As health care providers endeavor to vaccinate millions of Americans against Covid-19, some are looking to their annual flu vaccine drives for guidance.

It’s the “dress rehearsal” for the Covid vaccine effort, said Dr. Ron Yee, the Chief Medical Officer of the National Association of Community Health Centers.

Many health centers—pegged as key players in President Biden’s vaccination plan—are preparing to receive their first allotment of doses, if they haven’t already. Staff are securing refrigerators for cold-chain storage and conducting patient outreach—similar to how they might prepare for a typical flu season. And at health centers that have already received the vaccine, providers are carrying out familiar processes: reviewing medical records, screening for contraindications, and updating immunization registries.

In Los Angeles, California, the staff at QueensCare Health Centers are planning to emulate the socially distanced flu clinics they held last fall.

“We’ve learned a lot about how we can bring a lot of people to an event and then vaccinate a large amount in a short period of time,” said Marina Snitman, the director of pharmacy at QHC. In addition to a pop-up clinic, the health center set up a drive thru site where patients could come get vaccinated without leaving their cars.

While the basics are comparable, administering the Covid-19 vaccine does present unique challenges, from storage requirements to distribution. “Flu, fortunately or unfortunately, is a lot easier than the Covid vaccine,” said Snitman.

For health centers like QHC, who serve anyone regardless of their ability to pay, the eligibility requirement adds a layer of complexity. “We have to make sure patients belong to a particular tier,” explained Snitman, “whereas the flu is ‘Come and get it,’ no matter how old or where you work.”

Determining a patient’s age is relatively easy, according to Snitman. But verifying where they work could prove more difficult. Though plans have yet to be solidified, the health center is considering sending out a survey or administering a questionnaire upon check-in to gauge the type of work patients do.

Despite the red tape, Snitman says her objective remains the same: “To vaccinate everybody who wants a vaccine,” an admirable, but ambitious goal, especially if flu vaccination rates are any indication.

According to the CDC, just under 50% of the U.S. adult population receive their annual flu shot, and that’s not simply because they don’t want it.

There are “so many competing priorities and competing stresses in [people’s] lives,” said Elisabeth Gundersen, the President of Medspire Health Mobile Clinic in Butte County, California. “They want the vaccine and they understand the importance of it, but it takes a lower priority to the other things that they’re dealing with.”

Many of Gundersen’s patients—some of whom lost their homes in the 2018 Camp Fire—are experiencing food insecurity, joblessness and homelessness.

During Medspire’s annual flu vaccine drive, teams of medical volunteers go to local trailer parks and homeless encampments to offer the vaccine to those with limited access to medical care. “The traditional medical system is that patients come to us at our convenience as providers, but as we know that doesn’t work for a lot of people,” said Gundersen.

As the clinic prepares to administer the Covid-19 vaccine, they expect to follow a similar model: homeless outreach, pop-up clinics, and home visits for those unable to make clinic hours.

One difference will be the extent to which they address vaccine hesitancy. “There’s a lot of very common myths out there,” said Gundersen.

Given the rapid development of the Covid-19 vaccine, many of her patients have expressed concerns about its safety. Others are generally dubious of conventional medicine. “There’s this fear of government control,” she said. “’Is this something the government is doing because they want to control me?’ That’s something I’ve heard multiple times.”

Medspire plans to work up a series of informational materials addressing common questions and misconceptions about the vaccine. But, according to Gundersen, the most effective means of dispelling hesitancy is one-on-one communication. “Listening to [patients], hearing them, and in speaking to the concerns, alleviate them. That’s also really important.”

This kind of communication builds trust with patients, says Gundersen, making street medicine providers particularly well-positioned to administer a vaccine for Covid-19.

“You’re not going to get people struggling with homelessness and mental health to come to, for example, the Oakland Colosseum to get a vaccine,” explained Gundersen. According to Medspire’s model, a personalized approach is key.

“We know people by name. We know which trailer they live in. If we can’t find them, we know who their friend is,” she said. “It’s a tightly knit community.”

During the 2020 flu season, Direct Relief distributed over 32,000 flu vaccines to safety net providers across the United States, including to QueensCare Health Centers, which hosted flu clinics with the support of Direct Relief and Clorox, and to Medspire, which also received donated flu vaccines. Direct Relief also provided more than 9,000 vouchers for free flu shots at CVS pharmacy.