Syringes are prepped with the Moderna COVID-19 vaccine before being administered at Richmond Raceway in Richmond, Va., February 2, 2021. (Parker Michels-Boyce/ For the Virginia Mercury)
Over the last month, state and federal officials have directed thousands of COVID-19 vaccines to large-scale clinics in vulnerable communities with high rates of coronavirus cases — all in areas with significant or majority Black and Latino populations.
The sites have been touted by leaders as a core strategy in expanding access to vaccines among communities of color, where immunization rates are consistently lower than they are for White Virginians. “We have done a very good job in the commonwealth in addressing this issue,” state Health Commissioner Dr. Norman Oliver said at a news briefing last month in response to questions over vaccine equity.
“We have brought on staff in our emergency support team that is doing outreach in these communities,” he added. “We’ve put boots on the ground in all 35 of our health districts and those teams are doing your basic sort of community organizing — door to door, working with faith leaders, community-based organizations to bring people from these vulnerable populations to our vaccination sites.”
But data from the clinics, provided to the Mercury by the Virginia Department of Health and Federal Emergency Management Agency, show participation at the sites has been mixed — and in some cases is declining — despite a steady flow of doses. Supply to one clinic in Danville was cut dramatically from 3,000 doses a day to 250 as residents failed to fill available appointments. Those uneven results, coupled with a degree of vaccine hesitancy that experts say will take more hands-on effort to overcome, are impeding the larger state goal of vaccinating as many Virginians as possible, as quickly as possible.
FEMA’s site in Norfolk, for example — operated and supplied by the federal government in partnership with state and local agencies — recently opened for walk-ins after local health officials struggled to add more residents to the district’s pre-registration list.
There’s been an uptick in shots since the change in policy, but the site is still operating below its planned 3,000-dose-a-day capacity. By how much often varies — the clinic delivered 2,314 shots last Friday but only 947 two days later, according to FEMA spokeswoman Corey DeMuro.
Data from state-run sites can be equally underwhelming. A community vaccination clinic at a former Gander Mountain store in Prince William is currently receiving 4,000 doses a day despite administering fewer than 3,000 daily shots for most of April. On two days in late March, fewer than 70 people showed up for doses at Danville’s clinic in an old JCPenney.
In Portsmouth, second-dose appointments can boost the total number of vaccines administered at the city’s Sportsplex, according to VDH spokesman Logan Anderson. But on a recent Monday, the site gave out 607 of its 1,000 daily doses.
National officials have been quietly pivoting away from large-scale sites amid growing evidence that more Americans prefer to get their vaccinations from neighborhood pharmacies. In Virginia, local leaders and community advocates are also questioning the approach as the state’s data continues to show significant disparities in who’s accessing the shots.
According to VDH, White residents (a little less than 70 percent of the state’s total population) make up about 65 percent of people in Virginia with at least one dose. Black residents make up just over 14 percent, despite comprising almost 20 percent of the state’s population.
Latino residents, at nearly 10 percent of the state’s total population, appear on par when it comes to shots — accounting for 9.5 percent of Virginians with at least one dose. But major gaps in state reporting make demographic data impossible to rely on. Despite reminders from state leaders, and emergency legislation requiring vaccinators to collect race and ethnicity data from patients, there are more than 1.1 million shots lacking that information.
Justin Crow, the director of VDH’s Division of Social Epidemiology, said one recurring problem is that some vaccinators only seem to take down the data if a patient isn’t White.
“Sometimes we think that if someone is White or non-Hispanic, people consider that ‘normal,’ so they skip those boxes,” he said. The department has spent weeks trying to estimate race and ethnicity data in cases where it’s missing — a process that involves matching surnames with available census tract data.
When administrators make those matches, the number of shots among White and non-Hispanic Virginians tends to increase, according to Crow.
“Just looking at the vaccine dashboard online, the uptake among White Virginians is much higher than among non-White,” he said. “That certainly seems to be the case.” Local health leaders have also acknowledged the disparities as a persistent challenge in the state’s rollout.
“We see it both for COVID cases and for vaccines,” said Amy Popovich, nurse manager for the Richmond-Henrico Health District. “Our White residents are getting access to vaccines and getting vaccinated at a population rate much higher than our African American and Latinx neighbors.”
Early warning signs
Some equity concerns date back to the beginning of the state’s vaccine rollout. In early January, The Virginian-Pilot reported that a Google Translate error on a state webpage resulted in Spanish readers being told they didn’t need a vaccination. When the state launched its centralized pre-registration site in March, the Spanish version again relied on rudimentary Google Translate (spokeswoman Dena Potter described it as a “temporary stopgap” in a comment to the Mercury).
Today, the state site includes a more sophisticated Spanish translation and a call center that can provide interpretation in more than 100 different languages, according to Potter. VDH’s vaccination FAQ page also includes professional translations in Arabic, Chinese, Korean and Spanish.
But a more fundamental problem has always been the outsized importance of the Internet distributing information and for finding and booking an appointment — an inequity “baked into” the process, according to state vaccine coordinator Dr. Danny Avula.
For most of the vaccine rollout, scheduling a shot was a three-pronged process. First, register through the state website or the hotline (which refers back to the website as the “fastest way” to pre-register). Then, wait for an email or text — which can look different depending on the health district — confirming you’re eligible for an appointment. Then, register through another online system to schedule an appointment. It’s now possible to schedule an appointment through the hotline, but that involves navigating through a number of options and waiting for an operator to become available.
That process only covers slots offered through local health districts. Private pharmacies have a separate scheduling system that’s often entirely online. It’s a system that precludes anyone without internet or a reliable computer, but also creates barriers for anyone who’s not particularly web-literate.
“You have so many African American seniors who aren’t online,” said Michael Jones, a Richmond city councilman and pastor at Village of Faith Ministries. “And it’s not because of poverty. It’s just because they’re older. I’m not on TikTok, but a lot of young kids are.”
Pre-registration data highlights how many Virginians the process has left behind. According to data from VDH, 53 percent of the state’s more than 2.7 million registrations were among White residents as of April 8. That dataset includes most pre-registrations from local health districts, with the exception of Fairfax County, which retained its own sign-up system even after the state launched a centralized site (Crow said the data does capture about 260,000 county residents who registered through both systems).
Just over 10.5 percent were among Black residents, and roughly 5.5 percent were among Latino residents, though the two groups make up nearly 20 percent and 10 percent of the state’s total population, respectively. So when local health districts began pulling from those lists to book appointments at vaccination events, communities of color were already largely underrepresented.
Critics say those underlying problems are something large, fixed clinics fail to address. With the exception of FEMA’s site in Norfolk, all of the state’s community vaccination centers require pre-registration and appointments. Meanwhile, some health districts are struggling to boost vaccinations even with state-run sites.
Counties in the Crater Health District, for example, have some of the lowest vaccination rates in the state, despite a clinic at Virginia State University in Petersburg that’s allocated 3,000 doses a day. For most of late March and April, it’s failed to meet that capacity — sometimes by hundreds of doses a day.
“I really feel like there are all these resources, but in a crisis, they circled the wagons around what was comfortable for them and comfortable for the people in the room making the decisions,” said Phyllis Simon, an attorney in Herndon. She also serves as a steering committee lead for an anti-racism workgroup organized by Rowan Tree, a women’s coworking space in Herndon.
Last week, the group helped organize a virtual town hall on vaccine equity in Fairfax County, where Black and Asian residents, especially, are being vaccinated at much lower rates than their share of the county’s population. Weeks before, they sent a joint letter to county leaders with specific recommendations for increasing outreach and narrowing vaccine disparities.
Many of them mirror priorities recommended by the Virginia Latino Advisory Board months earlier in an annual report to the governor. They include things like more direct outreach through canvassers and community health workers to expand access and promote trust in the vaccines. One critical recommendation in VLAB’s report was a guarantee there would be no immigration status checks for any COVID-19 testing or treatment.
“I was pushing for several weeks, through the Secretary of the Commonwealth’s Office, for the Office of the Attorney General or the governor himself — somebody — to put out a formal announcement that the undocumented community can get vaccinated,” said VLAB chair Paul Berry. “Proactive messaging that the state doesn’t care about your immigration status.”
‘What they did not really count on was people not wanting to travel’
At least one news release from the governor’s office specifically mentions that the state’s centralized registration site won’t request a social security number or ask about immigration status. But there’s not a Spanish translation available for the online release, and it hasn’t been a central message in Northam’s public briefings.
National reports indicate that many of the requests for ID or residency status have come from pharmacies and other clinic sites. VDH’s own FAQ page specifically states that “some localities may restrict vaccination to residents, and may need some type of proof of residency for vaccination.”
As the state moves further into its vaccination campaign, those continued omissions have frustrated Berry and other community advocates, many of whom have highlighted potential shortcomings with the state’s outreach for months. Many local health districts are staging their own community clinics or — in the case of Richmond-Henrico — hiring eight additional community health workers and 10 part-time outreach coordinators focused primarily on vaccine messaging.
But the Virginia Department of Health has never established uniform guidance for health districts when it comes to COVID-19 vaccination, and multiple local health officials have told the Mercury they’ve wished for more instructions. Both Berry and leaders at Rowan Tree pointed to more walk-up availability and mobile vaccination units as two areas where state leaders could take a lead.
Dr. Vanessa Walker, the state’s deputy secretary of health and human resources, said “planning is underway” for more mobile clinics, but couldn’t provide specifics on the program. Berry said the suggestion was politely declined at a recent meeting between VLAB and the governor.
“He responded by listing the different entities that are already doing that,” Berry said. “The National Guard has five vans out and he listed two other organizations. So, he was supportive of the idea, but the polite inference that I gathered was, ‘Other people are already doing that.’”
In a Thursday email, Northam’s spokeswoman, Alena Yarmosky, pointed to nine different initiatives that the administration had launched specifically to expand outreach in the Latino community, including translation services available at all state-run clinics. Many had launched recently, including a 30-second ad premiering on Northern Virginia’s Telemundo station encouraging vaccination among Latinos. Another April 2 op-ed in El Tiempo Latino, a free weekly newspaper in the Washington, D.C. region, discussed the safety of vaccines for pregnant women and refuted the myth that they cause infertility — a persistent (and untrue) online rumor.
But one of the state’s most high-profile stumbles in its community vaccination efforts highlighted the importance of early and hands-on outreach even in smaller communities. In mid-March, the state optimistically began pushing 3,000 doses a day to its clinic in Danville, a majority-Black city of roughly 40,000 people on the Virginia-North Carolina border. Yet the city still has a lower vaccination rate than many parts of the state.
For a few weeks, the large state-run clinic largely supplanted local efforts, which had been organized through a local taskforce that included city and county officials, nearby Averett University and Danville Community College, Cherrystone — an association of local Baptist churches — and Sacred Heart, a Catholic Church in Danville with a large Hispanic congregation. The Pittsylvania County and Danville chapters of the NAACP played a significant role in organizing clinics and pre-registering people for appointments.
Crucially, the locally organized events also rotated. “We did some onsite at the health department, but we’d go all over” said Dr. Scott Spillmann, director of the Pittsylvania/Danville Health District. The district had organized two clinics at the JCPenney before the state took over, but had also gone throughout Pittsylvania County — to schools, churches and one large agricultural center in Chatham. In many cases, Black-owned businesses and community churches helped provide transportation to the site.
“We did it because it’s our community and we care,” said Frances Tucker, who helped schedule appointments with the Pittsylvania NAACP. Progress wasn’t necessarily fast, though she said the district was consistently filling up appointment slots. But it was personal. Tucker gave out her home phone number to help register people for appointments. In one case, a woman called with the names of eight different people from her family and other homes in the neighborhood. Tucker registered them all, but none of them had email at home, she said.
“I told her, ‘You know what, I’m going to print this form and shove this appointment confirmation in your mailbox,’” Tucker said. And she did, for all eight (though she asked them to bring younger relatives with smart phones to their second-dose appointments).
When the state launched its own clinic, Spillmann said officials were so optimistic that they asked the district to divert 2,000 of its own doses to the JC Penney site. Two weeks later, fewer than 200 people showed up. The state began reallocating doses to other districts, but not before Danville became a flash point for other local health departments who were still struggling to meet their own local demand.
“I think from our perspective, we felt frustration that a site in Danville was getting lots of vaccine and was only able to meet half of the demand,” said Ryan McKay, the director of policy and planning for the Blue Ridge Health District. At the time, the district wasn’t receiving enough vaccine to move through their own pre-registrations at two mass vaccination sites in Charlottesville.
“And then to hear reports of students from UVA and Virginia Tech driving down and getting appointments while we’re still struggling to get through 1a and 1b — that was very frustrating,” he said. “We really believed that we could be using that vaccine here so we could catch up to others and then to Phase 2 by April 18.”
Eventually, at his suggestion, Spillmann said the state moved back to a satellite model, rotating clinics to some of the locations the district had been using before.
“They were trying to give the opportunity to vaccinate as many people as possible, as quickly as possible,” he said. “But what they did not really count on was people not wanting to travel.”
Some of the same people who were resistant to go to Danville for a vaccine would drive into the city to shop, he pointed out. But, in addition to legitimate transportation barriers, the state is also starting to grapple with vaccine hesitancy among all sorts of Virginians. In a news briefing earlier this week, Avula — the state’s vaccine coordinator — said Northern Virginia, Blue Ridge and the Richmond region remained some of the only areas in the state where demand for the shots still outweighed supply.
That likely means direct outreach — and prioritizing convenience — is going to become a key priority for Virginia if it hopes to vaccinate the majority of its residents. Currently, less than 25 percent of the population is fully immunized.
“It seems like a lot of the folks who want to be vaccinated have already been vaccinated,” Avula said.
“It really just means there’s less low-hanging fruit than we otherwise thought,” he added. “And getting more people vaccinated is going to be much more of a ground game. Much more work in communities doing satellite clinics, going into neighborhoods — all of that type of work.”
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