Four minutes before the start of a pop-up vaccine clinic in a Great Barrington parking lot, Community Health Programs staff huddle inside the bright orange Mobile Health Unit.
“We need pens,” someone calls out. “Where are the pens?”
The vaccinators have been readying themselves for the past hour, rushing to fill the van with syringes, signs and doses of the Moderna vaccine. The details still are coming together at the last possible moment as the van pulls up in a church parking lot ringed by white blossoms.
Scribes grab clipboards and pull on jackets before they head outside, where several cars already have pulled in for the Friday morning clinic.
Zenani Santos, 19, waits in one of those cars. Santos, one of just over a dozen people registered for this site, describes herself as “in the middle” on the vaccine enthusiasm scale.
“I’m glad I made this decision,” she said. “But, I also feel like knowing more about the vaccine is good, and I still don’t know as much as I could.”
For months, the Mobile Health Unit has been on the road, trying to reach Santos and many other people with varying levels of vaccine enthusiasm, first as a branch of the Berkshire Vaccine Collaborative, and now with doses supplied directly by the federal government.
Along with nonprofit partners like Bridge, a Lee-based multicultural organization, and Volunteers in Medicine, CHP has been trying to inoculate the county’s most vulnerable residents, overcome hesitancy, smooth out the process and help close racial gaps in vaccination rates. As part of that effort, the Mobile Health Unit hits the road five days a week.
Santos, who learned most of what she knows about the vaccine from the supermarket where she works, which gave out information, came around to getting vaccinated and decided she wanted the Moderna vaccine — the two-dose regimen gives her confidence, as do the company’s Massachusetts roots, in Cambridge.
Her reasoning, she readily admits, might not be on solid scientific ground.
“It’s not really factual,” she said with a laugh. “It’s just my logic.”
Part of what finally persuaded Santos to get the shot was just how easy it was to sign up for the clinic. Registrations were organized by Bridge.
“You do it for your peace of mind, to keep the people around you safe,” she said. “And, it’s here. So, I might as well do it.”
‘Pockets of communities’
Early in the rollout, equity advocates pointed out that the state’s distribution system — large-scale clinics and online registration — inevitably prioritized people with computer literacy, free time and access to transportation, often wealthier and white residents. The access barriers, combined with early reports that people of color might be more vaccine-hesitant, worried advocates.
“We are seeing that wealthier people with more access have gotten more vaccines,” said Gwendolyn VanSant, CEO and founding director of Bridge. “And wealthier people in this community are often white. It’s a reflection of everything about the pandemic.”
As of Tuesday, 47 percent of white residents in Berkshire County had received at least one shot. The same was true for just 26 percent of Black residents, 30 percent of Latino residents and 39 percent of Asian residents, according to state data. The vaccination gap for Black residents in the Berkshires was even larger than the disparity statewide.
State officials have said that early racial disparities likely were due, in part, to age-based eligibility restrictions. People 75 and older make up 8 percent of the white population in Massachusetts, a rate that drops to 4 percent for Black residents and 2 percent for Latino residents, according to U.S. Census data.
Now that the registration floodgates have opened, though, local equity advocates and health care providers are focused on overcoming the remaining hurdles.
“We really try to get deep into the pockets of communities,” said Michelle Derr, director of family services at CHP. “We still have a lot of people to vaccinate.”
There are many reasons why someone might want to get their shot through CHP, the van staff point out. Some people are hesitant to get vaccinated in the first place, or uncomfortable at the big public clinics. Others face technological challenges, language barriers and transportation issues, or simply have not been able to secure an appointment.
“We just did an 81-year-old who couldn’t get into a clinic,” Derr said. “We’re still capturing all those people.”
Since January, the van has administered shots at senior housing, low-income housing, the homeless shelter at the former St. Joseph Central High School in Pittsfield, the Elizabeth Freeman Center and in parking lots in various downtowns, collaborating with local officials and councils on aging to find recipients, sometimes making repeat stops every few weeks to catch people who change their mind.
On the road
As the van leaves Great Barrington and rolls slowly along Route 7 to Sheffield, the vaccine team — it’s made up of Derr, several nurses and scribes, a social worker and Mary Feuer, assistant director of family services — takes the brief respite to discuss the next clinic.
In a typical day, the van delivers about 100 doses, with some clinics as large as 60 recipients and others intended to catch just a handful of people. When the van arrives in Sheffield, only one car has pulled into the tiny parking lot, wedged between a moss-covered fence and white Colonial buildings.
After a few minutes, Derr heads over to the nearby gas station to see if any employees need a shot. She also offers the vaccine to a nearby driver, who shakes his head, grins and points to his arm. Already vaccinated.
With such small numbers at each clinic, and a relatively high rate of no-shows, Derr and her team sometimes have to go fishing for potential recipients. That means calling up nonprofit partners, going door to door in some neighborhoods and, once, even ducking inside a supermarket during a rainstorm to find someone who needs a shot.
“We’ve never wasted a dose,” Derr said.
Half a dozen people get doses in Sheffield, and, when the team stops at Guido’s Fresh Marketplace for lunch, it manages to snag 10 more people, mostly store employees and construction workers at a nearby site.
The greater good
At 2 p.m., the van stops in Lee for the final first-dose clinic of the day, where a small crowd already has gathered. Staff from Bridge, which has partnered with the health center through a CHP vaccine hesitancy grant, are on-site to help translate Spanish and assuage fears.
“Our partnership helps people trust this process,” VanSant said. “And the more people in the community who get it, the more people will trust it.”
Recipients at this site are among the most skittish of the day. Several are uninsured and nervous. People in one car tell the vaccinator that they only want Pfizer and have to be gently reassured that Moderna shots are just as good — and just as safe.
As a member of the state’s committee on vaccine messaging, VanSant has spent a lot of time thinking about hesitancy.
“There’s kind of a trap, to think, ‘Oh, we have to get these Black folks, or these Trump voters, we gotta get them in,’” she said. “It’s easy to focus on this and not focus on what the real, presenting problems are.”
VanSant was grateful for the chance to get people vaccinated in their cars, surrounded by Bridge staff and their family and friends. Several Bridge staffers pointed out one obvious difference between the mobile clinics and the major vaccine sites — the public clinics have a large police presence, and the pop-up sites have none. That factor alone could make some people of color more comfortable.
Several recipients at the site needed almost no convincing to get their shot.
“I want to get back to normal,” said Willard Durant. “I want to see my grandkids, my kids.”
Like many others who showed up at Friday’s clinics, Durant found it almost impossible to book a shot online. Hesitancy, though, never was an issue for him or his family.
“No offense, but the idea that Black people don’t want it, that’s hype,” he said. “I don’t know a single person who said no. But, I don’t know about other people. Maybe we’re the only ones who want to live.”
For Dondei Dean, a Pittsfield community organizer, getting vaccinated was “always a given.” Her family, though, has not come to a consensus. Some of her relatives were eager early on, while others still are holding back.
“It’s mistrust of the state, mistrust of the medical system,” she said. “Or they’re concerned about long-term effects. I understand that.”
Even in her own life, as a small, Black woman, she often finds herself on the defensive in medical settings. The vaccine, though, felt like an obvious choice, in no small part because it was a way to give back to people around her.
“I’m trying to do my part,” she said. “It’s for the greater good.”
As the Lee clinic continued, more and more people arrived at the lot — so many of them brought in simply by word-of-mouth that the CHP van ran out of first doses, VanSant said. Bridge ended up registering at least half a dozen people for a future clinic.
“These are people who don’t have insurance, who don’t have computers, who came on foot,” she said. “I’m so proud of our community for getting word out to the most vulnerable.”
The long haul
Many organizers who spoke with The Eagle said the hesitancy wall they had expected never materialized, as they found they could help sway many people with just a little more information.
Ilana Steinhauer, executive director of Volunteers in Medicine Berkshires, said many of the organization’s uninsured and immigrant clients wanted to be inoculated; they just needed a little help getting into the system.
“People want the vaccine, and we have had almost nobody know how to access it,” she said. “We’ve been using every point of contact to get people signed up. Text messaging, face-to-face visits, everything.”
Like Bridge, Volunteers in Medicine partnered with CHP to perform outreach through the hesitancy grant. The organization also hosted the CHP mobile clinic.
Those kinds of clinics will go on as long as CHP and it partners can find arms to fill them, Derr says. Long after the large-scale clinics eventually shut their doors, the van probably still will be on the road, tracking down the last few people who might be open to a vaccine.
Derr says the task requires constant innovation — and no small amount of patience, as evidenced when a final car drove up at the first clinic in Great Barrington. More than an hour had passed since people were expected to arrive, and the staff already had packed up to leave.
An excited murmur broke out inside the van as the car neared.
“Is it her?”
They had been trying to get this patient into a clinic for days, giving her instructions to various sites through a Spanish interpreter. Staff already had marked her as a no-show for the day.
At the last possible moment, though, there she was. Syringes and clipboards came back out of storage as Derr looked out the window and grinned.
“We’re going to be late,” Derr said. “But, it’s fine. We have to meet them where they’re at.”