Do you know someone who is unsure about taking the COVID-19 vaccine? If so, knowing their barriers and beliefs can help you understand how to start a conversation with them. CCI and the National Association of Community Health Centers (NACHC) host a lively discussion about innovative community outreach practices for COVID-19 vaccination. We focus on key research around "vaccine personas," and frontline stories from community health centers. Advance health equity and design out-of-the-box solutions!
Do you know someone who is unsure about taking the COVID-19 vaccine? If so, knowing their barriers and beliefs can help you understand how to start a conversation with them.
CCI and the National Association of Community Health Centers (NACHC) host a lively discussion about innovative community outreach practices for COVID-19 vaccination. We focus on key research around "vaccine personas," and frontline stories from community health centers. Advance health equity and design out-of-the-box solutions!
Here’s where you can learn more about the people, places, and ideas in this episode:
This is an automated transcript. Please excuse any errors or hilarious mistakes.
Welcome to the health pilots podcast presented by the center for care innovations. This podcast is about strengthening the health and wellbeing of historically under-invested communities. Every episode offers new ideas and practical advice that you can apply today. This episode is adapted from a recent webinar, enjoy I'm
Sofi Bergkvist them the president of Center of Care Innovations since September. So I joined during the pandemic and I'm experiencing everything, but that means getting to know a team and partners in a virtual world. And I can't wait to meet many of you in person. Um, I see the light at the end of that tunnel. Um, so central Kerry innovations has been around for about 20 years. So before we get started, I want to introduce you to who we are as hosts, both CCI. And we do this together with NAC. So we have been around for 20 years and started off working with safety net providers in California. Over the last 10 years, we have expanded that work to work with partners across the country, and also with community-based organizations, knowing that the changes we hope to see and the transformation that the country needs is really about working directly with the communities.
So partnership between providers and communities, um, and payers to achieve the change for fair, just Justin inclusive opportunities for everyone to be healthy can go to the next slide. Uh, our mission, just so you can see what our mission is that we spark seed and spread innovations that strengthen the health and wellbeing of historically under-invested communities. And we create lasting change in collaboration with our partners in the health ecosystem. Health ecosystem can mean many different things, but one of those partners is the national association for community health care clinics. We work with them on a few programs. We see them as a very important partner given how they are engaged directly with community health centers across the country. Um, and we see them as a partner for the work to spark seed and spread innovation. Um, but over to you, Ron, I would love for you to introduce a little bit about NAC, um, before we dive into the program for today.
Sure. Thanks Sofi. And thanks again to everyone for joining us today. Um, also thank our great partners, Sofi and BU, and the staff over at the center for care innovations, but also Shelly spires of the Albany area, primary care association at the end, Georgia, and then Del Garcia of the migrant clinics does network. Um, just thank you all for partnering with us in this very important work. And again, Sofi said, mentioned, I'm Dr. Ronnie, I'm a family physician, and I have the privilege of serving as the chief medical officer for the national association of community health centers. Um, in that gets the association representing the over 14,000 community health centers, uh, sites across the country, located in every state territory and district of Columbia serving over 30 million patients annually. And in reflecting on what happened over this past year, I think of three things first, how the COVID-19 pandemic impacted the lives of our patients, families, and communities we serve, but also the health center staff, their families, and loved ones as well.
The second thing was, this was a time of unfortunate despair and loss though. It moved us toward a new level of innovation to better meet the needs of our patients and communities. And finally it brought about a new commitment to health through the lens of health equity central to the mission of health centers, where we live and work every day. So through this though, this year was really a year of challenge and innovation. We also learned the importance of listening to our patients and our staff, and co-designing the solutions with them and not for them. So today's call will further this work by looking at the science of building confidence and trust in COVID vaccines through the excellent work of Sergo ventures and real stories from health centers on the front lines. So thank you again for this opportunity. And we look forward to working with all of you in finding solutions that add value to our patients and our communities. So thanks again for joining us to turn it back over to you. So
Thank you so much, Ron. So that's why we're here today. Most states in the us have now vaccinated 50% of the adult population, and that's a real milestone and we're starting to have more and more things to celebrate. Uh, San Francisco general hospital had several COVID admissions earlier this week, and I think it's important that we celebrate those milestones, but it's also important to remember that we haven't yet climbed the mountain. Uh, the threats of COVID 19 is not over many more people must, must get vaccinated. And we see a rapid decline in vaccination rate in the country. It is 50% lower this vaccination rate in may than it wasn't April. So it's really tapering off. So how can we reach the people that are facing barriers? And we are here today because many of the providers that we work with are looking for solutions and they come to us to ask and we always bring them, um, solutions from, from other partners that we have.
And I'm so grateful that we have three fantastic speakers that will guide us and share their lessons today. We're also hoping that will be an interactive session. So share your reflections ideas and questions in the chat. The real resources are sitting with you. So put links in the chat if you want to. We will also, after this meeting, make sure that we share resources back to everyone. So the first person I want to introduce is Samma, uh, I met Samah when I lived in India and I was amazed by how she and her team had the ability to use tools from behavioral science and data science and work with the local communities and together unlock solutions. So circle ventures that she co-founded works around the world. And we're really lucky that they have grown their work here in the U S and as an example, CDC has adopted circles, vulnerability index in their work to respond to the pandemic. SEMA is, as I mentioned, the co-founder and CEO of circle ventures. And then she's also an assistant adjunct professor at the Harvard school of public health. She worked at the bill and Melinda gates foundation before she started surrogate ventures. She has a PhD in cellular and molecular biology, which is even a handful for me to say, and a master in neuroscience. And I'm just so grateful to have you here today. Say, mom, thank you,
Sofi. Hello everyone. It's such a pleasure and honor to be here with you today. Uh, I'm really excited to learn actually. Uh, so I'm going to get us started right away. Um, wonderful. As Sofi mentioned, um, we're gonna, I'm going to talk about our vaccine work, uh, and essentially the goal here is how can we think about solutions, um, to really drive the remaining gap? Um, so quickly as Sofi mentioned that won't go deeper, we are a nonprofit sort of a ventures, and essentially you work in partnership with a range of organizations, public private. Uh, we work with departments of health, community organizations. I have an organizations really to unlock solutions to help. I would have focused on precision knowing that resources are limited. How can we be super targeted in reaching the communities we want to reach with the solutions that are really going to drive change?
Um, so coming to the COVID vaccine uptake, we actually about a month and a half ago predicted this plateauing that we're seeing right now. So, uh, the screen line here, what the early projections that were made by the New York times and others based on the very encouraging daily vaccination rates. And so our, we were, um, if we continued on that path, we were expecting to reach about 80% by July. Um, and by asking a simple question, one of our surveys, which is when do you plan to get the vaccine we put we've projected this actually pledge plateauing starting in late April may. And so the, the orange is a projection, and unfortunately, um, this projection seems to be holding true. So this is the actual numbers that we are tracking. Um, they're about 50% number that Sofi highlighted as, as you can all, um, appreciate that as the one dose, that is the first dose, there was of course the second dose that also needs to happen.
So the question is, how do we close this gap? How do we ensure, um, for example, to reach president Biden's goal by July 4th, how do we ensure a SIF 70% of adults are vaccinated? Um, so that was our key question is really how do we, um, look at and understand the barriers to vaccine uptake and the approach we took is slightly different. So, you know, there've been many, many surveys out there that are looking at barriers to vaccine and whether people are getting vaccinated and, and those are great. And one of the things that we're seeing a lot is the discourse is around, you know, white versus black versus Latino communities, Republicans versus Democrats, women versus men. And those are very, very helpful. However, I think one thing to realize that that's not, um, very actionable, right? I think what we really need to understand what are those underlying reasons, which are very genuine, that people are not getting vaccinated and how do we target the solutions to the right person?
So the approach we took is what we call psycho behavioral segmentation, which is an approach that's widely used in marketing. And that's really about bucketing people to different groups based on the, the ways they relate to a product or a service. Um, and then the other thing that we're providing is actually granular data. So today I'm going to present you state data, but we are going all the way to the county level and we are going to be monitoring this over time. So really seeing how these patterns are changing. Um, so the question we're trying to answer is who is not likely to get the COVID vaccine, Y Y and therefore, how do we respond? There's a lot of work that's gone into it. I'm not going to go into the methodology, but I'm more than happy to answer methodological questions, but through a series of surveys and studies, we did since December, um, on various validated nationally representative plot, um, panels, as well as on the Facebook platform, so that we can get very large numbers.
We actually, um, identified five different types of people living in the United States in the way they relate to the COVID vaccine. So, um, this, these five types are, um, and, and this distribution, I just want to say is from, uh, January, and I'll show you how these numbers have changed, but essentially we have one group of people who we are calling enthusiastic. These are people that are highly likely to get the vaccine. So from a scale of one to 10, their likelihood is really high. It's about nine. Um, so these are great. These are probably people like many of you on this call would just could not wait to get the vaccine. And in fact, these are the ones who really got the vaccine so far. Then we have another group which are called the watchful. The watchful are so folks that have middle intention to get the vaccine, and they really don't have barriers per se.
But what they do want to see is more people around them, friends, family, getting back stated so they can feel comfortable, and then they will, you know, jump on the bandwagon. So they want to wait and see. And these other three groups are really the most critical. These are the ones that truly have barriers that we really need to think about how to address. So one group is what we call the costs. Anxious. The cost anxious are people that have traditionally delayed seeking care. Despite the fact that a large proportion of these actually do have health insurance as per our surveys about 72%, but they really perceive costs and time barriers in terms of seeking parents specifically in getting the COVID vaccine, even though the vaccine is free, they perceive it to cost them something. Another group of folks are what we call the system.
Distressors. These are people who believe that people of their race are treated unfairly on the healthcare system, by the health care system. And then finally, we have this group, what we call our COVID skeptics, which have the lowest likelihood about 2.3. And these are folks who really don't think that COVID is a concern, and they believe in at least one conspiracy when it comes to COVID. The final thing I will say about these different personas is that all political affiliations and race affiliation and races and ethnicities are actually found in all of these five personas or segments. So these are not unique to a particular race or political affiliation, even though for example, among skeptics, we find a higher proportion of Republicans and independents and among system distressors we find a slightly higher proportion of communities of color. So how have these, um, how the segments of the population shifted or have they been shifted?
And the answer is yes. When we looked at this again in, um, March late March, what we found obviously is a large proportion of the adults by then had gotten back needed. Then the share of the enthusiasm went down considerably because many of them get that got vaccinated. And these middle segments, which we call the persuadable also shrunk. So the watchful went from 20% to six, the cost anxious from 14 to nine system disruptors from nine to seven. Um, however, the COVID skeptics are the ones that have remained really stapled. These are the ones that have not moved. And that makes sense because their likelihood was extremely low. This is a very busy slide, but what we ended up, uh, or we were able to do is actually look state by state across the United States. So each of these lines represent a single state and really understand what percentage of the population, um, is of a particular type apology.
And one of the things we've found, um, is for example, in states like Arkansas, North Dakota, these have the highest proportion of COVID skeptics. Um, and so that's really good to know because that gives you a sense of what are the barriers in those communities and therefore what needs to be addressed in states like Mississippi. On the other hand, we found that among the adults, they had a very high proportion of costs, anxious people. And in states like Delaware, actually the highest proportion were watchful. And this just shows you again, that distribution and another way I'm highlighting, uh, DC, where we see a good chunk of system distressed hers, Arkansas, as I mentioned, skeptics, um, Mississippi, um, uh, cost anxious, um, just to show you the variability across the country in comparison to the, uh, to the national picture, this, this, um, information, or I should say we wrote a, I mean, you may have seen it.
We wrote a piece about this in the New York times, which actually allowed people to go in and really understand, um, get a sense of their, their states. Um, so that was really interesting to actually see all of the commentary that was coming from the readers in terms of how this related to them moving on. The other thing I will say that we also looked at what are the experience and anticipated barriers in getting in getting or projecting to get the vaccine. And we looked at a number of things from time website crashing, availability of appointments, um, difficult to traveling to the vaccination site, et cetera. And again, here also, so again, this is busy, but I will zoom in. This is showing you the different types of barriers we looked at. Each of these thoughts is a particular state, and we saw again, a lot of variability across the United States.
So, um, the most reported challenges, which is, I think is very interesting and important to keep in mind, we're actually structural and access barriers. So there were, as it was not having time, it was concerned over cost and not no available appointments, but although we know this has been addressed, um, recently, um, so then for example, in a state like Maryland, 35% of people reported not being able to schedule an appointment in Arkansas, um, Minnesota, New York, Wyoming, uh, Louisiana, a good chunk of folks reported not having time, uh, in, um, in Nevada and Kansas, um, that, you know, more than 10% of folks reported concerns over cost. So what can we do? So once we understand the typologies that people are a part of, we can actually think of very targeted solutions. Um, so for example, if we look at the watch, well, what is really important for them is, as I mentioned, seeing others getting vaccinated, so it will be important to make this very visible, um, and also for them to provide a vaccinate or vaccinate late option for the cost anxious, it is really about bringing the service as close as possible.
So, um, using all sorts of models of mobile vaccinating and, um, grocery stores in the subway in, you know, community centers, whatever my churches, whatever it may be, so that it is very accessible and enabling them to take time off of work, um, for COVID skeptics. On the other hand, it is really important to listen and acknowledge and not to be confrontational, um, and then to continue the conversation with your facts. Um, so it is really about listening, acknowledging, and providing facts rather than combating their facts. And then the other, um, neat thing about this is you may ask, well, okay, how do I know what typology a person is that I meet, or a person in my family? Well, you can ask simple six questions, which we were able to develop, um, which take less than a minute. And when 97% accuracy, the, um, answer to these questions will tell you whether a person is a skeptic, it calls anxious or watchful, and that will enable you to actually tailor the response.
So finally then how can we use this in a healthcare setting? Well, one way is, um, in the interaction between providers and patients, and one of the things that I think many surveys have highlighted is that people really trust their providers. And so have a big role to play in this. And so providers could ask these simple questions if they don't know their patient population well enough, um, to, to understand what typology that person belongs to. And then, um, put forward a series of messages that we know work for each kind of typology. These could also be integrated into an app. So for example, if you have a way of reaching your community through a mobile app, um, these questions could be integrated in there and you could actually understand what a particular type of type of person is, and actually put forward, um, you know, predetermined messages, um, that are targeted for that, um, for that person.
And finally, you know, throughout other surveys, then I'm curious to know whether you've seen this, even in healthcare centers, we see staff that are, you know, that have barriers and that may be still resistant to taking the vaccine. And so, um, this kind of tool can be used in a healthcare setting where again, um, it can be used by, um, by the Senate to better understand their stuff and provide them the services and the responses they need. Um, you can actually go on, on, on a website and I can share this link and do this, um, questionnaire yourself and figure out what type of person you are. Or you can do this with a family member or a friend it's actually really fun. Uh, and then it gives you a whole set of set of prompts depending on the type of persona you are. And that's it for me is I'm happy to take questions. Thank you very much.
Thank you, Sam. And the first question which we always get is what about the slides? There are so many great, great things in there. And would we be allowed to share the slides with this community? Absolutely. Another question is how have you seen this being used? So you gave a few examples, but in terms of use that has been most impactful from your perspective, you could speak a little bit to that. How was
It actually used in practice?
Yes. Um, so different ways that I, and I will say that we are just in the journey of starting to work with partners. So for example, in Rhode Island hospital, this has been used in an emergency, um, health department, uh, for actually patients coming into the emergency center and the, and the emergency physicians understanding what technology or particular person is. And then thinking about a tailored response. We are partnering with a whole set of health departments that are designing, um, the vaccine uptake responses. Um, and with them, they're actually, we're working with the county level data to think about how can we have Taylor county level responses. So those are the two ways that we are actually using it right
Now. That's great.
Another question is what, what are things that you're learning that you think will be relevant for a post pandemic world about the personal one, but also overall in, in the work that you've done
On COVID response?
Um, I think overall in the COVID response or on this vaccine, particularly I get started with this one. Yeah. Uh, I think, you know, one of the things too we're learning is, you know, we talk a lot about hesitancy. Uh, I think the, you know, in the media, you've heard a lot hesitancy. I mean, one of the important things that we're learning and it's clear from the data that actually access issues are still a really big, um, barrier and concern. And so, which is in some ways good news in my opinion, because those barriers can be solved easily more easily than for example, changing a person's belief. Um, so I think access time, um, all of those are important barriers. I think the other thing that we're seeing is tremendous variability across the United States, um, all the way down to state and council counter level, which, which really says that the response has to be so, so, so locally tailored, um, and so local, uh, local in terms of where you want to put your resources and how you want to respond. So my opinion, those are for me, the big learnings, um, from, from this vaccine work. Great. Thank
You so much. Another question is, does it cost anything to use this tool and where can they find it? Sophia, your colleague has put the link to the precision for COVID, but when it comes to the personas and the tool you just shared, how can people find it and does it cost anything to use it?
Yeah. Um, so please do so the tools available, please do reach out to us so we can help you, um, think through how to integrate it. Um, it is, um, for free for not-for-profits, uh, but we do call, we do charge for for-profit enterprises. So feel free to reach out to us, and we're happy to partner with you and work
Out a model and the
Community here on the coal or not-for-profits. So all of you please reach out to, to Sophia and SEMA. Um, we're going to move on and I hope that you will learn from the coming two percenters that are working on exactly this. Um, we're gonna start with Delaine. I got to see yah. She is director of international project and emerging issues at migrant clinicians network. She has dedicated more than 25 years to the health and wellness needs of migrant and other underserved populations. And we have heard here from rural Texas in the car. Thank you
For joining us. Thank you. I apologize for the setting, but I'm on a trip at a cross, the border between the us and Mexico viewing all of the, uh, immigrant shelters between San Diego and Harlan Harlington. And so I've now made it to San Benito, Texas. So I have another day and a half. Um, but see what I have to say exactly what you're talking about is what we saw in the field, um, and what we keep hearing. And when you talked about underlying reasons, the cost anxious, I think is truly the case in terms of time and costs originally. Um, not understanding some of the places where you could get it. Uh, the fact that they heard so many then rolled us into those systems distressed who had that feeling anyway, certainly when you start looking at immigration and the impact of migration on people's willingness to step up to a governmentally funded and supported process, uh, for healthcare.
And that what you get hearing in the news is that even when they were placing, um, COVID centers in communities of color, that, you know, 75, 80% of the individuals who were vaccinated, there were actually white members of the community who had come into that area, uh, to gain quicker access. And so I think that there were a number of individuals who were already fearful, who are already distrustful in the way that you described a CMI in terms of the systems distrust, and that the reality of this, as it kept rolling out and systems kept crashing or were difficult to get into, or any time you showed up, you were asked for some, um, method of identification, hopefully that it would be governmentally sourced. And that is generally not the case meant that there were a lot of individuals where through word of mouth and word of mouth is faster than almost anything we've seen.
Um, because social media is so important. Uh, the use of what's app, things that were coming out on Facebook, people were learning right away too, if they didn't distrust it to distrust it. And that seemed to go up more and more with time. Interestingly, when you started talking about the COVID skeptics, what I've heard in a number of places as I've been interviewing people who were present in that setting, I've been working in a great deal in the Mexican conflict because there are 50 in the U S and within the Mexican consulates, there is a project called [inaudible] and the [inaudible] are trying to stand up. If not clinics internally to the consulate, then certainly broad connections to local settings where individuals can be vaccinated. And I've been present in a number of these settings and spoken to folks who might not have originally been skeptical, but the amount of negative information that came out in social media, WhatsApp, and Facebook and Twitter, Instagram, all sorts of things was so intense that they then became skeptical of the value of the COVID vaccine.
And then we started to see so many more of the messages of it was an effort to implant a chip in my arm so that I could be tracked because people wanted to know about my immigration. And then when they started to have problems with Johnson and Johnson would immediately emerged was this was an effort to sterilize immigrant women so that they would not be having children at a rate that was then going to mean that non-white populations became the majority over a white population in the next 10 years or so. And so, yes, I agree completely the, the underlying persona, uh, is, is so important. And yet it's so mutable, uh, because I think that the gentleman that I'm thinking of specifically had already made an appointment was ready to go and be vaccinated between when he made his appointment and the date, the appointment was to come the amount of negative information that he was bombarded with and was able to take in was enough to make him miss that appointment.
And that when I spoke to him some weeks later, made him unwilling to consider it again. And for him to be able to say to me, I am really afraid. I'm very afraid of this. I don't know what it means, but, but something is going on and it feels like what they're trying to do is hurt me. Um, and so I think that, that, you know, they might've had an original fear, but then I think that there were a lot of people who through externally generated fear, um, then were, were swayed and dissuaded from taking it on. I do think the issue with Johnson and Johnson was unfortunate, um, because for migrants, particularly the Johnson, Johnson, and Johnson one, and Don was going to be such a strong solution that even now when you say, but really the risk of COVID is so far greater than anything that could happen to you as a result, because it has been so rare.
And it's such a small percentage of women. It's not sufficient, um, to move many people beyond that. On the other hand, what I will say to you is individuals who are just coming into the country, because my work in the last, uh, 10 days has been at the immigration shelters who are receiving people immediately from CVP, from customs and border patrol. And these individuals by and large are welcoming the opportunity to be vaccinated. And a majority of the shelters that I visited are utilizing Johnson and Johnson, and they are able to vaccinate, I would say 95% of the, of the immigrants who come in in rapid order. Some of them are not there more than two or three hours, which means that they're going to start traveling right after having been vaccinated. I hope that they are able to take care of themselves and that they don't have really, um, extreme reaction because some of these folks are in for a three and four day bus ride, um, to go from, you know, Tucson, Arizona to Bridgeport Connecticut.
Uh, but what I do see is enthusiasm because many of them have been in detention and they do feel like they've been exposed that there have been no protections for them. And so the first opportunity that they've had to be vaccinated, they're really very excited and very willing. What I have seen interestingly, at a number of the shelters is that young Latino men seem particularly unwilling to be vaccinated, which is interestingly consistent with some work that we did a few years ago with Latino migrant men, we were able to survey a good quantity of them. Many of them, um, had a misunderstanding about the value of vaccine from a preventative point of view. So I do believe we've not done a good job describing prevention and talking about what it is that you achieve with vaccination. And I do know that if you are from cultures where there's not a real understanding of the benefit of insurance of doing something today to prevent catastrophe in the future, which is generally the case in, in much of Mexico and Latin America, that that kind of education needs to be thought through more carefully.
And that we also heard from these men that, um, they didn't need to be vaccinated because they weren't sick. So they associated an injection with a curative position as opposed to a preventive position. But then they also talked about that. They felt like a number of men, not themselves, but a number of men were fearful of needles and that was keeping them from being vaccinated. And I do see that there is still some of that, and I'm not quite sure, you know, where it's present and what it might come from and what would be our best solution forward. Particularly if we have very short time to work with individuals, um, who are being offered a vaccine and are hesitating out of that fear. But I would say that everything that we're seeing on the ground is absolutely consistent with, with what Sima's research is reporting and that all of our work has to be, hyper-local directed. We've got to understand where our pockets of individuals who've not access to not being able to access, or who've been fearful to access, uh, vaccination are located and how we can reach out to them and what the message for them that will be compelling for their interests is so that we are really looking at them individually, um, and with a real heart for what it is that might be keeping them, um, from seeking the vaccine care they need. Thank you. Thank
You so much, Dell. Um, if you were to point out, I know it needs to be hyper-local the, how we respond to this challenge, but if you want to point out a few examples that you have seen most promising in addressing these barriers.
I think what was really, uh, wonderful to watch is I was working with one of the [inaudible] in south Texas and the console that there was very familiar with the areas of her community, where individuals might have not fully regularized, which is the word that's used, their immigration status, and that there were large numbers of families there. And she went out of her way to make connections with the schools and the churches and the social service organizations that previously had done elder care. They're just starting to come back online to speak to them about the importance of vaccination and that as the console, as someone who represented to Mexican nationals in the U S she understood the importance and she wanted to offer her own assurance. That was incredible. Uh, what I also just saw too, the flew from San Diego was able to work with the [inaudible], which are essentially us businesses.
He was able to do an agreement with the university so that the nurses could do the application and the county so that he could receive the vaccines because he was able to approach them and said that he, he understood they had more vaccines than arms. And what they were able to negotiate was a walk across the bridge. So that Michaela employees were met by us nurses and vaccinated with county vaccines. And he negotiated 10,000 doses, 9,000 went to Michaela employees, and a thousand went to immigration personnel from the Mexico side because they had yet not been vaccinated. And these are individuals who move back and forth. They live in San Diego, they work and you wanna, or, you know, vice versa. They have family members that do both things. And I think that this was a really wonderful solution of seeing where you have American interests on the border. And it just needs to be a collaboration between the medical school, the county, a person like the Mexican conflict and American businesses.
Thank you so much, Dell. We have time for one more question for you, which was, um, what are you finding to be the most effective and efficient tools to combat misinformation, and particularly when it is given via social media?
I think it is what SEMA was, has said also, which is the more people are seeing family members, neighbors, and friends being vaccinated that they're stepping forward, that they're taking that action. And that it becomes then more that the person who is unvaccinated remains an outlier in their group, we're working with Hispanic construction workers association. They were able to call in their memberships of thousands of construction worker for men to say, bring in your workers and that it became not obligatory, but as a benefit of membership to the association. And more and more, we started to see construction workers coming in to be vaccinated in large numbers, which was one of the strongest groups that we were working with that were resistant to coming in. They didn't see the value the time. Well, you know, the time costs, uh, the skepticism, all of it was present. We're seeing it really moved differently. Now.
Thank you. Fantastic example. Um, we see so many inspiring collaborations coming as a response and really finding the strength of other organizations to deliver those messages. So thank you so much. Now we're going to move on to Shelley Spears. She's the CEO of Albany area, primary healthcare, she, which is one of Georgia's largest community health centers. She has a deep understanding of human resources for health, and obviously from her current role, but also previously she was the human resource director at Dooly county medical center. Shelly, thank you so much for being here with us today. You are serving a slightly different from, from Dell that we just heard about. So we'd love to hear who are you serving? What are the main challenges you are facing and what are some of the most promising practices that you have been trying to test that and try it out and maybe tried out things that didn't work. We would love to hear that as well. So people don't don't try things that are less promising,
Right? Yeah. Thank you so much. Um, uh, yes, I'm Shelly spires. I'm the CA for Albany area for my healthcare, um, in Albany, Georgia, in case you couldn't tell by the accent. So, um, certainly serving, um, the underserved population, uninsured and under-insured population, um, in the south Georgia area just quickly to give you just an idea of the size, which 27 locations, 47,000 established patients with about 170,000 visits per year. Um, we employ about 371, um, employees, and, and I share that data to, um, go on to say that, um, to put how bad it was, um, into perspective with 371 employees. Um, we had 117 positive within the first three months, um, uh, the outbreak. And so, um, you can do the math and know that that's a huge chunk of my workforce. Um, so it was pretty bad in the area. One of the things that, um, we have continued to, uh, emphasize, uh, in our community as well with our patient population, of course, is the education component and really understanding the vaccine and what's behind it.
Um, so one of the ways we, we started with that, um, initially with our staff, because there was a sense of hesitancy, if you will, amongst our own healthcare workers. As I said, we had a huge, um, outbreak within our organization as to why the, the healthcare, uh, employees were not interested in the vaccine. And so we actually are very fortunate to have, uh, a variety of providers that are employed with us. And, um, we have one who used to work from NIH. Uh, we have one who was a pharmacist before they were an internist, and then we have a general internist. And so we pulled what we call our three wise women together and actually broke it down so that we could understand how vaccines are made. They ingredients in the vaccine, um, really digging into the statistics and what that looked like. And so we, we actually made some headway.
Um, we went from about 30% up to about 80%, um, just within our workforce today, we've administered over 12,000 vaccines in our organization. And, um, we feel like that's a huge accomplishment considering we're not, we're not a big organization where we're a nice size, but we're not huge. Um, one of the things we've realized in some of the interviews and some of the discussions we've had and with the community and churches, um, we're working with them, we've collaborated with the hospital and some others, um, is that trust is key. And I think, uh, um, alluded to that through some of our data collected, um, with some of the interviews they've conducted. And what I think we have found is our population that is still out there. Um, I think they're more in a watchful if you will really wanting to see what happens, um, what becomes of the individuals who get it, but more say that trusting voice.
And, um, that could be the provider is say same as said. Um, but a lot of times is, you know, even someone in the community that you trust. And so one of the things that, um, we're working on developing is, uh, creating community health workers and really establishing that program and taking our mobile units into some geographical areas that we can identify about our own patients who have not received the vaccine and really just spend some time there once a week until we can really understand why people are resistant to, um, you know, getting the vaccine. And so that's one of the things that we're excited about implementing and seeing how far it gets us with our patient population. Um, so the other things that we have, um, really made sure we tried not to, um, condemn or be little are, you know, really kind of give, um, uh, facial expression to the answer.
No, I haven't gotten the vaccine and really just more inquire as to do you mind me asking why you ban sharing? And, um, for example, yesterday we had our last day of our mass vaccination site. We've moved it back into our clinics. And so I had opportunity to, um, talk with an individual they're receiving her first day. And, um, if I had to guess probably African-American female around the age, I'm not good with ages, but about 50. Um, and she said, you know, I was just scared. I was just afraid and I've had time to kind of see and observe and, and I'm ready to do it. I'm ready to get my, my vaccine. And so it was interesting to, to hear that maybe, you know, the time the that's been given to individuals to really digest what's, um, going on with the vaccine may be a key to us, um, improving that and creating that access for those patients who are coming around.
One of the things that we did, um, is of course we held two huge mass vaccination clinics, um, on a Saturday at a gymnasium here, um, collaborating with the school system. And one Saturday we administered 200, the next Saturday, we administered 500 from eight to 12. Um, and so we really just kind of tried to pick times and days that, uh, with bring populations in, I guess, or patients in and they were near bus stops. So we tried to make sure transportation was not an issue. Um, we also had, um, opportunities where we would send out patient blasts through text messaging. Um, we would send it out through emails, patient portal. We use social media, we continue to utilize the radio. Um, so we're using all of our, um, outreach avenues to really, um, reach all the patients so that we can make sure they're educated our chief medical officer's later role in making sure the community is aware and we're continuing, um, to really, you know, try to be creative with our ideas.
And so one thing we've done here recently is for our workforce, we were able to, um, give a day off with pay if you were vaccinated and next month, um, we are till June the 18th. I believe if we can get 75% of our workforce vaccinated, we'll get an additional day off. Um, that's free. So just trying to be creative with some incentives for the staff, we, as far as the patients go, we have actually, um, we take our patient list. Um, so we had EMR. So we take our patient population out of our universe who have not received the vaccine. And we start working that list. And what we have found is the accessibility is one thing, but patients want to talk to a person. And so when you have things that are online, where you go on and register, or you go on and sign up, we found where was not near as, um, uh, great as the ability to call and get someone at my center. And that's been key. Um, because while they have someone on the phone, they could ask some of those questions when they're on the fence. And so we've, you know, we've certainly tried to make accessibility and the fact that you've talked to a real lab person, um, easy, so accessibility has been something we've tried to break all barriers.
Thank you so much and spot on time. Um, first of all, fantastic that you're investing in your own staff and giving them incentives for getting vaccinated, recognizing that they are the ambassador so creative with giving them the time off, um, question around the community health workers that you're working with that are going up to listen, how do you, or do you train them to be prepared to answer questions given the skepticisms they may be facing and different conspiracy theories that they may have to, to answer to was also an earlier comment around that? How do you, how do you deal with misinformation and, and what position are the community health workers to to address that?
Sure. So we actually collaborate with our medical school, Morehouse school of medicine here in, and, um, they train the community health workers. And so we go ahead and make sure we have a consistent message as that's, what's going to be key. Um, if I'm a community health worker and you are, I mean, either one of us go to that home to visit a patient, we need to have the same message. And so ensuring that we have scripted in information where, you know, we don't deviate, we try to stay on task and on track. And if we don't know, write the answers down. So when we get her back, we can, we can get the patients the right information. So we try to just make sure it's a consistent message.
That's great. And have you started that work as of yet, or they are in training right now. Great. Um, and question to you, what are the lessons that you have during this period and the response that you have given, um, for a vaccine outreach that you will, that will stay with you that will inform your work going forward?
Wow. Um, you know, I think that the most important thing is, is that we don't take anything for granted. You know, um, I think that I, um, was probably ESO focused on, you know, patient, um, disparities and health disparities and making sure that we moved the needle and so many other things that he never stopped to think that something could come in and interrupt all of that. And in a blink of an eye. And we, you know, we had some challenging times when we lost an employee due to COVID and I had two, um, nursing staff that, um, lost their spouses about taking it home from here and giving it to their spouses and they unfortunately passed away. And so we're still dealing with a lot of grading and, um, a lot of those sort of, uh, emotions here and in our own organization that, you know, I think, uh, you know, most importantly, we have decided as an organization that whether there's a will, there's a way, and we will not let this pandemic keep us from taking care of our patients. And we, we, we did, we went outside the box on so many areas to make sure our patients were still safe, sane about,
And hopefully those investments and healing is also things that we can learn. And remember for the future, we're going to take a question from the audience. So Matthew McCurdy, he's director programs at health design ed at Emory. So in your state is also the founder of black health, an organization that creates space for critical conversation about racism, health, and new ways forward. And he's been very engaged in, in also vaccine outreach, but Matthew, you can come up on stage and ask your question.
So, um, so we've been talking a lot about sort of community mobilization and how to get community involved in these vaccine efforts. And so a question that I have is just given that there are different groups, I was talking about personas, we're talking about ethnic and racial groups, we're talking about ages and all of those groups have different structural barriers and different fears. Um, how do you decide the partnerships that really work and really can be effective for getting to, um, vaccine uptake? You know, what challenges, what challenges have you had with that, or what successes have you had.
Yeah. So I'll take that one. Um, okay. Um, so yeah, what we have really focused on is not necessarily, um, which population to, um, put emphasis on, but more so the flexibility from our organization to be able to flex our message, to meet the needs of those particular patient populations. So, you know, of course, when we meet with our consortium of, um, black pastors here that are a group of pastors from a lot of the churches here in south Georgia, we, we gear our message toward their congregation. So you've got a variety of ethnic, you got a variety of ages. And, and then of course, when we have an opportunity to get to a high school, we changed that message to meet the needs of that particular age population. What we're seeing here in south Georgia is what we're identifying is, is the age of about 40 ish, 40 to 50 ish that we're really trying to connect with, um, trying to really understand why they're not wanting the vaccine.
So still again, um, the message has the same meaning that it may be, uh, the message is a little bit different so than it resignates with that particular population. And I think that that has always been, you know, a difficult piece because even going into communities now, and we've seen this really come to light with this enormous infusion of money from HERSA and from the CDC and all of those grants requested that they be coalitions that included a CBO of some variety or another. And what we were hearing from our colleagues in CVS was, you know, the, the, the state doesn't even know we exist. We've never worked with the health department or the health department has never worked with the health center or, you know, and so what has really become the case is there's needed to be a period of meeting one another.
Unfortunately, it's been accelerated by the availability of funds now to do programming. But what it has meant is that if the community truly understand how to reach in, and they are approached by the state or they're approached by a health center or another group, they are able to say, we can, we know where the arms are, and we know how to stand this up. And what we need for you to do is show up with clinicians and vaccines and trust us that we will know how to bring people in. And those conversations have changed a little bit. And it is really my hope now that because this has been a requirement, it will start be a much easier piece that holds forum even after we get past this pandemic. Um, but it is truly turning to the most grassroots of your group and asking with whom is it that they work and with whom have they been successful. Um, and that Alliance then can be built out.
Thank you, Del and Matthew back to you then quickly for, you might be one minute. That was great for the Adele. Um, and, and I have, I think that those coalitions, how can we sustain them? Because I think that there's so much more they can achieve for health in our communities. But, um, Matthew, you talked about targeted. So a few words about your approach and how, what are the tools you use to be targeted and then meet those with the questions that you're then addressing the needs of that local community. Yeah,
Absolutely. I think, uh, here in Atlanta, what we've seen most recently is sort of we've hit a vaccine plateau. Um, and I think people have seen this in other places as well. Um, but there are still people who need to be vaccinated. I think we've talked about that a lot. Um, and those, those are people who have different barriers and different fears. Um, and so what we've really started to lean into is sort of how can we get better data to better understand, um, who these people are, where they are and what interventions they need. Uh, so with our partners, um, in on health, um, and also sort of adventures in the big scene where we've worked with you all as well, um, we're leaning into this COVID community needs index. I'm really just thinking about, um, again at the zip code level, at the census track level who really needs to be vaccinated, what are their barriers and how can we change or modify our intervention to better serve them? So we're trying to do that at the hyper-local is a term. I hear everybody saying now it's a high priority.
And so that's sort of the approach that we're working through right now, um, to, to customize our interventions based on the need that we see and based on the needs of the community. I love Matthew. I am so old that I remember public health nurses who used to go door to door, door to door is still going to be one of the only ways we understand fully what's needed in our neighborhoods and in our communities. And so when I say community health workers going out there, for example, we had them working in Puerto Rico before Maria, because Zika has the house Maria hit. They could tell you where everybody should be, who was missing, whose house got washed away and who was still present. So it is that that knowing your community deeply, it's going to make such a difference.
Thank you so much. So hyper-local and creating coalitions to, to allow us to do most justice to that, but thank you for joining us. [inaudible].