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Hassan Ibrahim was excited in mid January when his Minneapolis clinic received its first supplies of COVID-19 vaccine. But he knew that getting the shipment may have represented the easy part of the job.
During the first couple of days, about 60 to 70 percent of the patients Hassan and his colleagues called would express hesitancy. The most common concern they told him was that the vaccine could harm or even kill people. Each time he heard this, Hassan, a registered nurse and clinic supervisor, would cite figures from the federal government to explain why the vaccine is widely safe.
Hassan told any patient who asked that he’d been among the first staffers to get a vaccine at Axis Medical Center, a Minneapolis primary care clinic that serves a predominantly East African clientele. He repeated all of this on the Somali American TV web channel during a broadcast the last weekend in January.
Now, as Axis enters its third week delivering vaccines to elderly patients, some of that messaging is starting to pay off, albeit slowly. About half the vaccine-eligible patients Axis calls are currently expressing hesitancy, according to Juan Lewis, a family and internal medicine doctor at the clinic. Some patients are starting to recognize the outreach.
“I had one person who told me this morning, ‘I listened to your voice on Somali American TV, that’s why I decided to come in,’” Hassan said.
Axis is one of the state’s 17 federally qualified health centers, also known as community health centers. They deliver standard care like routine physicals and sick visits, as well as management of more chronic conditions like asthma and diabetes. Most of their 200,000 patients across the state fall below the federal poverty line and a third of them don’t have health insurance. Nearly 70 percent are people of color.
Because of these demographics, community health centers like Axis have been on the frontlines of battling COVID-19 since the start of the pandemic. Jonathan Watson, CEO of the Minnesota Association of Community Health Centers, estimates that community health patients are consistently testing positive for the virus at three to four times the statewide average.
That’s why the state is giving community health centers like Axis early access to vaccines. In doing so, community health clinics are attempting to shift gears and begin working on what will hopefully prove to be the beginning of the pandemic’s end—delivering vaccines.
No vaccine in December—and limited prospects
In the final weeks of 2020, prospects for community health centers looked bleak. At that time, Watson said he and others learned that the Minnesota Department of Health wasn’t planning to prioritize the 2,000 people who staff community health clinics for the first rollout of vaccines.
Watson and his colleagues, who advocate for the state’s community health centers, made their case to MDH Commissioner Jan Malcolm. Community health workers are delivering tests and working with COVID-19 patients every day, they explained. Malcolm agreed, and soon the state added community health workers to receive some of the state’s early allotments of vaccine. Then, recognizing that the clinics serve as an inroad to underserved communities, MDH allowed the clinics access to a limited number of shots for older patients.
This turnaround from the state happened relatively quickly.
“In late December, we didn’t have any line of sight that we were going to get any sort of vaccines for our staff or patients,” Watson said. “And within one month, MDH turned around and delivered the goods to us.”
Theoretically, that should have solved the problem there and then. But some of the clinics weren’t prepared for this shift.
Axis, for example, struggled at the beginning to find eligible patients willing to get vaccinated. On the first day, January 20, just five of the first 50 patients Axis called to offer vaccination appointments signed up. Two weeks later, things have slightly improved, Lewis said.
He said the word of mouth about the vaccine in the communities Axis serves is likely driving more people to get the shot.
“It’s getting a little bit better,” Lewis said. “It’s changing by the day.”
Axis has administered about 600 shots, both Hassan and Lewis estimated: So far, they’ve been averaging about roughly 60 doses a day. Last Saturday, the clinic had its most productive vaccination drive when it administered about 100 shots.
Across all 17 community health centers in Minnesota, MDH has granted about 13,000 vaccine doses for patients 65 and older since beginning to offer doses last month. In total, the 17 clinics serve about 22,000 patients aged 65 and over. All the clinics are using the Moderna vaccine.
Through the Association of Community Health Centers, each clinic requests a certain number of new shots from MDH at the beginning of each week. During the first week, in mid-January, Watson said his association requested and received 4,900 doses. The following week, that number increased to 5,000.
This week, it dropped to 3,200 doses. The reason for this, Watson said, is that some clinics have shots left over while others are reorganizing to deliver vaccines more efficiently in the future.
Despite the hesitancy they’re encountering from some patients, the community health centers appear to be getting their vaccines out at high rates. For the first week, all 17 clinics reported to the state that they administered 95 percent of their vaccine supply. For the second week, that number shot up to 100 percent.
Calling 2,800 patients for vaccine appointments—and then calling again
Staffers at Minnesota Community Care in St. Paul, which serves a large Latino population, attribute this success to their relatively robust vaccine outreach drive. There, eight staffers are in charge of contacting the clinic’s 2,800 patients who are senior citizens—mainly by calling and texting them.
By the end last week, the clinic’s staffers had called all these patients—some of them multiple times. As of last Friday, 60 percent of the patients called were either scheduled or had already received their shots, said Shawna Hedlund, the clinic’s director of access and advocacy.
The remaining 40 percent of eligible patients are a mixture of people who’ve expressed hesitancy or have been hard to reach.
To get around this, Minnesota Community Care has developed a strategy: Schedule vaccine appointments in the morning in case they have leftover doses to offer later in the day to eligible patients who are visiting the clinic for other reasons.
Hedlund said this approach worked with at least one patient on a recent Friday morning—a woman visiting the clinic for a dental visit. It turned out that even though Minnesota Community Care hadn’t managed to reach this patient for a vaccine appointment, she had been trying unsuccessfully on her own to receive one through the state’s lottery system for senior citizens.
“Our clinic manager approached her and asked if she wanted her vaccine, and she couldn’t believe it,” Hedlund said. “She was ecstatic.”