Ann Cunningham walked up and down Lincoln Highway in Coatesville on Friday morning, asking everyone she encountered — in laundromats, front porches, even parked cars — the same question: Have you been vaccinated?
At the People’s Barber Shop on Third Street, she found Nigel Styl giving a trim to a customer. Just a week earlier, Cunningham had persuaded Styl, 49, to walk across the street to the clinic inside the Coatesville Area Senior Center and get his first coronavirus shot. But his 46-year-old client, Bakari Green, was turning out to be a harder sell.
“I don’t want to be the guinea pig,” Green said. Cunningham listened, shared her vaccination experience, and answered his questions. Styl did too.
“I’m going to leave this right here for you,” she said, waving a flier with more information on the county’s vaccination efforts. “All you’ve got to do is walk over there across the street.”
Cunningham has these difficult conversations often as she pounds the pavement trying to increase the vaccination rate in Coatesville, where 75% of residents are people of color and the median household income is $45,000 — less than half of what it is across the rest of Chester County, the state’s wealthiest. Some people, especially young people, shut her down immediately, and that can take an emotional toll. But she is inspired each time she convinces someone. On the last Friday in April, she persuaded a few dozen.
“We’re seeing that outreach is critical,” said Cunningham, a member of the city’s New Life in Christ Fellowship church, which has worked to bring more vaccines to Coatesville. “We have to actually go to people and say, ‘Go get it, now, from here.’”
While vaccine hesitancy is one factor contributing to declining demand for the coronavirus shot in recent weeks, plenty of people across the region and the country — particularly people of color or lower-income residents — still face other obstacles, such as transportation, work hours, physical limitations, or caregiving obligations. Community leaders and volunteers need specific tactics to reach them, and to then defeat hesitancy once they do.
The efforts happening now, sometimes in partnership with local governments, are smaller and slower than the earlier rush to stand up mass clinics. But many Pennsylvania adults who have yet to receive a dose may well get vaccinated this way: thanks to one volunteer’s knock on their door, or because their church hosted a clinic, or persuaded by someone they trust.
Just under 18% of Black Pennsylvanians and 7% of Asian/Pacific Islander residents had received at least one dose by the end of April, compared with 44% of white residents, according to the most recent state data. As the country aims for a 70% immunization rate, every shot is critical.
Officials and advocates in Philadelphia, where the vaccination rate is lower than the surrounding suburbs, have highlighted the need to reach underserved communities. So have leaders in the suburbs, where access barriers exist, too. In both places, there is a patchwork of efforts to help.
“If we want herd immunity, we can’t only think of people who are going to stand in line for six hours or the people who are going to rush to find a location,” said Daveda Graham, cofounder of Nurses United Against COVID-19, a grassroots organization vaccinating people in Delaware County. “We have to also think of people who that’s not feasible for.”
Some are waiting for the shot to come to them, perhaps in the hands of their own doctor. Others simply don’t feel an urgency. Many are fearful — for a range of reasons, including systemic disadvantages.
The hesitancy reflects inequities and health disparities in treatment in communities of color, said State Rep. Joanna McClinton (D., Philadelphia and Delaware).
“But also, in predominantly white rural communities you’re seeing similar reactions,” she said, “and you have to wonder: Is it because of a lack of constant access to good health care?”
The news of the last week may kick people into gear: Pennsylvania’s Department of Health said the state’s mask mandate would be lifted if 70% of adults get vaccinated, and President Joe Biden set a July 4 goal for 70% of Americans over 18 to have had at least one dose.
Providers and volunteers say outreach efforts are working, even if it takes time. Many people who are unsure about the vaccine change their mind after talking to someone about it. As of Friday, more than 51% of all Pennsylvanians had at least one shot, compared with 39% on April 13 when Gov. Tom Wolf expanded eligibility to anyone 16 and older.
Cunningham has seen firsthand that taking the time to engage in person is crucial, especially in Black, brown, and lower-income communities. It works to change minds.
“Then the narrative [in the community] becomes ‘Are you crazy? You haven’t gotten the shot?’” she said.
Timing is everything
In the Delaware County borough of Folcroft, Graham and cofounder Markeya Johnson-Williams stuck a sign in the ground at 5 p.m. Wednesday outside the municipal building: “SPECIAL EVENT,” it said. Inside, on the floor of the borough’s basketball court, the two nurses readied enough syringes of the Pfizer vaccine to give shots for several hours.
Nighttime neighborhood clinics are critical for reaching people who can’t take time off work to get vaccinated or drive miles to a mass site, said Graham. They’ve been careful to choose familiar places where locals hold children’s birthday parties or stand in line to vote.
At one site, she said, a patient told them: “I’m not against the vaccine, but I told everybody: ‘I’m not going to get the vaccine until the vaccine comes to me.’”
A lot of people share that mind-set, Graham said.
Miles away, in Kennett Square, LeeAnn Riloff has seen the same phenomenon at the La Comunidad Hispana, a health center focused on serving the Latino community. The slowdown sits in stark contrast to earlier in the rollout, when phones were ringing off the hook with people seeking appointments.
Riloff, the center’s development director, said those still unvaccinated might not be reluctant. “They might just need it almost brought to their doorstep,” she said.
Nationwide, the percentage of white people inoculated with at least one dose is 1.6 times higher than for Black people and 1.5 times higher than for Hispanic people, the Kaiser Family Foundation found in a late April analysis.
With the coronavirus having disproportionate impacts on people of color, ensuring equity in vaccine distribution is key in preventing existing racial health disparities from worsening, experts say.
Many of the efforts are homegrown, such as church-based outreach groups and Nurses United. But some partner with the counties, which now allow walk-ins at mass clinics, incorporate night and weekend hours, and send vaccination teams to low-income housing, mobile-home communities, and homebound and homeless people.
Chester County Commissioner Josh Maxwell said it’s key to earn residents’ trust so they know “we’re looking out for their health.”
Trust and information
When an acquaintance of Shiekh M. Siddique walked into the vaccine clinic at his Upper Darby mosque last week, Siddique asked him: Where’s your wife?
The man, there to get the shot, said his wife wasn’t sure about getting vaccinated.
“This is at your doorsteps,” Siddique, the mosque’s cofounder and vice president, said he told the man, one of about 300 vaccinated last month at Masjid Al Madinah’s clinics. “You don’t have to take off work and drive miles. …Go home and bring your wife.”
Later that day, she arrived for her first shot.
Though hesitancy and access barriers are often discussed separately, they go hand-in-hand for many, community leaders said, and officials are often wary of opening clinics in places where demand seems low.
And once people get past the other barriers, hesitancy is often what’s left.
Outside another barbershop in Coatesville, Cunningham asked Maleak Gray, 36, if he’d gotten his shot.
“I don’t do those. I’m smarter than that,” he said. “You know about the Tuskegee Experiment?” — a reference to the infamous government-sanctioned study that allowed hundreds of Black men with syphilis to be left untreated for decades.
Cunningham nodded but reminded him of the disproportionate impact the COVID-19 pandemic has had on Black people — and the disproportionate risks they will continue to face if much of the community remains unvaccinated. She reminded him about how many white people have been lining up for the shot.
“We cannot wait for others to take action for us,” Cunningham said in an interview. “And though we have dealt with many forms of mistreatment in the past and certainly are still dealing with systemic racism, we are in a position right now to take action to protect our community.”
Like Siddique — whose clinics had interpreters for Chinese, Hindu, Bengali, and Spanish speakers — LaTadra Mosley, administrator of New Life in Christ Fellowship church in Coatesville, and Daniel G.P. Gutiérrez, the bishop of the Episcopal Diocese of Pennsylvania, said faith communities can be powerful messengers, particularly in combating misinformation.
“We’re like, ‘Hey, we’ve even got footage of our pastor getting the vaccine — this is not a hoax,’” said Mosley, who is working with Cunningham and Chester County to bring a clinic to the church’s parking lot this month.
In Southwest Philadelphia, the New Fellowship Missionary Baptist Church hosted a Rite Aid-sponsored clinic Tuesday — the first in the zip code, said McClinton, who represents the area. In West Philadelphia, State Sen. Vincent Hughes (D., Philadelphia and Montgomery) has been calling constituents, encouraging them to get vaccinated, and helped organize five Saturday clinics.
Outreach, McClinton said, is the key.
“People are still dying from this. It is not last year’s problem. It is still this year’s problem,” McClinton said she tells neighbors and constituents. “So we have to get brave. We have to trust the science. And we have to protect ourselves.”
Cunningham foresees continuing her work through the end of the summer, hopefully with more volunteers and community engagement. Next Thursday, the county’s mobile vaccination unit will sit in the church parking lot, and Cunningham and others are planning a block-party-like event to entice people.
Gutiérrez, the bishop, agreed this is a long-haul commitment.
“If it comes down to it,” he said, “as we get into the summer, heck, I’ll go door-to-door knocking.”