In the days before an east Los Angeles Covid-19 vaccination site opened in a Latino neighbourhood that was hard-hit by the pandemic, people flooded California's online booking system to snap up appointments. The software accepted hundreds of ineligible residents from wealthy enclaves such as Beverly Hills.
Jim Mangia, chief executive of St. John's Well Child & Family Center, said not one of the first 300 people to book an appointment lived in an east Los Angeles ZIP code and many were not eligible under existing guidelines for age and occupation.
Mangia unplugged the site from the state's My Turn online system. Then 15 staffers spent two days calling ineligible people to cancel appointments. Food service union officials and local immigration support groups helped recruit eligible residents. Four outreach workers walked the streets for hours, talking with people and posting flyers emblazoned with a phone number for scheduling vaccine appointments.
Such low-tech, shoe-leather strategies are informed by on-the-ground data that government-funded community health clinics such as St. John's have been collecting for decades.
President Joe Biden announced in February that he was turning to the expertise and deep community connections of the more than 1,300 such clinics across the country. As part of a strategy to increase vaccinations in communities devastated by coronavirus, administration officials reached out to clinics in every state, where staff know that the impoverished Latinos and Blacks they serve are being vaccinated at about half the rate of whites - despite being at least twice as likely to die from Covid-19.
Reuters spoke with a dozen clinics in Los Angeles, Oakland, Philadelphia, Detroit, Miami and Birmingham, Alabama, that are getting vaccines into the arms of people who have trouble securing appointments via overrun internet booking systems or getting to mass vaccination sites due to lack of technological savvy, time or transportation.
The clinics offer low- to no-cost medical services to almost 30 million people across the country – including essential workers who harvest, sell and cook food; clean homes and hospitals; and care for children, the disabled and elderly. In its first four days, St. John's inoculated 1,400 people in east LA - among them food cart vendors, housekeepers and gardeners, Mangia said.
The United States is in a race to rollout vaccines as more contagious variants of the virus are discovered, posing a new threat to areas where infection rates are highest.
'How Equity Gets Ignored'
States including California and Texas redact information about race and ethnicity when they report vaccination data, citing patient privacy. That results in an incomplete picture that hobbles efforts to identify gaps, guide ongoing policies and direct resources to areas beset by entrenched medical inequities.
As of Thursday, the CDC only had race and ethnicity data for 53% of the roughly 74 million people who have received at least one vaccine dose. Within that group, 66% were white, almost 9% were Hispanic or Latino and nearly 8% were Black, the data showed here.
"Often times this is how equity gets ignored – because it just doesn't get measured in the first place," said Dr Abdul El-Sayed, an epidemiologist and former director of Detroit's health department.
The federal government requires the community clinics it funds to collect race and ethnicity data. But they had vaccinated relatively people few before the latest push - 370,079 shots as of March 5.
The community clinics use robust patient data to bolster vaccination campaigns. Their staff are also trusted healthcare providers who can help dispel hesitancy toward the vaccine in vulnerable communities that is rooted in distrust of the government and historical episodes of medical exploitation.
AltaMed Health Services, one of the nation's largest community clinic operators, uses records from its roughly 300,000 Southern California patients to create lists of eligible patients. Dr Sherrill Brown, its medical director, said staff then reach out via text and email.
"We try to bombard them with the information so that they have as many opportunities as they can to schedule an appointment," Brown said.
Philadelphia's Public Health Management Corporation identified 12,000 vaccine-eligible patients at its five federally funded clinics and added a special phone tree for vaccine calls. The Philadelphia clinics are inoculating unsheltered patients, public housing residents and teachers at schools for students with special needs.
Alabama's mostly Black north Birmingham, a neighbourhood grappling with poverty and health problems linked to steel plant pollution, got its first vaccines after the Biden administration intervened. Alabama Regional Medical Services, a community clinic serving the area, on Saturday started vaccinating its own patients and residents referred by local ministers and public housing groups.
"We're going to clear the backlog for the 35207 ZIP code," said Christopher Mosley, its outreach director, referring to local demand.
Federally allocated vaccines are also starting to flow into metro Detroit, Michigan, said Anthony King, CEO of the Wellness Plan, a clinic operator in the city that is a hot spot in the state with the nation's highest infection rate.
Meanwhile, California doubled doses shipped to clinics in neighbourhoods where Covid-19 cases and death are highest, and quickly vaccinated 400,000 of its most vulnerable residents.
"That's how it should have been all along," said Dr Jerry Abraham, who leads the vaccine team at Kedren Community Health Center, which serves south-central Los Angeles' Latino and Black communities.
As he spoke, security guards waved seniors through its main checkpoint for no-wait inoculations.