When I heard the news that the COVID-19 vaccine would be opened up to people 65 and older in Pennsylvania, I felt a mixture of relief and dismay.
Relief, because as a recently retired, longtime public health nurse, I knew that getting this vaccine into the arms of the older population who are at the greatest risk for serious complications and deaths is part of the critical first phase of quelling the pandemic.
Dismay, because my experiences working with the most underserved populations in Allegheny County for nearly 20 years have made me acutely aware that 21st-century necessities such as smartphones, internet and computers are out of reach for a number of low-income people, especially older ones.
The Allegheny County Health Department has vaccination clinic sites in Monroeville and Castle Shannon. Their system relies predominantly on online signups for quickly disappearing appointments. Limited phone registration made little progress in reducing access barriers.
The department also proposed that people unable to get an appointment at the clinics should try to find appointments through the state-sponsored online registration tool that identifies other providers giving vaccines around the state. While the state has recently ordered that all sites provide phone numbers for signups, I fear that still falls short.
Health systems that prioritize people who are able to go online for hours, hunting for scarce vaccine appointments, are creating barriers for vulnerable people who often have spent most of their lives pressing their noses against the window of a healthcare system that doesn’t seem to care about them.
This is not hand-wringing conjecture. I am currently working part time for Project Destiny Inc., a community social services nonprofit located on the North Side. Because I am the organization’s only registered nurse, I tend to get folks referred to me who are older, low income and have complex health issues. Overwhelmingly, they don’t have computers in their homes, nor do they have smartphones.
Let me describe an individual who was recently referred to Project Destiny and assigned to me. I will call him Mark. He is only 58, but has been out of the workforce for a while due to a failing heart. He lives with his 82-year-old mother who has a host of medical problems herself. They told me with gratitude and satisfaction that they have enough food and no overdue utilities, but there is no internet and computer in the home. They manage on fixed incomes, but limit their expenses. As Mark told me, “All I need is a flip phone.”
I asked whether he would like to see his mother get a COVID-19 vaccine. First question — “How much will it cost?” When I replied that there was no cost, he asked how it could be arranged. I told him that the appointment had to be scheduled online. He gave a sardonic chuckle, “Well, that’s not going to happen.” I asked if there were family members who might be able to do it and he answered, “Yes, but they are very busy with their own families. I’m the one who takes care of Mom. She is my responsibility.” I wanted to end the conversation on a more optimistic note and said that if I heard that vaccinations were available at a site near their home, we could try to get his mother there.
While the department recently mandated phone-based signups, the change is more than a month too late, and those struggling to sign up by phone are still competing with people able to quickly snag appointments posted online.
On Jan. 11, a virtual town hall meeting about COVID-19 took place with then-Secretary of Health Dr. Rachel Levine. In addition to reporting the latest confirmed cases and deaths, she detailed the efforts to distribute vaccines and directed the participants to the Getting the COVID Vaccine online registration tool. Participants were encouraged to ask questions, so I asked whether other means to register for vaccine appointments such as telephone hotlines were being considered. Dr. Levine responded that there were no plans for setting up phones because older residents without computers can get family members to register them for appointments.
Yes, Dr. Levine was correct to a degree. I am sure that many adult children and grandchildren will be happy to make the time-consuming effort to secure online appointments for their older loved ones. However, there is a problem with that approach. It presupposes that all older adults, even low-income vulnerable ones, have family members who have ample time to devote to finding elusive, online vaccine appointments.
Based on years of work in the community, I know that low-income, vulnerable elders sometimes have children and grandchildren facing similar stressful social and economic constraints. The pandemic has exacerbated this situation. It has taken a disproportionate toll on women and people of color — more job loss, more financial hardship, more stress with trying to get their kids to do online learning and so on.
Is it realistic or, more importantly, equitable to expect that these families who may be working demanding frontline jobs or trying to work from home while overseeing their children’s virtual education now have to add extra strain to their chaotic lives by playing online vaccination appointment ‘Whac-A-Mole?’
Add to this the fact that one of the major resources for low-income city families are libraries, which have been closed for months, except for pick-up and drop-off. Library computers and the assistance of librarians were a vital lifeline to the outside world and now that has been cut off for vulnerable residents.
Project Destiny, where I work, was founded in 2004 by Reverend Brenda Gregg to help serve the needs of struggling families in the North Side, although they serve anyone regardless of location. Despite the limitations imposed by the pandemic, Rev. Gregg and her team have found creative ways to respond to the many challenges facing their families. They have been working tirelessly to partner in the distribution of food, assisting families in caring for their young children while parents must work, working to assist children in virtual education, as well as offering free flu vaccines and COVID-19 testing. The latest challenge is getting the COVID-19 vaccine to their older constituents who are now eligible.
Concerning vaccine distribution efforts, Rev. Gregg said, “It will take all of us, working together to plan a system that is clear and simple as possible for all people to access. We must make this the highest priority as we have done with getting food to our families.
“The system must be equitable in getting vaccines to the community. The system cannot be about access through those you know, rather than for all our residents. We cannot have our most vulnerable residents worried about whether they can ever get their vaccine. We cannot have people driving all the way to Erie to receive a vaccine shot and we know this is happening right now. This is just not acceptable at all.”
Rev. Gregg co-chairs the Faith-Based Health Collaborative, which includes 60 affiliated churches throughout Allegheny County and extends into Beaver County. She notes that thousands of church members from the collaborative reach out to church leaders, trusting that their churches will help them navigate the complicated healthcare system. “Our community-based network of churches wants to be a part of the solution,” Rev. Gregg said. “We will open our churches, our offices, our buildings as we do currently with offering flu vaccines and COVID-19 testing.”
In 2019, my final year as a public health nurse at the Allegheny County Health Department, a strategic plan was issued. The plan identified five strategic priorities deemed as critical to the department’s mission: innovation, policy leadership, health equity, community engagement and workforce/infrastructure.
All are important, but health equity is near and dear to the heart of this public health foot soldier. If we look at challenges and problems through the lens of health equity, we can figure out solutions to barriers. If our most vulnerable residents are having sustained difficulty accessing online vaccine appointments, then let’s organize a massive phone bank.
The effort from the county and United Way to use 2-1-1 to register people for vaccination was a welcome step, but I am afraid my experience with the phone system was probably not unique.
I tried calling at noon on Feb. 4 to see if I could get an appointment for my sister-in-law. I called five times and received a busy signal. I was willing to hold, but each time, I was disconnected after a minute or two. Finally, at 12:20 p.m., I gave up. If I gave up, I imagine others gave up.
Yes, I am glad that that 750 people got through and got appointments, but this is not what I have in mind for a robust, user-friendly phone bank. It must have extra capacity for multiple phone lines and tons of volunteers to answer the phones. Back in the day, candidates running for office set up their campaign headquarters with numerous volunteers to answer multiple phones to take donations. Why can’t this be done on a more massive scale for the vaccination effort?
I envision dedicated volunteers who will talk with compassion to fearful and frustrated residents. If there are no appointments available at the moment due to lack of vaccine, we can take down names, ages, addresses and numbers and make lists of people who will be called back when the vaccine becomes available in their area. Then we can call these people back with good news.
Yes, phone banks with multiple lines are expensive, but it can be done with the support of local foundations and money from government pandemic funds. COVID-19 is the biggest health crisis we have faced in decades. I am willing to volunteer for the vaccine phone bank. I know others are willing to step forward, too. Let’s do this.
Lorraine Starsky is a registered nurse. If you want to send a message to Lorraine, email firstname.lastname@example.org.