Community-based health care providers like the Southern Jersey Family Medical Centers, which serves tens of thousands of low-income residents in five largely rural counties, are essential parts of the state’s strategy to vaccinate vulnerable populations against the coronavirus.
But creating a local vaccine clinic is not enough to ensure that Black and brown communities have sufficient access to immunization, according to public health leaders. While people of color have suffered outsized impacts of COVID-19 in New Jersey and nationwide, they have made up a small percentage of those vaccinated — and more needs to be done to ensure the lifesaving serum is distributed equitably.
For example, when the Southern Jersey centers created a vaccine sign-up on its website, the slots were quickly booked by people from more affluent areas, CEO Linda Flake recalled. “Those 7,000 people who signed up online are not our patients,” she said, since many of the residents and farmworkers the group usually serves have limited access to technology. (The registration process has since been revamped.) “It’s not a single approach that’s the right approach, it’s got to be a multi-faceted approach,” she added.
Flake and others underscored the need for greater public education and direct, personal outreach around the vaccine, particularly among the Black community, which has long been mistreated by the medical system. These messages need to come from trusted community leaders, like family doctors and pastors, and be delivered via television commercials, social media and printed materials like palm cards that could be left at barber shops and nail salons.
“My experience has taught me you have to take it to the people,” Lt. Gov. Sheila Oliver said during a Facebook live event she joined last week with Gov. Phil Murphy, state health Commissioner Judy Persichilli and leaders of the state’s Black community. The six state-run vaccine megasites are not easily accessible for people without cars, Oliver noted, so the state needs to consider “grassroots projects” like leaflets for local businesses. “I think that is the way we’re going to have to get more connected.”
Partnering with community centers, places of worship
State officials have acknowledged these disparities and insist vaccine equity is a priority. The state’s ‘vulnerable populations plan’ calls for partnerships with community centers and places of worship to create vaccine clinics focused on specific communities, with the first scheduled to start Monday afternoon at the First Baptist Church of Lincoln Gardens, in the Franklin section of Somerset Township.
“We have work to do,” Murphy said during the Facebook event last week. “No one is declaring victory on this call. We’ve got a long way to go.”
The faith-based partnership also plans to bring dedicated vaccine clinics to Trenton, Elizabeth, Vineland and Paterson, all of which have racially diverse and vulnerable populations hard-hit by the pandemic, state officials said Friday. These will operate temporarily, with each seeking to vaccinate some 3,000 people over two weeks and then re-opening several weeks later to provide the needed second shots.
These pop-up clinics will be hosted by an established church, mosque or synagogue easily accessible to the local population. While the state created six vaccine megasites in locations served by public transit — and at least 200 other clinic locations have been set up — health leaders note these are still out-of-reach for many residents. Perhaps most important, immunization appointments for these specialty clinics are only available through the faith-based partner organization and not open to the public at large through online sign-up.
“I want to say, very clearly, you are at the top of the list” for vaccine priority, Persichilli said at the Facebook event. The state Department of Health has scheduled several online forums dedicated to answering questions from members of minority communities and is working with providers to help them reach Black and brown residents.
Assemblyman Dr. Herb Conaway Jr. (D-Burlington), who is also Burlington County’s health commissioner, said it makes sense to engage churches and other trusted local organizations to connect underserved individuals with vaccine appointments. Megasites are “the efficient way to get a lot of vaccines into the arm of people,” he said, “but where’s the rub? When you have a digital divide, you know you have a problem built in.”
Vaccine equity team created
Health care providers are also working to close the vaccine’s racial gap. Bergen New Bridge Medical Center, a massive county-owned hospital in Paramus with a history of treating vulnerable patients, partnered with civic groups and Black clergy to create a vaccine equity team.
The team, announced Friday, will educate the public, identify eligible recipients who might not have access on their own, help them register for an appointment and provide transportation to the clinic, if needed. To kick off, a group of two-dozen community leaders were immunized Friday in hopes of inspiring confidence in the vaccine and the process, officials said.
“This pandemic has highlighted healthcare inequity in many communities which can only be countered by putting our words into action,” New Bridge CEO Deborah Visconi said. “Through this new initiative, our medical center will be a source of information and support, and work to ensure vaccination appointments are reserved and easily accessible for our Black and Brown neighbors.”
Data from the health department clearly highlights the need for greater vaccine equity. Of the 1.37 million shots administered for which demographics were recorded, 5% have gone to Hispanic individuals and 3.6% to Blacks. More than half of the vaccines have gone to white residents.
However, Latinos — who make up roughly 19%, or one in five of the state’s population — have comprised one in four of New Jersey’s coronavirus cases and nearly one in five related deaths. Blacks — 14% of state residents — accounted for 12% of the cases and 17% of the deaths, a COVID-19 mortality rate twice that of white individuals.
Persichilli said the state’s vaccine plan – which seeks to immunize 4.7 million adults – prioritizes protecting health and also “societal function.” While coronavirus is most deadly for elderly individuals, she notes it has also proved devastating for other groups, like Hispanic men in their 30s and 40s, who die at 2.5 times the rate of their white counterparts.
Taking a toll on families, local communities
Losing these breadwinners takes a tremendous toll on families and local communities, noted Dr. Denise Rodgers, a family doctor in Newark, academic leader at Rutgers University and professor at its Robert Wood Johnson Medical School. While the state initially prioritized nursing home residents for the vaccine, Rodgers would like to see additional focus on Black and brown populations of all ages. “In public health we talk about ‘years of potential life lost’ all the time,” she said.
Limited supply has hampered the state’s vaccine rollout on all levels, but Rodgers, Conaway and others said directing more doses to community-based medical providers or local drug stores, can help ease the racial disparity in immunizations. They welcomed news last week that President Joe Biden’s administration would be providing additional vaccine doses to Federally Qualified Health Centers, like the Southern Jersey Family Medical Centers.
While New Jersey didn’t qualify for the first round of additional FQHC vaccine distribution, 21 of the the state’s 23 community health centers – where three-quarters of the patients are racial or ethnic minorities – have already administered more than 40,000 shots, according to the New Jersey Primary Care Association, which represents these facilities. Together, these centers are currently receiving roughly 5,000 doses weekly, which officials said is not enough to meet current demand, let alone expand efforts to dispatch workers to vaccinate homebound seniors or seasonal farmworkers, as Flake hopes to do in South Jersey. (Southern Jersey Family Medical Centers led the state’s efforts to test farmworkers for COVID-19 last spring.)
Community providers like hers also need additional resources to pay for per-diem vaccinators and other costs associated with the immunization clinics, Flake said, while megasites have had access to additional state funding. But FQHCs and other local providers do have another important asset, she said. “They trust us,” she said of the largely Black and brown patients her program serves. “You can open all the mega-centers you want, but the trust is with the community provider. We’re the community provider.”