Heading into the holiday season, Dr. Keith Winfrey was hopeful that this winter would be a mild one for colds, flus, and other respiratory ailments.

No such luck.

“It’s been a late ramp up, but it’s hitting hard now,” said Dr. Winfrey, who is chief medical officer for the New Orleans East Louisiana Community Health Center, or NOELA. “The last two or three weeks, we’ve been seeing a surge.”

In late August and September, Dr Winfrey recalled, many patients were asking for flu and Covid-19 vaccinations. Widespread shortages meant there weren’t enough booster shots to go around.

But NOELA has begun receiving flu and Covid-19 vaccines through a Direct Relief program that supplies community health providers across the country with vaccines designed to reduce the risk and severity of infectious respiratory diseases.

For the 2024-2025 winter season, Direct Relief has provided slightly above 400 partner organizations with 27,800 Covid-19 vaccines, 17,700 flu vaccines, and more than 7,500 doses of antiretroviral medication to treat cases of flu.

Health centers, community clinics, and other nonprofit health organizations are often trusted sources of information and consultation for patients. “When it comes to preventive services, those relationships make a difference,” Dr. Winfrey said. He can only offer the vaccine, though, if there’s enough supply to meet patient needs. “When we have individuals like that who are interested, having a source of vaccine available has been beneficial.”

Many nonprofit health providers relied on the Bridge Access Program, a CDC program that offered Covid-19 vaccines to uninsured and underinsured patients. When it ended in August of 2024, providers had difficulty sourcing enough vaccines for vulnerable patients. Direct Relief began delivering Covid-19 vaccines to partners during the pandemic to meet emergent needs. As a result of its growing cold-chain capacity and close relationships with medical company donors, the organization began offering Covid-19 vaccines as part of its ongoing programmatic support in October of 2024, in addition to its long-term provision of flu shots.

When Direct Relief announced vaccines were available in October, the organization was “inundated” with requests, said Katie Lewis, regional director for U.S. Programs.

After Covid-19 vaccines became unavailable through the government, Southern California-based clinic group El Proyecto del Barrio, Inc. was forced to buy them, said medical director and physician Dr. Karmen Tatulian. Their budget allowed them to purchase 20,000 vaccines – not nearly enough for their approximately 50,000 adult patients – to see them through a busy flu season.

“This was absolutely not expected,” she said.

Dr. Tatulian explained that, while the county provides children’s vaccines to nonprofit providers who adhere to strict regulations, adult vaccines are “fully the financial responsibility of our organization.”

Both Covid-19 and flu vaccines “help to keep the community healthier,” she said. People will often hear from a family or community member that El Proyecto del Barrio offers vaccines, and reach out to them. It’s important to have the shots available: “The help that Direct Relief is providing…it’s difficult to overestimate.”

Recent wildfires across Los Angeles County have added new challenges. Dr. Tatulian reported that people are “busy with other problems” even as poor air quality makes respiratory problems worse. “Definitely, we have more work,” she said.

For providers at the University of Arizona Mobile Health Program, receiving vaccine support has been a boon. “It’s been incredible to just have them on hand,” said mobile health coordinator Alicia Dinsmore.

As a free clinic, the mobile health program previously referred patients to the county for flu and Covid-19 vaccines. But for patients lacking transportation or reliable child care, needing to make another appointment often meant they didn’t get boosters at all. “There’s a huge dropoff” when the clinic refers out, Dinsmore said. Having the vaccines on hand “has been a really useful resource to increase vaccine uptake.”

The mobile clinic rotates between nine regular sites – schools, churches, a local soup kitchen – and patients will often visit the clinic for their vaccines while they’re getting lunch or attending a community event.

Dr. Person-Rennell thinks this has been an above-average season for respiratory infections, although formal data isn’t available. “Our respiratory season has been full of influenza, Covid, and RSV…just based on my clinical experience,” she said.

Close relationships with patients – and treating the clinical relationship as a partnership – has been key to educating patients about vaccines and helping them work through hesitation, said medical director Dr. Nicole Person-Rennell. Listening to concerns, talking through past vaccine experiences, and helping patients make a plan that works for their health needs are all key.

For Dr. Winfrey’s patients, that trust and rapport often make the difference between whether or not a patient chooses the flu or Covid-19 vaccine. “The older patients who have been my patients for years will tend to accept the recommendation and get vaccinated,” he said. “The longer we’ve been caring for them and have been their advocate, the more likely they are to…receive the care.”

Somewhat unusually, he’s still recommending flu and Covid-19 boosters to patients late in the season, especially older patients and those with diabetes, hypertension, and other health conditions that increase the risk of severe impacts from respiratory ailments.

“Where we would normally expect some of our flu to wane, it may extend well into May,” he said. “I would still recommend the flu vaccine.”