continued despite the arrival of the more contagious Delta variant, which has prompted new urgency for vaccinations and door-to-door outreach backed by President Joe Biden. 

With appointments at mass distribution sites going unfilled, local organizations say these one-on-one, community-based vaccine outreach methods are becoming more crucial than ever. And as challenges surrounding vaccine accessibility and hesitancy mount, the Allegheny County Health Department [ACHD] is looking at all strategies to increase the number of shots distributed.

The intersection of hesitancy and accessibility

A significant share of vaccine holdouts fall into two groups: those who don’t want to get the vaccine, and those who haven’t been able to.

These two issues — hesitancy and accessibility — will play a key role in the second half of the rollout, experts say. In Pittsburgh, community organizations have been working to confront both issues in the communities they serve.

“We are at a stage where it really is about hesitancy, but having ready access is important to address those hesitancy concerns,” said Dr. Tracey Conti, program director of UPMC McKeesport and a member of the Pittsburgh-based Black Equity Coalition. 

Accessibility challenges are compounded by the fact that those who face barriers to vaccination, such as the homebound, are often more vulnerable to COVID-19.

Demand for at-home vaccinations has remained high throughout the rollout, according to Bill Connolly, mission director for Pittsburgh Mercy. Around two months ago, the nonprofit began shifting its focus to vaccinating individuals who weren’t able to travel to its flagship clinic on South 9th Street, with over 110 at-home vaccines administered as of June in partnership with The Midwife Center for Birth & Women’s Health.

“There are plenty of individuals who can’t leave their homes, that rely on people coming into their homes to take care of them,” Connolly said.

Other individuals, such as people experiencing homelessness or those with mental illnesses or intellectual disabilities, may be reluctant or unable to enter large-scale distribution sites. Those groups could be more comfortable receiving the vaccine in a smaller, more personalized setting, where their needs are accommodated, Connolly said. 

“There needs to be a focus on all vulnerable populations, and their accessibility to the vaccine,” Connolly said. “I see that need remaining, and remaining consistent.”

The entrance to Casa San José’s Covid-19 walk-in vaccination clinic next door to their main office. (Photo by Nick Childers/PublicSource)

Pockets of vulnerability

Disparities in vaccine uptake have also proven to be deeply tied to race, geography and trust in the institutions spearheading the rollout.

A Spotlight PA investigation found the state is leaning on community-based organizations to help shrink a “significant gap” in vaccine distribution between white communities and communities of color across Pennsylvania. In neighborhoods where a significant portion of the population is reluctant or unable to get vaccinated, that difference can leave the entire community vulnerable to the continued spread of COVID-19.

In a June 30 COVID-19 briefing, ACHD Director Dr. Debra Bogen said the county is analyzing vaccination data to pinpoint underserved communities. While the process is ongoing, early indications show residents of the Mon Valley, as well as people of color — especially Black and Asian residents — have lower vaccination rates, Bogen said. 

This disparity has also been an issue in Allegheny County’s immigrant and refugee communities, which have faced unique challenges in the rollout, including their own reasons for vaccine hesitancy.

“Not everybody received information in a timely fashion, and that is just because most things were coming in English,” said Khara Timsina, executive director of the Bhutanese Community Association of Pittsburgh [BCAP], which has provided education and resources to Allegheny County’s predominantly Nepali-speaking Bhutanese refugee community. “What those vaccines are, how the vaccines work, what kind of vaccines are available, the safety concerns related to the vaccines — when these things are not available in their language, that is a challenge.”

For residents who don’t speak English, the challenge was a lack of information. The task of translating and distributing facts surrounding every new vaccine type fell to Timsina’s team and others like it. 

Once the weather turned warm, Timsina worked with local healthcare providers and the health department to bring mobile vaccine clinics to Bhutanese neighborhoods south of Pittsburgh, then promoted the openings by phone to over 1,000 refugees. 

Now, Timsina estimates 80% to 90% of Allegheny County’s eligible Bhutanese population has received the vaccine, partially thanks to the BCAP’s ability to promote vaccine availability in a community already anxious to receive a dose. He realizes other underserved communities may not have been so organized, so eager or so quick to trust the institutions behind the rollout.

Claudia Sanchez, Health Care Navigator at Casa San José, speaking with Alex Castaño after his vaccination shot. (Photo by Nick Childers/PublicSource)

Trust is a challenge Claudia Sanchez has encountered often as health care navigator at Casa San José, which serves Pittsburgh’s Latinx community. 

Questions about required documentation or whether the vaccine carried a price tag created confusion, which in turn stoked mistrust, she said. 

County and state authorities have expanded Spanish-language vaccine information, but concerns linger. And in the absence of widespread Spanish-language media in the Pittsburgh area, countering misconceptions has proved difficult, Sanchez said.

“Trust is built with language,” she said. “It’s difficult to trust something that you don’t understand, that you cannot read, that you cannot hear.”

Casa San José worked with other organizations and health providers to provide transportation, coordinate clinics and walk community members through every step of the process.

For communities like those BCAP and Casa San José serve, progress is coming, incrementally, with every new dose. But the threat of the virus will remain until everybody in every community buys in, Timsina said.

“We are not safe until the rest of us, the general community shows interest and gets vaccinated,” he said

Meeting people where they are

Mass distribution sites, while effective early in the rollout, can only do so much. Vaccine clinics in smaller, more familiar settings in underserved communities reach groups larger sites didn’t.

State and local health authorities have been engaged in these community-based outreach efforts since fairly early in the rollout, with tools such as mobile clinics and pop-up vaccine sites. 

Initially, Harris of Pittsburgh Mercy felt health authorities were slow to leverage the expertise of community organizations working on the ground to fill gaps in the rollout — especially because organizations like his are well-equipped to identify areas of need.

The county health department has continued to provide transportation and at-home vaccinations to those who need it, in addition to staging vaccine events across the county, Bogen said during the June 30 briefing — though she noted the events rarely see more than 10 people per day. 

The department is also expanding its cooperation with community leaders and local organizations.

“We will explore and consider the most creative and innovative messaging and outreach opportunities,” Bogen said.

For some county residents, the decision to get the vaccine is also a matter of convenience — whether they can get it on their time, on their terms. 

Leighann Bacher, who helped create the grassroots group Get Pittsburgh Vaccinated, stressed the importance of convenient access.

“If they’re at their doctor’s office, they would get it, but they wouldn’t go out of their way to schedule an appointment,” Bacher said.

Get Pittsburgh Vaccinated now has just shy of 40,000 members on its Facebook page, where residents post evidence of its impact. In one post, a user thanks the group for helping her family get vaccinated at a local pharmacy chain. Another said her vaccine-hesitant boyfriend decided to receive a dose after the group advertised a nearby walk-in clinic, leaving him with “no more excuses” not to get one.

Get Pittsburgh Vaccinated has also become a destination for people who are homebound and looking to secure at-home vaccine appointments, serving as a link to local pharmacies and organizations, like Pittsburgh Mercy, that provide doses.

The impact of individual decisions can ripple through a community. And if one person in a neighborhood gets the vaccine, Harris said, others are more likely to follow suit. 

Community organizations can be the catalyst.

“The domino effect goes both ways — positively and negatively,” Harris said. “If we can impose on that in any way shape or form, I’m OK with that.”

Chris Hippensteel is an editorial intern for PublicSource. He can be reached at christopher@publicsource.org.

This story was fact-checked by Catherine Taipe.

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