With the closure of mass vaccination sites, it’s all about “ground play”


NEWARK – There were only six tiny vials of coronavirus vaccine in the refrigerator, an Air Force nurse on duty, and a trickle of patients on Saturday morning at a federally-run mass vaccination site here. A day before its doors closed for good, this once frenzied operation was strangely calm.

The post-vaccination waiting room, with 165 socially distanced chairs, was largely empty. The nurse, Major Margaret Dodd, who usually looks after premature babies at Brooke Army Medical Center at Fort Sam Houston in San Antonio, had already booked her return flight. So was the pharmacist, Heather Struempf, who was returning to the Wyoming nursing school.

Across the country, one by one, mass vaccination sites are closing. The White House first admitted on Tuesday that it would fall short of President Biden’s goal of having at least partially 70% of American adults immunized by July 4. The flip side stems from the reluctance of some groups, the slow pace of acceptance by young adults, and a flurry of other complex factors.

The Newark site, which closed Sunday, was the last of 39 federally-run mass vaccination centers that administered millions of vaccines over five months in 27 states – a major turning point in the effort Mr Biden described last week as “one of the biggest and most complicated logistical challenges in American history.” Many state-run sites are also closed or will be closed soon.

The country’s abandonment of high-volume immunization centers is recognition of the harder road to travel, as health officials turn to the ‘field game’: a highly targeted push, similar to an effort. out of the vote, to persuade the reluctant to be shot.

Mr Biden will travel to Raleigh, North Carolina on Thursday to highlight this long-term work. It won’t be easy – as Dr Anthony S. Fauci, the President’s coronavirus response coordinator, found out last weekend, when he went door-to-door in Anacostia, a neighborhood majority black from Washington, with Mayor Muriel E. Bowser.

In an interview on Tuesday, Dr Fauci said he and the mayor spent 90 minutes talking to people on their porch. But even with a famous doctor at the door and the prospect of freebies at a high school vaccination center a few blocks away, many were hesitant. Dr Fauci said he persuaded six to ten people to get vaccinated, although he met outright refusals.

“We would say, ‘OK, come on, listen: get out there, walk down the street, a few blocks. We have incentives, a $ 51 gift certificate, you could enter a raffle, you could win a year’s groceries, you could win a Jeep, ”said Dr. Fauci. “And several of them said, ‘OK, I’m on my way and I’m going.'”

But in Newark, where more than three-quarters of the population is black or Latino, the numbers tell the story. In Essex County, New Jersey, which includes Newark, 70.2% of adults have been vaccinated. But Essex also includes wealthy suburbs; in Newark, the figure is 56 percent, Judith M. Persichilli, state health commissioner, said in an interview.

The Newark vaccination site, at a converted sports facility at the New Jersey Institute of Technology that usually houses the school’s tennis teams, was set up and managed by the Federal Emergency Management Agency in conjunction with the Ministry of Defense and other federal agencies. It opened on March 31; when operating at full capacity, its medical staff administered up to 6,700 injections per day.

As of Saturday, the daily count had fallen to around 300. The long, hallway-shaped tents that once protected patient lines from the cold were empty. Of 18 registrars, only four were in use and most vaccination booths were unoccupied.

Most of the patients, including some adolescents brought in by their parents, were there for their second dose of the Pfizer-BioNTech vaccine. Many – like Abdullah Heath, 19, who took a year off after high school and will go to Rutgers University in the fall – said they were hesitant. But Rutgers demanded the vaccination, so Mr. Heath had little choice.

“I wanted to wait and see how the others were when they took the picture,” he said.

Alfredo Sahar, 36, a real estate agent from Argentina, said he received his first dose on a whim, without an appointment, when he and his wife visited the Newark site . The couple showed up for their second dose on Saturday with a young friend, 19-year-old Federico Cuadrado, who was from Argentina and received his first injection.

“Relax that arm,” Major Dodd said as Mr. Cuadrado rolled up his sleeve. But she won’t administer her second stroke; as the site is now closed, he will have to go elsewhere.

At the height of its vaccination campaign, New Jersey had seven mass sites: six state-run, plus the FEMA site in Newark. Two of the state’s sites have closed, another will close this week and the final three are expected to do so in mid-July, said Ms Persichilli, a nurse and former hospital official. She called the FEMA site, which has vaccinated 221,130 people in total, “invaluable.”

Mr Biden has repeatedly said that fairness – ensuring that people of all races and income have equal access to care and vaccines – is crucial to his response to the coronavirus. FEMA determined the locations of its mass vaccination sites using the Centers for Disease Control and Prevention’s “Social Vulnerability Index” to identify the communities most in need, said Deanne Criswell, the FEMA administrator, in an interview.

It was a learning experience for the agency, she said, adding that 58% of the roughly six million vaccines given at mass vaccination sites had been given to people of color.

“We didn’t have a manual for this type of operation,” Ms. Criswell said. (The agency now has a 44-page one.)

In New Jersey, traffic to mass vaccination sites began to decline about six weeks ago, Ms. Persichilli said. Around this time, the state shifted to a ‘hub and spoke’ strategy, creating pop-up sites in churches, barber shops, and storefronts surrounding existing vaccination centers that could stock and provide vaccines.

The state also has 2,000 canvassers – 1,200 paid, partly with federal taxpayer money, and 800 volunteers – who knock on 134,000 doors in areas with low immunization rates to direct people to nearby clinics. . And the Department of Health is planning vaccination clinics at a rock music festival, balloon festival and rodeo in Atlantic City.

Overall, New Jersey is way ahead of most states: 78% of adults have received at least one dose of the vaccine. In four states – Mississippi, Alabama, Louisiana, and Wyoming – the figure is less than 50%.

“We’re running a marathon, and we’re in the last few miles, and we’re exhausted, and these will be the toughest,” Ms. Persichilli said. “But they will also be the most satisfying.”

Public health officials know that the last mile of any vaccination campaign is indeed the most difficult. The eradication of smallpox, considered the greatest public health triumph of the 20th century, came after a highly targeted global campaign that spanned two decades. Polio has still not been eradicated in some countries, Dr Fauci said, due to reluctance to immunize, including among women who express unfounded fears of infertility.

“We should have eradicated polio a long time ago,” he said.

The federal effort has been huge, involving more than 9,000 people from across government, as well as 30,000 members of the National Guard supporting vaccination against Covid-19 in 58 states and territories, according to Sonya Bernstein, senior policy adviser for the White House.

With the closure of major vaccination sites, FEMA is also pivoting. The agency still supports more than 2,200 community vaccination centers and mobile vaccination units. Now, FEMA is rolling out a new pilot program to offer shots in or near recovery centers it sets up after hurricanes and other natural disasters. The first of these opened this week in St. Charles Parish, Louisiana, which has a large minority population and was devastated by Hurricane Laura last summer. According to CDC data, only 51% of the adult population of St. Charles Parish has had at least one injection.

In Newark, the mood on Saturday was bittersweet. People like Major Dodd and Ms Struempf, thrown together in a crisis, exchanged phone numbers with new friends and colleagues as they planned to go their separate ways. After living in hotels for over two months, they were both eager to leave and nostalgic for the prospect.

Michael Moriarty, the FEMA official in charge of vaccination operations in the New York-New Jersey region, inspected the premises: vacant cubicles and chairs, boxes of unused latex gloves, brown paper stuck to the floor for cover tennis courts. It wouldn’t take long to cancel, he said, adding: “They will be playing tennis here at the end of the week.”

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