Opinion: Tactics other states use to boost vaccination rates

A medical staff prepares Pfizer's COVID-19 vaccine at a vaccination site in Boulogne Billancourt, outside Paris, Friday, March 19, 2021. The French government has backed off from ordering a tough lockdown for Paris and several other regions despite an increasingly alarming situation at hospitals with a rise in the number of COVID-19 patients. (AP Photo/Christophe Ena)
A medical staff prepares Pfizer's COVID-19 vaccine at a vaccination site in Boulogne Billancourt, outside Paris, Friday, March 19, 2021. The French government has backed off from ordering a tough lockdown for Paris and several other regions despite an increasingly alarming situation at hospitals with a rise in the number of COVID-19 patients. (AP Photo/Christophe Ena)

Credit: Christophe Ena

Credit: Christophe Ena

A relatively slow rollout here has contributed to another COVID-era phenomenon: line jumpers, a catch-all term for people in Georgia who bent the rules to get vaccinated.

Amy Pisani won’t soon forget the two hours she spent on the phone with an elderly woman who lives in Newnan.

Even though the 77-year-old woman was eligible for a COVID-19 vaccine, she kept running into roadblocks when she tried to sign up.

“I’d entered in all her data and nothing would happen. It would not send her an email,” said Pisani, who visited five different websites that winter day. “Nothing was working for her.”

Pisani serves as executive director of the Washington, D.C.-based nonprofit, Vaccinate Your Family. Former First Lady Rosalynn Carter is a founding board member and co-founder. And in recent weeks, frantic seniors have been calling Vaccinate Your Family daily, looking for help in securing a COVID-19 vaccine appointment.

The problem has been particularly acute in Georgia. In Pisani’s view, the web site, run by Georgia’s Department of Public Health, is “not normal” because it directs users to register for vaccine wait lists at multiple participating sites.

That could help explain why the state’s vaccine penetration rate consistently ranks among the nation’s lowest. And the slow rollout earlier contributed to another COVID-era phenomenon: line jumpers, a catchall term for people in Georgia who bent the rules to get vaccinated.

Allison Salerno
Allison Salerno

Credit: contributed

Credit: contributed

Before recent expansion of who was able to get the vaccination, some exasperated and not-yet-eligible Georgians were even driving to neighboring states to get the shots.

To limit that kind of behavior, observers say Georgia needs a centralized pre-registration site. And vaccinators need to be more diligent about working with groups at high risk for COVID-19 and its complications. The impact of COVID has been disproportionately fatal for those who lack access to health care, Georgians living in poverty and people in communities of color.

While Georgia has struggled, some other states, such as Wisconsin and West Virginia, have had more success.

Could those lessons help Georgia vaccinate more at-risk people?

‘The right thing to do’

In Wisconsin, the vaccine penetration rate ranks among the nation’s highest.

From the start, the state allowed vaccinators to “sub-prioritize” at-risk people within eligibility groups for vaccine appointments, said Shiva Bidar-Sielaff, vice president and chief diversity officer at UWHealth, the academic medical center and health system for the University of Wisconsin. UWHealth has more than 50,000 primary care patients 65 years or older across several counties.

Without nearly enough vaccines, the organization decided to send vaccine invitations first to groups identified by the CDC’s Social Vulnerability Index as at a higher mortality risk for COVID-19, said Dr. Matt Anderson, UWHealth senior director of primary care.

That meant patients who are Black, Native and Latinx got early invites for vaccine appointments, he said.

“We believe it’s the right thing to do,” Anderson said. “And everyone’s gotten an invitation at this point.”

That commitment to vaccine equity extends to Public Health Madison Dane County (the county’s public health department) and all five local health systems. They are working collaboratively to educate the community and distribute vaccines, ensuring that community organizations can refer eligible people when excess vaccine is available, said Bidar-Sielaff.

In Madison, Wis., Mount Zion Baptist Church, the city’s largest African American congregation, has partnered with UW Health to inform Black residents about the vaccine and to set up appointments for them.

Carola Gaines, co-chair of Mount Zion’s Health Ministry, said the first step to reaching communities of color is to have trusted community leaders educate them about the vaccine through webinars and Facebook live sessions.

In Madison, when a local health system has excess vaccine COVID-19 shots, Mount Zion offers waiting lists of eligible at-risk people in the community. Black community leaders are not only phoning community members to encourage them to get vaccinated, they also are setting up those appointments, said Gaines, who co-chairs the African American Health Network of Dane County.

Similar efforts are now underway in Georgia, in places like Randolph County, which last spring had the highest rate of infections per 100,000 residents of anywhere in the state, according to AJC reporting. Volunteers who had previously worked on get-out-the-vote campaigns are knocking on doors and pursuing other tactics to try and convince people to sign up for COVID-19 vaccinations.

Georgia’s still-low rate of getting shots into arms shows more work is needed.

‘Stop being selfish’

Making that task more challenging here is that, instead of signing up with a statewide pre-registry, many Georgians must maneuver through an ever-changing maze when trying to schedule an appointment.

That means calling or going online and leaving their names and personal medical information with various private registers, such as at supermarket pharmacies and urgent-care providers.

“When states don’t enforce strict guidelines for residency, age, health and occupation it creates chaos,” said Pisani.

When COVID-19 vaccine supplies are limited, such a haphazard approach increases the likelihood that at-risk residents won’t get a vaccine appointment at all, said Bidar-Sielaff.

“Having strict guidelines allows a person to understand when they will be eligible and to go about their lives in as safe a manner as possible while they wait their turn,” Pisani said. “This creates a system of equitable distribution but also alleviates stress.”

“People who have been historically marginalized, people who are frontline and central workers, those are not the people that have the privilege and ability to inform themselves of everything that is within the system and figuring out the way through,” Pisani said.

Meanwhile, some vaccinators in Georgia had, in effect, standardized line jumping by posting a “waste list” at days’ end, where residents, regardless of eligibility status, jostle online or by phone for appointments before the vaccine doses expire.

But when states have a centralized pre-registry, vaccinators can access that list when a person doesn’t show up and find the next eligible person, said Dr. William Petros, dean of the West Virginia University School of Pharmacy.

That limits the possibility of ineligible residents getting a vaccine before their higher-risk neighbors do, he said.

West Virginia regularly ranks the nation’s highest for vaccine penetration rates.

As for Georgians scrambling, or who’ve driven to neighboring states to get shots in their arms?

“There’s no reason to work yourself up into a frenzy trying to get to the head of the line,” said Pisani, of Vaccinate Your Family. “We’re supposed to be part of a community, a social contract. Stop being selfish. Why not offer your time to enroll other people?”

Last week, Pisani called the 77-year-old woman she had been helping and discovered she had finally gotten her first COVID-19 shot – thanks to a friend who helped her book an appointment.

But the woman, Pisani said, was worn down by the ordeal.

“She sounded exhausted.”

Allison Salerno is an Athens-based print and audio journalist.

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