Upping Bay Area vaccine rate, one holdout at a time
On a recent afternoon in San Francisco’s Excelsior district, Katherine Flores waved down a stranger to ask: “Have you been vaccinated?”
Joel Marquez said he had not — he’d had an appointment a few weeks ago, but missed it because his wife was sick that day. Flores sprang into action, firing off a series of questions she’d been trained to ask as a “vaccine ambassador” who goes door to door, street by street, to try to get San Franciscans vaccinated against COVID19.
The ambassadors also canvass in the Bayview, Visitacion Valley and the Tenderloin, areas where vaccination rates are lower than the city average. The program, funded by a $500,000 Crankstart Foundation grant and
coordinated by the San Francisco Department of Public Health and UCSF, pays college students like Flores $20 an hour. It is slated to run through the end of July, but its leaders are hoping to get a federal grant to expand and extend it another 18 months — one sign that even as the country returns to some semblance of normalcy, the push to get shots into arms is far from over.
Health officials are relying on such oneonone efforts to replace mass vaccination clinics as a primary way to reach people who are unsure, distrustful or simply haven’t gotten around to getting vaccinated.
As they stood, masked, outside a Mission Street restaurant, Flores continued: Do you live in California? What’s your name, phone number and date of birth? Which day is best?
With each response, Flores clicked through a web portal on her phone, then asked Marquez to sign his name on the screen. In less than five minutes, he was booked to get his first shot the next day at a vaccine site down the street. He walked away with a flyer with the address of the site and a QR code so he could make appointments for his wife and children.
“I’m glad he found someone who spoke Spanish, because if not, we probably wouldn’t have gotten him,” said Flores, 22, a physiology major at San Francisco State University.
It’s hard to pinpoint whether such vaccine outreach programs are directly driving San Francisco’s high rate of full vaccinations, which at 73% of eligible residents is among the best in the nation. There are lots of reasons people get vaccinated, and high education and income levels tend to correlate with high rates of vaccination. But the canvassing is making a difference in the neighborhoods that need it the most, officials say.
In two months, the San Francisco ambassadors’ work has led to 150 people getting vaccinated, said Dr. Jonathan Fuchs, who helps oversee the program as the health department’s lead on neighborhood COVID vaccine efforts. Most of them live in the city’s southeast sector, and most are Latino and Asian American. Statewide, 40% of eligible Latino residents have been fully vaccinated — lower than California’s overall rate of 59% — while a higher proportion of Asian American residents, 77%, have been vaccinated.
“I do think (outreach) is a contributing factor” to the city’s high vaccination rate, Fuchs said.
Millions of dollars are going into similar vaccine outreach programs across the region and state, financed by a mix of federal, state, local and philanthropic funding. In contrast to the spring, when mass sites such as the Oakland Coliseum and Levi’s Stadium were vaccinating thousands of people a day, outreach efforts are now making progress at a slow and painstaking pace — 20 shots here, 10 shots there. Even two shots in a day in a hardtoreach community is considered a win, health officials said.
During the first few hours that Flores’ group was in the Excelsior neighborhood on a recent Friday, they signed up just two people for vaccine appointments. The vast majority of the people who answered their door said they’d already gotten their shots.
As the U.S. vaccination campaign enters its eighth month, this scenario is increasingly common in the Bay Area, where overall vaccination rates are high. Seventy percent or more of eligible residents in most local counties are fully vaccinated. But many undervaccinated pockets remain, and unvaccinated people are vulnerable to the delta variant that is picking up speed in California. These are the targets of oneonone, communitycentered outreach efforts.
“We’re really digging into the places of very low vaccine uptake and putting in the time and attention,” said Tuere Anderson of the Alameda County Health Care Services Agency. “One person getting vaccinated is a success.”
Health officials are homing in on census tracts with lower vaccination rates and on reaching demographics that are lagging behind others. In Alameda County, for instance, officials are partnering with Street Level Health Project, an Oakland community group that works with immigrants, to bring shots to nonEnglishspeaking day laborers in the Fruitvale district, which has one of the lowest vaccination rates in the county. One popup clinic this month got shots to 200 workers, and the group plans to hold additional clinics in July.
In Santa Clara County, officials are pushing to reach a
few groups that have been falling behind on vaccinations — including Latino men, teens and young adults, and older white men. A recent vaccine event with the San Jose Earthquakes got 80 people in the door for shots. A fourhour mobile vaccination popup in downtown San Jose got about 20 people vaccinated, most of them young adults.
“We’re going to get fewer doses at these events, but they will add up and be very meaningful in the end,” said Dr. Marty Fenstersheib, the county’s COVID vaccine officer. “We bring out the forces to do them, but every little group of 20 or 40 is closer to that goal.”
A couple months ago, if a mobile vaccination unit administered just a handful of shots a day, that would have been too small a number to justify going back to that location. Now, that’s becoming the norm.
“We are coming into the long game here,” said Dr. Matt Willis, public health officer for Marin County. His department is sending staffers to grocery stores, shopping centers and other public spaces in undervaccinated parts of Marin City, Novato and the Canal neighborhood of San Rafael.
“If a team comes back having vaccinated 10 people, that’s OK,” Willis said. “That’s a success.”