Frustration surged not long after the COVID-19 vaccine rolled out to the Clark County public in January.
Despite Clark County landing one of the state’s four mass vaccination sites, vaccine was still scarce, and plenty of people 65 and older struggled to find doses as they became eligible.
In that moment, excitement and optimism turned to frustration and pessimism for many.
In order to secure a jab, you needed a good internet connection, internet savvy and transportation to reach the Clark County Event Center at the Fairgrounds near Ridgefield, where most of the county’s vaccine allocation was shuffled.
It also helped mightily if you spoke English, and worked a job with flexible hours.
Compounding the issue was a vaccine allocation shortage to Clark County from the state that left the county thousands of doses shy of what its allocation should have been.
Some local health providers, more centrally located than the fairgrounds and with patients ready for doses, went weeks with few first-dose allocations, unable to vaccinate those in need.
What was initially promised as an equitable rollout turned into a lottery-like system that benefited those with free time, good internet and reliable transportation.
But as weeks wore on, and new populations were made eligible for vaccine, the process smoothed out. What seemed daunting in late January — everyone 16 and older eligible — not only became feasible, but even got pushed up to mid-April.
Not long after that, Clark County, and the rest of the U.S., hit a once-unthinkable point. Supply of vaccine outpaced demand. It’s now as easy as it has ever been to get a shot, but there are fewer and fewer takers.
National vaccinations have fallen from a peak of 3.3 million vaccine doses administered per day in mid-April to less than 2 million doses per day.
As Clark County Public Health Officer Dr. Alan Melnick told the Clark County Board of Health last month, local vaccinations have slowed considerably.
“We’ve got all these spots available and people are not showing up,” Melnick told the board of health.
The county and country’s vaccination efforts have reached a new, more difficult stage. Instead of people lining up in droves at mass vaccination sites, or hitting refresh trying to book an appointment, health providers, health departments and community organizations have to find those in need and inoculate them, said Melissa Martin, program manager for Public Health’s chronic disease prevention program.
“We have to make sure we are bringing the vaccine to places that need it,” Martin said.
Bringing vaccine to the people
The U.S. recorded a small boost in vaccination interest after those 12 to 15 years old were made eligible for the Pfizer COVID-19 vaccine last week.
That decision made an estimated 17 million people eligible nationwide for vaccination, but polling has shown that as many as 20 percent of parents don’t want their children to be vaccinated, and another 25 percent of adults say they don’t want to get vaccinated themselves.
Decline in demand means vaccine outreach will be critical moving forward.
Public Health, along with medical providers and community organizations, have been working on vaccine outreach for months now. Efforts have ranged from a web form to pair people to vaccine to more recently using pop-up vaccine clinics in neighborhoods that need inoculations and are at higher risk for COVID-19 and virus complications.
In early March, PeaceHealth Southwest Urgent Care in Vancouver hosted a vaccine clinic that inoculated nearly 700 people of color.
The drive was organized by PeaceHealth, Public Health, the NAACP in Vancouver, the Pacific Islander Community Association of Washington, Southwest Washington League of United Latin American Citizens Council 47013 and Odyssey World International Education Services.
The head of Odyssey World, Karen Morrison, said she and other people have been going around Clark County on foot trying to individually increase vaccine uptake.
Morrison will discuss concerns people have about the vaccine and leave flyers at restaurants, bus stops or even inside restrooms.
She said the individual connection seems to pay off.
“Our outreach needs to go further than assuming that everyone has a computer or social media,” Morrison said.
Jasmine Tolbert, president of the NAACP’s Vancouver branch, has worked with Odyssey World on the flyers and community outreach. Tolbert said they’ve gotten more than 1,000 flyers into the community.
Tolbert said her work in the beginning of the vaccine rollout focused more on creating access, but now she’s focusing more on outreach.
“We are having to switch our efforts around because people don’t want the vaccine as much,” she said. “It’s boots to the ground now. Folks are more open to get the vaccine if they are talking to a physical person about it.”
Joseph Seia, executive director for Pacific Islander Community Association of Washington, said PICA-WA is pairing Pacific Islanders to vaccination through a partnership with Kaiser Permanente.
Each Saturday, Kaiser’s Cascade Park Medical Office is reserving 40 vaccination appointments for Pacific Islanders. Seia said weekend appointments are easier for people to make because they don’t have to choose between work and vaccination.
Pacific Islanders can schedule appointments by calling or emailing Layla Afu, PICA-WA’s program director for Southwest Washington. She can be reached at 360-334-1322 and firstname.lastname@example.org.
Seia said PICA-WA has created its own standing and pop-up vaccine clinics, and with the help of medical providers, has vaccinated more than 3,000 Pacific Islanders across the state.
Seia said the fact that PICA-WA is leading the vaccination charge helps with access and trust.
“It’s about looking at a community and seeing them as an agent of vaccination in their own community,” Seia said.
Ed Hamilton Rosales, the president of LULAC 47013, has helped Public Health find areas for pop-up vaccine pods, as well as stressing the need to bring the vaccine to Clark County’s food processing plants.
Workers at Firestone Pacific Foods in Vancouver, which had the county’s largest outbreak, were offered a vaccine clinic earlier this spring. Public Health gave out close to 550 doses of the COVID-19 vaccine at Firestone and three other area food processing plants in late March and early April.
Public Health has since conducted pods in the Fruit Valley neighborhood in Vancouver and at Woodland High School in Woodland. Another pod took place at Hathaway Elementary School in Washougal on Saturday.
In all, Public Health has administered more than 3,000 doses at its short-term pods, and done dozens more inoculations for homebound and unsheltered populations.
Mobile pods have generally targeted areas with higher populations of people of color, more isolated areas, those on lower incomes or areas where more kids are on free or reduced-price lunch plans.
“For our community that’s a big deal,” Hamilton Rosales said. “We’ve been able to get the vaccine closer to the people without going to their houses.”
Breaking down barriers
Outreach like this is necessary because people of color, poorer and more rural communities experience greater barriers to getting vaccinated.
There can be trust issues among people of color that are rooted in the American medical system’s racist history, but a National Public Radio/Marist poll of 1,809 adults from mid-April showed that 66 percent of Black people had been vaccinated or planned on being vaccinated, compared with 68 percent of white people and 68 percent of Latino people.
Forty-four percent of Republicans and 38 percent of white men said they would not get vaccinated, the largest cohorts to decline vaccination in the survey.
Those numbers show that Black people and Latino and Hispanic people aren’t less interested in getting vaccinated, but according to data and medical experts, it’s harder for people of color to access vaccine.
“We need to remove as many barriers as possible,” Melnick said.
That’s why the county’s vaccination site is now staying open later on some days — for people who can’t get a dose during work hours. And Clark County has a vaccination hotline staffed by people fluent in multiple languages. The same language assistance is offered at its vaccine pods.
According to The New York Times, the racial vaccination disparities have begun to shrink, but still exist.
The country’s top infectious disease expert, Dr. Anthony Fauci, highlighted the deadly toll of COVID-19 for Black people, Latino and Hispanic people, American Indian and Alaskan Native people, native Hawaiians and Pacific Islanders, who have all died of COVID-19 at higher rates than white people.
“Now, very few of these comorbidities (with COVID-19) have racial determinants,” Fauci said at a May 16 Emory University virtual commencement address. “Almost all relate to the social determinants of health dating back to disadvantageous conditions that some people of color find themselves in from birth regarding the availability of an adequate diet, access to health care and the undeniable effects of racism in our society.”
An evolving plan
The main vaccine outreach focus for Clark County right now is finding pockets of people who want the vaccine and getting it to them.
That means getting the word out about vaccination clinics in a way that is culturally aware and accessible for multiple languages, said Marissa Armstrong, public information officer for Clark County Public Health.
After the mass vaccination site opened near Ridgefield in January, Clark County planned its vaccination site at Tower Mall in Vancouver because Tower Mall is near public transit.
“Our plan evolves and depends on where the need is after hearing from the community where the need is,” Armstrong said.
The mobile vaccine pods have been an efficient and equitable way to increase uptake, according to statistics.