This time last year, sirens were a constant sound in New York City, and elsewhere in the U.S. as the COVID-19 pandemic surged. While those who could stayed inside and worked from home, community health centers (CHCs) throughout the country did everything they could to keep their doors open and provide essential healthcare, in person or by pivoting rapidly to telehealth, and to add essential COVID-19 testing capacity. In January 2021 the news broke that vaccinations would soon be distributed, offering a way forward from a year marked with uncertainty. The promise of vaccinations led to new questions. How would the vaccine roll-out proceed? How could the vaccines be distributed equitably and who would ensure that underserved communities were reached? In March 2021, the Biden Administration announced that it was investing $10 billion to expand access to COVID-19 vaccines and build vaccine confidence in the hardest-hit and highest-risk communities. This investment included $6 billion to community health centers. To understand what the vaccine roll-out looked like on the ground and how community health centers were navigating this new pandemic-related challenge, I reached out to our colleagues at Callen-Lorde Community Health Center in New York City and Community Health Center, Inc. in Connecticut.
Callen-Lorde Community Health Center, NY
Callen-Lorde Community Health Center was created specifically to serve LGBTQ+ communities and traces its roots to the Stonewall era in the late 1960s. The health center has since grown into a network of primary care centers across the New York City, with locations in Manhattan, Brooklyn and the South Bronx. Each site offers a wide variety of services, including comprehensive primary care, on-site pharmacies, behavioral health services, women’s health, transgender health, and medical case management support, and access to dental care.
"We have connections to the communities that we serve that are unique and very often are the only connection individuals have with the health center." I spoke with Dr. Peter Meacher, Callen-Lorde’s Chief Medical Officer, who underscored the importance of the health center’s relationship with its community in the vaccine effort. Callen-Lorde is focusing on vaccinating those patients who are less likely to find vaccination appointments on their own and who might otherwise fall through the cracks. The health center is administering vaccinations at all three of its sites and has focused its efforts on those patients who are most likely to get very sick if they get COVID-19, those who are at risk because of age, race and ethnicity, and transgender/ non-binary persons. “We have connections to the communities we serve that are unique and very often are the only connection individuals have with the health system,” said Dr. Meacher. “Trust around the vaccine is a huge issue and trust is something that is often unique between the patient and the federally qualified health center in a way that the patient might not trust so many other aspects of the health system.”
Dr. Meacher explained the health center’s strategy as carefully nuanced to prioritize medical issues, but also address social determinants of health, noting, “We went from thinking we would vaccinate every patient to realizing that actually our job is to focus on the people who are not going to go to mass vaccination sites. Those are the people where FQHCS have an advantage with and a responsibility (to) because of the trust and relationship that exists between these patients and medical staff at FQHCS.” Dr. Meacher emphasized that some of Callen-Lorde’s patients might feel uncomfortable going to a mass vaccination site for a variety of reasons, “whether it’s the technological divide—TurboVax and Dr. B require a tech competency and access to tech that is beyond the reach of many people—or because they are transgender and have had terrible past experiences in our health system, we want to make sure we are reaching out to and getting them vaccinated at Callen-Lorde.” TurboVax, a free tool developed by N.Y.C.-based software engineer Huge Ma as a public service, compiles the available vaccine appointments from the three main city and state vaccine systems and provides near real-time availability on Twitter. Dr. B, founded by former ZocDoc CEO Cyrus Massoumi, alerts people who are willing and able to travel within the city on short notice to available stand-by vaccine appointments.
"We went from thinking we would vaccinate every patient to realizing that actually our job is to focus on the people who are not going to mass vaccination sites" Dr. Meacher explained that while the health center no longer experiences significant supply challenges, the uncertainly around vaccine supply can make planning difficult. Callen-Lorde was selected to participate in the Health Center COVID-19 Vaccine Program, which has since been extended to invite all funded and look-alike community health centers. The health center has offered the Moderna vaccine. The two-dose vaccinations are an extra challenge for some patients, whose life circumstances and other health conditions may make it hard for them to return for a second dose. When we spoke, Dr. Meacher was waiting to find out if Callen-Lorde had been approved to distribute the single-dose Johnson & Johnson vaccine. Earlier this month, administration of the Johnson & Johnson vaccine was temporarily paused by the Food and Drug Administration (FDA) and the CDC because of a potential link between the vaccine and serious blood clots. The CDC and FDA have since lifted the pause, allowing use of the Johnson & Johnson vaccine to resume without restrictions, noting that “women younger than 50 years old should be aware” that there is a rare but increased risk of this adverse event.1 It is still unclear how this temporary pause will affect the supply and future distribution of the Johnson & Johnson vaccine. However, if available, the single-dose Johnson & Johnson vaccine could be especially important for the health center’s patients, removing the obstacle of requiring that patients return for a second appointment.
The health center is pressing on, trying to get doses to as many people as possible. He stressed that it's important to help people understand that feeling unwell after being vaccinated is a normal response and just means the vaccination is working like it's supposed to. One positive Dr. Meacher noticed was that over the past few months, patients who had initially rejected the vaccine were changing their mind. “Some people just need a little time and as people see their friends, families and colleagues get vaccinated and not get sick, they are becoming more open to it.”
Community Health Center, Inc., CT
Community Health Center, Inc. (CHC, Inc.), started by activists in a Middletown, CT apartment in 1972, now provides medical, dental, and behavioral health services at 16 fixed sites to meet the needs of the entire community, including the uninsured, underinsured and vulnerable populations.
Mark Masselli, the health center’s founder and Chief Executive Officer, spoke with me about Community Health Center Inc.’s vaccine roll-out, and the challenges and successes of its testing and vaccine campaign amidst an unprecedented public health crisis.
Mr. Masselli has worked closely with the state of Connecticut, including the Governor’s office and Department of Public Health, from the earliest days of the pandemic. Prior to the vaccine roll-out, CHC, Inc. was already the largest tester in its state and has tested more than 600,000 residents for COVID-19. CHC, Inc. is currently running four mass vaccination sites in East Hartford, Danbury, Middletown and Stamford, in addition to providing vaccinations at its health center locations. These mass vaccination sites were opened at the request of the Governor’s office. CHC, Inc. was one of the first health centers tapped as part of the Biden administration’s Health Center COVID-19 Vaccine Program, and the health center has had good access to vaccine supplies.
On the grounds of a former airfield in East Hartford, the health center runs the state’s largest mass vaccination site, with the capacity to administer up to 5,000 vaccinations a day: “Everyone is doing what they can; someone who is 25 remarked that they had just vaccinated someone who was 105 years old, forging a connection between generations that I think is very important.”
CHC, Inc. also provides vaccinations in congregate settings like homeless and domestic violence shelters and Masselli spoke of the importance of providing care to farmworkers who are in smaller isolated areas that make them more difficult to reach. Mobile clinics are utilized daily to reach those living in underserved communities. To date, the health center has provided approximately 400,000 vaccines across the state of Connecticut.
"Welcome to the world of communty health centers, with the smallest resources you need to do the most" Adding the many resources needed for testing and vaccinations has brought challenges along with rewards. CHC, Inc. has continued to provide primary care for its community members to meet their ongoing health care needs. With vaccinations and COVID-19 tests come more patients seeking care. In less than a year, CHC, Inc. has seen more than 300,000 individuals new to the Health Center for COVID-19 testing. Masselli remarked, “Welcome to the world of community health centers, with the smallest amount you need to do the most. That’s true of CHCs around the country, with small resources prior to the pandemic, during the pandemic, and after the pandemic we don’t really have the resources to accomplish everything we want to. We have to really think about how we can do as much as our population needs us to do.” Masselli was thoughtful about the health center’s responsibility to not only add service capacity, but to reach those most vulnerable to infection and illness, and to “make sure that the population we care for is included in the strategies of our state and other states across the nation. Black and Brown and Indigenous populations need to be prioritized. The rates of hospitalizations and death have been higher for Black and Hispanic populations and a strategy needs to be determined to prioritize them.”
"We've lost the joy in healthcare and we need to find it again. Giving vaccines can bring the joy back to healthcare" Masselli also noted that it was important to acknowledge the responsibility to patients who are hesitant about taking the vaccine, and whose concerns may reflect a lack of trust and confidence in the medical system. “We need influencers from the communities that we care for who will talk with someone who might be hesitant.” Worries about the new variants persist, but Masselli ended on a hopeful note, remarking that, “There is a joy and excitement in both those who are giving it and those that are receiving and that is a whole different experience than the testing site. This is about getting a cure. We’ve lost the joy in healthcare and we need to find it again. Giving vaccines can bring joy back to healthcare.”
As of May 3, 2021, the death toll from COVID-19 has exceeded 51,800 people in New York state, including more than 32,600 in New York City, and 8,097 have died in Connecticut. COVID-19 has disproportionately affected Black and Hispanic communities. These inequities are mirrored in New York City’s COVID-19 vaccination rates, with recent data indicating that 44 percent of white adults have received at least one dose of the vaccine while only 26 percent of Black adults and 31 percent of Latino adults have received their first dose. Similar discrepancies exist in Connecticut where as of March 22, 2021, 37 percent of white residents had received at least one dose, in comparison to 20 percent of Black residents and just under 17 percent of Hispanic residents. As much as vaccinations offer hope and a glimpse of a pandemic-free future, it’s important that we continue to invest in community health centers to ensure that vaccines and essential services are accessible to the hardest-hit communities.