Despite being eligible for almost a month, most of Philadelphia’s senior citizens have not yet received shots, even as the city is on the cusp of expanding COVID-19 vaccine access to its entire adult population.

About 37% of people age 65 and older in Philadelphia, which has the largest share of senior citizens among America’s largest cities, have been fully vaccinated, data from the Philadelphia Department of Public Health showed. Even among people 75 and older, who have been eligible for vaccination in Philadelphia since Jan. 19, 48% have received at least a first vaccine dose. The data show the city lagging behind the rest of the state — and the country.

“That seems like a low number for what we’ve been doing, where we’ve been focused, where we’ve been working,” said Tony Reed, chief medical officer at Temple University Health System. “It tells me we have more work to do in that population, and it makes me wonder, ‘Where are they?’”

A lack of easily accessible sites and internet access have hindered seniors’ ability to get appointments in a system that relies heavily on digital scheduling. Many Philadelphia seniors own their homes — meaning they might not have access to resources and support networks available in senior housing or apartment buildings. A quarter of the city’s seniors live at or below the poverty level, said Karen Buck, executive director of the Philadelphia-based SeniorLAW Center.

The city’s vaccination rate for seniors is “devastatingly low for a city with such an enormous senior population,” Buck said. “We need to be more creative.”

» READ MORE: Vaccine eligibility expands across Philly, Pa., and N.J.; Del. opens to all adults Tuesday

City officials acknowledged that seniors living alone complicated vaccination efforts.

“It’s common sense that it requires more resources to vaccinate a single person living in their house than 200 people living in a single building,” said James Garrow, a spokesperson for the Philadelphia Department of Public Health.

This week, the city quietly began offering walk-up vaccinations every Wednesday for anyone 65 and older at three public health centers. About 200 people received shots without appointments this week at the three clinics, Garrow said. Jeffrey Brown, 67, learned of the initiative while watching the news Wednesday afternoon. He walked to the health center at 43rd Street and Chester Avenue, and, to his surprise, got a Johnson & Johnson shot in less than half an hour.

“Come down here next Wednesday and the line will be around the corner,” he said.

‘I wouldn’t have even thought about coming here’

Philadelphia’s vaccination rate for seniors is slightly lower than the 47% fully vaccinated in the rest of Pennsylvania. New Jersey has fully vaccinated about 55% of people 65 and older, while the national average is 76% of people 65 to 74, and 77% of people 75 and older.

White Philadelphians are overrepresented among older vaccine recipients — a trend playing out across all age groups. Almost half of the city’s residents 65 and older are white, according to census data, but they account for nearly 57% of the fully vaccinated people in that age group. Almost 42% of the city’s senior population is Black, but less than a third have been fully vaccinated.

Philadelphia Health Commissioner Thomas Farley said this week that he’s concerned unvaccinated seniors will have trouble getting doses after the city grants vaccine access to all adults on April 19.

Garrow said the city is asking all vaccine providers to prioritize people age 65 and older, even once more people become eligible. And he said vaccine providers are working to reach the city’s estimated 7,400 homebound residents.

Lindsay Dymowski, president of Centennial Pharmacy in Fishtown, has been hosting two to three vaccination clinics a week at senior living facilities and apartment buildings with large senior populations, and her experience bolsters concerns that those who live alone impact the percentage of seniors vaccinated. She’s noticed those living in congregant settings are getting vaccinated even before she arrives for the in-house clinics.

“It has been in the recent weeks we’re going to these senior complexes and we may have 70 people who have signed up for vaccine and we only get 15,” she said, saying many found other means to secure a vaccination.

She runs clinics in lower-income buildings more frequently than wealthier apartment and condominium complexes, where vaccination rates are generally higher. Regardless of income, people living in congregant settings seem to be having an easier time getting doses. She attributed that to building managers who have been proactive about sending out information about vaccination and coordinating clinics.

Bill Johnston-Walsh, state director for AARP Pennsylvania, said he believes that the seniors who haven’t been vaccinated either lack a support system of friends or family to help them make appointments, or haven’t heard directly from their primary care doctor that they should get vaccinated.

“Unless someone’s giving them that direction they freeze up and they’re not able to navigate the system,” he said.

Christine Jones, 70, who was vaccinated Wednesday at the West Philadelphia public health center, said she had tried to get appointments elsewhere without success. She didn’t expect to be able to get vaccinated so easily.

The walk-up sites at the public health centers are designed to make vaccination convenient and accessible, but because of the limited number of doses the city could offer, was not heavily promoted. The city initially expected to be able to offer 50 doses per site, though more were available than expected Wednesday.

“We are trying to be careful not to overpromise these clinics until we can better support them with vaccine,” Garrow said.

Jones went to the health center intending only to ask about what she needed to do to get a shot, she said.

“I thought I was just registering,” she said. “But I got the shot.”

Expanded outreach

Community advocates noted there is a road map to boosting senior vaccination. Groups that are conducting phone banking or door-to-door canvassing to register seniors find they are often receptive.

“I think it was so overwhelming at first that people kind of put it aside,” said Mary Kay Meeks-Hank, executive director of Face to Face, a Germantown service group that provides assistance to low-income residents and in late March began offering vaccinations. “Once people got it in their head that ‘vaccination will be right in my neighborhood,’ that makes all the difference.”

Philadelphia is expecting to begin a door-to-door registration effort this month, officials said. Ahead of the April 19 expansion of eligibility, AARP is sending emails and making phone calls to Pennsylvania members to encourage and help them to make vaccine appointments.

» READ MORE: Philly started allowing walk-ins at FEMA vaccine site to improve equity. It might be working.

Johnston-Walsh said the situation has improved from about a month ago, when seniors were struggling to find appointments or reporting that they had to drive a few hours from where they live to get a shot. But he’s still hearing complaints about trouble finding appointments, he said, and he is concerned about the number of seniors who have not yet been vaccinated.

“It’s definitely moving in the right direction,” he said. “We’re not as far along as we should be.”