Published in Health Care

Public health officials shift to a distributed approach to ensure COVID-19 vaccination rates continue to grow

BY Sunday, June 06, 2021 05:30pm

In the nearly four months between late January and May this year, the West Michigan Vaccine Clinic at DeVos Place administered more than 230,000 COVID-19 vaccine doses.

The mass clinic in downtown Grand Rapids significantly helped drive Kent County’s vaccination rate to 54 percent of eligible residents fully vaccinated and 60 percent partially vaccinated when it shut down last month, according to county officials.

Now that the DeVos Place clinic has shut down operations becasue of slower demand and given that vaccine doses are far more readily available, the Kent County Health Department has been altering course to achieve a 70 percent vaccination rate among residents.

“The strategy right now is to continue putting vaccines where people are already at and where they go on a regular basis,” said Dr. Adam London, director of the Kent County Health Department.

“During the last four months, we knew that the demand was so high that people were going to go wherever the vaccine was available. That’s why DeVos Place made so much sense for us,” London added. “We’re past that now. The theme now is to make the vaccine available where people are already going.”

That’s now the general strategy in many communities. More than five months after vaccinations started in December, health departments and health systems say reaching the 70 percent vaccination rate to achieve herd immunity requires evolving strategies and tactics as vaccination rates slow.

Rather than rely on large-scale clinics, health departments and health systems now focus primarily on getting people vaccinated at physician offices, hospitals or pharmacies, and working with churches, schools, community organizations, employers and even summer events and festivals. 

The Ottawa County Department of Public Health set up a tent at the Tulip Time festival in Holland in May to offer vaccines. The department provided 125 single doses of the Johnson & Johnson vaccine.

The focus on smaller “pop-up” clinics aims to reach “pockets in the community where we can help fill the need,” Ottawa County Public Information Officer Kristina Wieghmink said.

The Ottawa County Department of Public Health no longer operates a large clinic at the Holland Civic Center and for now still runs a vaccination site with Holland Hospital at Grand Valley State University’s Holland campus for second doses. 

The Department of Public Health also partners with employers for workplace vaccination sites, as well as with organizations that serve people who are homebound, Wieghmink said.

Branching out

Health departments hope to get as many people vaccinated during the summer as possible to help meet the 70 percent goal.

“We’re really focusing on accomplishing as much as we can before the fall and before the school year starts back up again. Having more inside activity is going to be an opportunity for the virus to spread more quickly, so we want to try to make sure that we combat that before fall,” Wieghmink said.

Spectrum Health in May began offering vaccines at more than 60 outpatient urgent care and convenient care centers and physician offices across 13 counties. The Grand Rapids-based health system last week also started to offer vaccines at workplaces with employers, said Chief Operating Officer Brian Basser.

“It’s a much more distributed approach and a much more targeted approach. It’s leveraging established infrastructure,” Basser said. “It’s really meeting the patients where they are and  recognizing the important relationship that occurs between a physician and their patients. We know that there is a real challenge with hesitancy and that people have questions, and connecting with their medical provider is perhaps the most effective way to overcome that hesitancy and get their questions answered.”

At its 14 hospitals, Spectrum Health offers a vaccine to any unvaccinated patient when they are discharged as an inpatient or from an emergency room visit, Basser said.

The health system has been scaling down operations at a vaccine clinic on 60th Street, where it’s only doing second doses and has provided more than 58,000 vaccinations. Spectrum Health continues to operate a drive-up vaccine site at 1300 Michigan St. NE in Grand Rapids.

Mercy Health also offers vaccines to hospital patients and is now moving vaccinations into primary care physician offices in Kent, Ottawa and Muskegon counties.

“Many of the Grand Rapids offices are vaccinating or will be vaccinating within the next few weeks and we’ll follow suit in the Muskegon, Grand Haven and northern network offices,” said Judy Binns, vice president of clinical services at Mercy Health Physician Partners.

Dr. Andrew Jameson, regional medical director for infection control at Mercy Health Physician Partners, said getting another 10 to 15 percent of the population vaccinated will require locations that are smaller and lower volume, but may offer more convenience for unvaccinated people than going to a large clinic.

“We have to go small,” Jameson said.

Incentivizing shots

Mercy Health also now provides vaccines at workplaces and wants to partner with businesses such as retailers or entertainment or sports venues on perks such as tickets to an event or gift cards.

“Those are some of the next steps to really incentivize people that may not be willing to (get vaccinated) but are now,” said Jameson, who notes “good, old fashioned bribery” may prove necessary for some people to get vaccinated.

Mercy Health still operates vaccine clinics at an office building at 44th Street and Kalamazoo Avenue in Kentwood, and a Shape Corp. office in Spring Lake. Soon, both clinics will only offer second doses.

In Ottawa County, the Department of Public Health has been encouraging employers to offer employees incentives to get vaccinated through added paid time off or a gift card of perhaps $100, Wieghmink said.

Federal laws allow employers to offer workers incentives to get vaccinated as long as the incentives are not “coercive,” according to updated guidance the U.S. Equal Employment Opportunity Commission (EEOC) issued May 28.

Sizable incentives could make employees feel pressured to disclose protected medical information as they answer disability-related screening questions before receiving a shot. Employers also may require workers to get vaccinated to enter the workplace, “so long as employers comply with the reasonable accommodation provisions” of the Americans with Disabilities Act, according to the EEOC.

Access challenges

In Kent County, pivoting from large-scale clinics means getting out more into Grand Rapids’ urban core and rural townships where vaccination rates are the lowest, London said.

Six rural, northern townships and high-density neighborhoods in the city of Grand Rapids have the lowest vaccine rates in Kent County and are below 50 percent in some areas, London said. Communities such as East Grand Rapids, Walker, Ada and Cascade have the highest rates that reach 70 to 80 percent or more, he said.

The low rates could stem from access issues. Rural communities don’t have the same density of clinics and available pharmacies as suburban communities, London said. Political views toward the vaccine have also played into the lower vaccination rates in those rural townships, he said.

In the city, some urban neighborhoods lack pharmacies that provide vaccines and there remains a lingering resistance to the vaccine from the historical lack of trust and skepticism some people of color have toward the health system, London said.

To overcome that reluctance, health departments have worked to partner with physicians, pastors, local business leaders and organizations that people trust.

Doctors are “the No. 1 trusted source from anybody” for encouraging people to get vaccinated, Wieghmink said.

Reasons people cite for not getting vaccinated range from a lack of trust of vaccines or the health system, to a lack of easy and convenient access, according to London.

Survey data indicate that 20 to 25 percent of people in Kent County are willing to take time to get a vaccine, but “they’re probably not willing to spend a lot of time or take a lot of special effort to go and pursue a vaccine, London said.

“They’re willing to take it if it’s brought to them and it’s made incredibly convenient, but they’re probably not going to make a special trip anywhere,” he said. “That’s why it’s important to get it into pharmacies and provider offices and it’s important to have it available in small clinics throughout the community.”

The Kent County Health Department has been considering working with employers and offering vaccines at the workplace. That’s an option that was not previously workable, as the health department and partners — Spectrum Health and Mercy Health — dedicated staff to the DeVos Place mass clinic that offered scale, efficiency and the capacity to do thousands of vaccinations a day when demand was high.

The Kent County Health Department is looking at coordinating workplace vaccinations through a regional collaborative that can match requests with providers, London said.

“Now we’re dealing with this portion of the population that might not go to a pharmacy or a clinic specifically for a vaccine, but they might do it if it’s in the cafeteria or the break room at work,” London said. “We are kicking the tires on that idea once again.”

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