When Urban Health Plan, a community health center in New York, found out that they were getting the Moderna Covid-19 vaccine, things happened fast.
Once they learned that they’d been approved for the vaccine, they received word that all vaccine orders needed to be placed by the following morning. A week later, they heard that the vaccine was on its way.
“Now we have to try to get them into as many arms as possible,” said Dr. Viju Jacob, an assistant vice president at Urban Health Plan.
That’s not as straightforward as it sounds.
To avoid wasting any of the vaccine – a single vial contains 10 doses – the health center is setting up appointments for 10 employees at a time, with an eleventh standing in reserve.
“The vaccine is not temperamental, but it has to be handled in a very specific manner,” Jacobs said.
All over the United States, community health centers are receiving vaccines. According to Dr. Ron Yee, chief medical officer at the National Association of Community Health Centers, it’s not yet fully clear how many of the nation’s approximately 1,400 health centers have received the vaccine, although it’s likely that more of them will receive Moderna vaccines, which are easier to transport and store.
But as they arrive, they’re being administered to employees, in some cases prioritizing those who have the greatest contact with patients – such as providers working in respiratory clinics.
It’s a glimpse of what’s to come as they prepare to reach out to, educate, and vaccinate a largely underserved population. And it’s not without its challenges, although health center leaders feel confident they’re up to the task.
“Great Faith”
“It’s important to note that vaccinations have been part of the mission of health centers for many years. They have the framework in place to vaccinate communities hard hit by Covid, the trusted relationships with community residents, and an understanding of how to communicate with their patient population,” Yee said.
“The [staff members] who are excited are excited,” said Dr. Tillman Farley, chief medical officer of Salud Family Health Centers in Colorado. “We’ve been in this mess for almost a year, and here we’re in the beginning of the end.”
Not all staff members are. The administrators interviewed for this story all said they’d seen less enthusiasm among their health workers and administrative staff than they’d expected.
But Susanna Perez, the executive director of Costa Salud Community Health in Puerto Rico, thinks that will change as the vaccine arrives.
Costa Salud received the Pfizer vaccine as soon as it was available – delivered by the National Guard and stored in refrigerators donated by Direct Relief.
Originally, Perez said, about 65% of her staff expressed an interest in the vaccine. Then, “when the vaccine came, everybody changed their mind, and now everyone wants to get vaccinated.”
Since the pandemic’s early days, health centers have played vital roles in administering Covid-19 tests, monitoring patients whose results came back positive, and contact tracing – all while providing routine care, much of it over telehealth.
As health centers purchase ultralow refrigerators and line staff members up to receive the vaccine, they’re well aware that this first round is a dress rehearsal for what’s to come.
“People expect us to be able to vaccinate…to rescue their lives out of the nightmare that they’ve been living,” said Dr. Steve Clarke, medical director of Community Health Centers of the Central Coast, in California. He’s not surprised by that expectation, he said. Patients relied on his health center to stay open as doctor’s offices all over the nation were closing, and to be able to treat patients in full PPE “when nobody had PPE.”
“It’s a great faith that people have in community health centers,” he said.
“A Trusted Source”
According to Dr. Farley, it’s precisely these challenges that make his health center in Colorado ready to vaccinate a large population.
“We have pretty robust testing facilities at all of our clinics,” Farley said. “Once we get to [vaccinating] the general population, we will convert most of that public testing to public immunization…it’ll just change from putting a probe up someone’s nose to putting a shot in their arm.”
For Perez, readiness came after experiencing Hurricane Maria in 2017. Despite the loss of electricity, water, and communications, her staff worked double shifts to provide ongoing services to patients.
“From then on, I’ve been working to prepare myself for things that are going to be worse,” she said.
Because health centers serve already-vulnerable populations – 62% of their patients are racial and ethnic minorities, according to the National Association of Community Health Centers – the faith that their patients have in them may put them in a good position to counter vaccine hesitancy.
“We’re a trusted source. We’re in the community…Many of our associates are also our patients and their families are also our patients,” Jacobs said. “They come to us for guidance, for advice.”
Farley explained the need for particular outreach to his center’s “communities of color, who have every reason to distrust the medical system.” And Clarke talked about the difficulties of vaccinating migrant farmworkers, many of whom are patients at the health center but whose work requires continual travel.
Dr. Lyle Ignace, chief executive officer of the Gerald L. Ignace Indian Health Center in Wisconsin, was particularly enthusiastic about the vaccine’s ability to reduce hospital admissions and fatalities in patients over the age of 65. “This could be an absolute game-changer,” he said. “This is the group that’s going to need to be prioritized over all other populations because of their higher risk of severe and poor outcomes.”
Yee explained that health centers would play an important role in two key issues related to the distribution efforts: vaccine hesitancy and vaccine equity.
“These are two different concepts, but important ones,” he said. “We need to ensure that underserved communities that have been hard hit by COVID have enough doses of the vaccine to stop the spread. We also have a lot of work to do to ensure that people feel safe in taking the vaccine by providing culturally and linguistically appropriate messaging around the safety of the COVID vaccine.”
“More than Gold”
Clarke said frankly that administering the vaccine to the general population would come with unique challenges. “We had the H1N1 mass vaccination in 2008, and that was nothing compared to what we have to do,” he said. “I see this outreach as being five to ten times more than that.”
But he said that Community Health Centers of the Central Coast was prepared – and could handle much higher quantities of the vaccine than it had received thus far.
For Perez, using the vaccine responsibly is her utmost priority – and she said Costa Salud, too, is up to the challenge.
The vaccine “is like gold. It’s a treasure,” she said. “It’s more than gold, because it’s life, and life doesn’t have a price.”
Since January 2020, Direct Relief has supported U.S. health centers and clinics with more than $37 million in grants and more than 13,000 shipments, totaling nearly $114 million, of medical aid.
