Yvonka Hall, a healthcare worker who leads the Northeast Ohio Black Health Coalition (NEOBHC), and the Rev. Lisa Maxine Goods, the pastor of Shiloh Baptist Church, share a common goal: getting their neighbors vaccinated.
To that end, they’ve been hosting vaccination clinics. Hall, in partnership with MetroHealth and Drug Mart, has vaccinated more than 120 Clevelanders in three two-hour clinics in the past three months. Greater Cleveland Congregations (GCC), which Goods is a part of, has vaccinated more than 4,000 Clevelanders over the last year.
“[That was] just with our efforts within the church,” Goods said. “But you know, we could probably do a lot more if we had support.”
Hall and Goods said the city and state governments’ efforts to spread vaccine information haven’t reached communities of color in Cleveland, which has some neighborhoods with vaccination rates around 35%, a stark contrast with wealthier, mostly white suburban communities, some of which have vaccination rates above 85%.
Offering gift cards at vaccine clinics has worked for GCC and NEOBHC, but they’ve both had to pool money out-of-pocket for that. Hall gives out lunches, masks and hand sanitizer too, all of which cost her.
“The efforts and the funding that the state and the city has had has not been in these underserved communities,” Goods said. “So it’s just been the churches and these federally qualified health clinics that are really trying to do the work.”
Yet now, several key officials have recently signaled that could change, in response to The Land’s inquiries and reporting on the disparity in vax rates. Leaders in the city’s government and public health sector are emphasizing targeted street-level outreach and community partnerships to build trust in the vaccine and bring it directly to residents’ doorsteps.
“In communities of color, there’s been a history of medical racism,” said Cleveland Mayor Justin Bibb in an early January press conference. “My administration, we want to tackle that head on. So we will be looking at some additional public engagement strategies to really address that lack of trust that exists in our hardest hit parts of the city.”
Promise of change
Bibb has promised change since winning election by an overwhelming majority in November, and his approach to getting more residents vaccinated is a stab at making good on that. He appointed a Covid-19 task force in his first week in office, bringing diverse community representatives together with local government and public health officials.
Then, on Jan. 31, he set a goal to vaccinate at least 60% of the city’s residents by the end of 2022, spurred on by a recently announced partnership with the NBA and the Cleveland Cavaliers ahead of All-Star Weekend coming to Cleveland on Feb 18.
According to the announcement, the NBA and the Cavs will:
Help the city launch popup vaccine clinics in the city’s “hardest-hit neighborhoods”
Participate in the city’s pro-vaccine communication campaign
Provide incentives for vaccinations such as tickets and autographed merchandise
And donate 10,000 Covid-19 rapid tests and 25,000 KN95 masks for distribution at schools and community centers. The NBA is also giving $100,000 to the Cleveland Foundation’s Funders Collaborative on Covid-19 Recovery.
Ward 9 councilman Kevin Conwell, who now leads council’s Health and Human Services Committee, said neither he nor council president Blaine Griffin were involved in the press conference and he wants the Bibb administration to keep him more informed.
“They just have to tell us what they’re doing,” Conwell said. “We don’t want to meddle, and we don’t want to do the same thing that the mayor is doing. But we will come in and help because we’re all in this together.”
Both the Cleveland Department of Public Health (CDPH) as well as the Cleveland Clinic have aligned themselves with Bibb’s message of community outreach and engagement. In fact, CDPH medical director Karen Cooper says the agency has been doing targeted outreach to different cultural and racial communities since last year. Citing one example, Bibb’s Chief Communications Officer Sarah Johnson said in an email that CDPH partnered with Urban Kutz barber shops in May 2021 to provide vaccines in the Cudell neighborhood.
Now, those efforts are ramping up, Cooper said. On Jan. 13, for example, CDPH participated in a vaccine information session for families in Breakthrough Public Schools. And On Feb. 5, the city provided vaccine doses for its partners at GCRTA and Asian Services in Action (ASIA) to bring the “Community Immunity Bus” — a GCRTA bus outfitted as a mobile vaccine clinic — to the Lunar New Year celebration in AsiaTown.
Elaine Tso, the CEO of ASIA and a member of Bibb’s Covid-19 task force, appreciated that kind of support. She said on-the-ground organizations can come up with culturally relevant messaging better than the city can on its own.
“Rather than telling us how it should be done, [Bibb] is asking us, you know, ‘What can we do? How can we reach this community?’” Tso said.
As of Jan. 18, Johnson said the department had vaccinated 41,019 people (it’s not clear if this includes only city residents), and overall, 199,349 Clevelanders have received at least one dose of the vaccine. CDPH also offers homebound vaccinations to older adults who qualify through the Western Reserve Area Agency on Aging (reachable at 216/621-0303).
That’s nearly as many as the Cleveland Clinic, which had vaccinated an estimated 50,000 Clevelanders as of Jan. 25, according to the Clinic’s director of media relations Andrea Pacetti. The Clinic administered nearly 7,000 doses of the vaccine at its clinics in Fairfax, the mostly Black neighborhood around its headquarters, and Ohio City, which had Spanish-speaking caregivers to serve Hispanic patients. It also partnered with CDPH to train on-the-ground healthcare workers on how to address vaccine hesitancy in their communities via webinars last year.
Vaccine disparities are a symptom of deeper disparities
Efforts like those are a step in the direction, said Loren Anthes, the chair of health planning at the Center for Community Solutions, but addressing vaccine hesitancy will take more than outreach and messaging. It will take investing in these communities in other ways, too.
“I think it’s really important to highlight here that the vulnerability for populations toward the virus trends very strongly with social vulnerability tied to poverty,” he said. “We can’t look at a map with those low vaccination rates without also looking at, essentially, a map that mirrors historical divestment and redlining practices and exclusionary zoning practices.”
Fostering healthier communities means enacting policies and programs that “enable people to more readily manage the conditions of a pandemic by reducing their vulnerability,” Anthes said. For example, mobile vaccination units ease accessibility issues for those without cars, but the long-term solution is investing in public transportation, he said.
Chronic disinvestment, fueled by systemic racism, in Cleveland’s mostly Black, east-side neighborhoods has fed into a mistrust of authority, said Ward 7 City Council Member Stephanie Howse, who represents Hough, AsiaTown and part of MidTown. As of last month, Hough had the highest Covid-19 deaths per capita in the city.
“People don’t believe us,” said Howse, who plans to walk door to door with a mobile vaccine unit to encourage residents to get vaccinated. “They don’t trust us. It’s only through consistency and showing up that you develop meaningful relationships and engagements, and getting some of those guards down to see that government can be a source for good.”
Data-driven site selection
According to Johnson, the city is already working to reduce the vaccine disparity using data that it compiled in a long-term report last August. This could help address complaints that the city hasn’t conducted a risk assessment or amassed data to understand the pandemic’s effects on different groups.
Even before Bibb got into office, the city had been using data to guide locations for vaccination clinics and targeted ads, she said. The city has been sharing with “grassroots organizations” data that shows the vaccination rates in each of Cleveland’s census tracts for “quite some time now.” Each census tract is a small geographical area that contains, on average, 4,000 people.
Although Bibb has pledged to be more transparent, the city has not yet responded to a Jan. 19 public information request for this data. Hall, who runs a “grassroots organization,” said she hasn’t received that data, and Tso said ASIA hasn’t either. Conwell said that city council could use this data, too.
The upcoming NBA and Cavs partnership will help the city prepare not only for dealing with the ongoing threat of Delta and Omicron, but for another possible Covid surge this summer, Bibb said. Local officials are banking on trust in grassroots organizations to help with that effort.
“It’s important for us not to reinvent the wheel, but to use those trusted organizations on the ground who can be that conduit for us to hit those hardest parts of our city,” Bibb said.
This story is part of The Land’s ongoing reporting initiative on health equity. Read more stories in this series here.
This project is part of Connecting the Dots between Race and Health, a project of Ideastream Public Media funded by The Dr. Donald J. Goodman and Ruth Weber Goodman Philanthropic Fund of The Cleveland Foundation.
Michael Indriolo is a reporting fellow at The Land
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