If last week’s vaccine rollout to seniors — where phone lines were tied up for hours and online portals crashed — is any indication, getting enough county residents access to the vaccine will be no small feat.
Health leaders at San Mateo County say they must vaccinate 90 percent of the adult population, or around 557,000 people, to achieve herd immunity locally. But even when supply catches up to demand and doses become widely available, many barriers stand in the way of getting enough shots into arms.
The location and timing of a site matters for working residents, language and technology can prevent signups, and so can fear, mistrust and misinformation. Shireen Malekafzali, county senior manager for Health Policy, Planning and Equity, said the hurdles are endless.
“There is so much to overcome to really make this accessible,” Malekafzali said.
Because of equity and accessibility concerns, the county is mobilizing now to gather community organizations that it says will be critical to outreach and scaling up mass vaccination. Composed of more than 100 community-based organizations and growing, the Vaccine Communication Equity Working Group met for the first time on Thursday.
“Our hope is that (the organizations are) really going to be bringing the voice of the communities they serve,” Malekafzali said. “The working group is centered around making sure we provide effective messaging and have the right outlets.”
On the Coastside, that means the county aims to work with groups like Puente de la Costa Sur to help reach farmers and farmworking families, Senior Coastsiders to help seniors sign up for vaccine appointments and avoid scams, and Coastside Hope to reach low-income families who may not have health insurance, in addition to many countywide groups.
Malekafzali said the county’s partnership with Puente and the La Honda-Pescadero Unified School District this year proved invaluable in standing up an effective testing site on the South Coast. She said those sites and last week’s mass vaccination of health care workers at the San Mateo County Event Center will help inform the county’s vaccination strategy going forward.
“We are exploring how our street medicine and mobile clinic people will be able to provide support, and how we translate what we’re learning there that might be the same,” Malekafzali said.
Coastside Hope Executive Director Judith Guerrero said outreach for the 2020 U.S. Census, which used a similar community-centered strategy to get the county the highest response rate in the state, will be a key model for the general vaccine rollout.
“Working with community-based organizations is going to be the best bet,” Guerrero said. “The ideal situation is to turn the Monday COVID testing into vaccinations, but there are so many factors into setting something up like that. It's not just the county, it’s state and federal.”
Senior Coastsiders Executive Director Sandra Winter agrees, and said she’s been working with the county to get COVID-19 and vaccine information to local seniors in English, Spanish and Mandarin. She said she hopes the senior center can play an even bigger role in opening up access.
“We’ve told them we’re very happy to be a site to administer the vaccine when the time comes,” Winter said.
But reaching herd immunity will take more than erecting local clinics. Officials must build enough trust so that residents actually get in line when their turn comes around. Guerrero said she worries about the politicization of the vaccine and wants to make sure residents know the vaccine is safe and effective, and that their immigration status will not be a factor in their eligibility.
“There is a lot of distrust in government, research and health care and that’s rightfully true given the painful history but also the current health inequities,” Malekafzali said at a county webinar last week. “There's also a lot of misinformation out there that spreads fairly quickly because of social media.”
Some private companies like Trader Joe’s and Instacart are even planning to pay their employees extra to get vaccinated once supply broadens. While Malekafzali said the county hasn’t yet considered an incentive program, nothing is off the table.
“Right now, we have so much more demand than we can meet with the current supply of vaccines,” Malekafzali said. “But we are very open to all pathways to reach our most vulnerable community members.”