Facing the drastic rise in cases and state restrictions that don’t preclude large groups of people from congregating, Oregon’s public health experts are getting creative in their efforts to get vaccines to demographics with lower vaccination rates.
Thousands of people in Multnomah County remain unvaccinated from the coronavirus, despite the vaccine’s open availability in major pharmacies and demonstrated efficacy in safeguarding people from severe symptoms and death. Oregon Health Authority reports 95-99% of the state’s new cases in August were attributed to the delta variant. As of Sept. 16, OHA reports more than 81% of diagnoses in the first half of September were reported from unvaccinated people. Regardless, the medical system in Oregon has struggled to keep pace with the latest surge. Only 63 ICU beds (10%) and 330 adult non-ICU beds (8%) were available in Oregon as of Sept. 20.
On the first day of the city’s “Here For Portland” reopening festivities, July 23, 366 new coronavirus cases were reported in Oregon. One month later, nearly 2,800 cases were reported in a single day. Although new case rates have gone down slightly in mid-September, the seven-day daily average on Sept. 20 remained at 1,677 — much higher than the seven-day daily average of 190 when the state “reopened” June 30.
Gov. Kate Brown has declined to reinstitute indoor dining or shopping restrictions to this point, despite the state still reporting some of its highest case numbers since the pandemic began. Charles Boyle, Brown’s deputy communications director, said the governor does not believe sheltering in place again would be as effective as it was last year, and is focused on maximizing the number of Oregon’s staffed hospital beds.
“The delta variant has changed the way we need to fight back against the pandemic, but the widespread adoption of vaccines has also changed the tactics that will be effective,” Boyle wrote in a statement to Street Roots. “In counties with high vaccination rates, because even fully-vaccinated individuals can be infected, masking is the most effective additional layer of protection to limit the spread of infection. At the same time, unvaccinated people should reduce their non-essential contact with others, particularly now with the prevalence of the more contagious delta variant.”
While Multnomah County’s vaccine equity plan acknowledges COVID-19’s disproportionate impact on communities of color, the vaccine still isn’t reaching BIPOC communities at the same rate as white communities. According to OHA’s data on Sept. 20, 58% of Multnomah County’s Black population and 56.2% of its Latinx population are vaccinated, compared to 60.9% of its Indigenous population, 67.3% of its Asian population, and 73.6% of its white population. Portland Mercury reported errors with OHA’s data for vaccinated Pacific Islanders and Native Hawaiians on Sept. 10.
The county’s largest healthcare providers, including OHSU and Kaiser Permanente, pivoted from mass vaccination sites at the end of June toward community-focused outreach efforts in an effort to address vaccine rate disparities. Vaccination specialists team up with community leaders, from clergy to drag queens, to meet people where they are, whether that’s at their jobs, houses of worship, or leisure hotspots, to administer doses while taking into account factors like needle aversion when offering one or two-dose shots.
“We always knew the mass vaccination site was never the end-all, be-all,” Catherine Potter, manager of Kaiser Permanente’s Community Health department’s Public Safety Net program, said. “It was what the state asked us to do as a large health system, to stand that up, especially when their vaccine supply was so limited. But, we always knew it wouldn’t meet everyone’s needs, and that was very true.”
Specialists from OHSU, Kaiser Permanente and health care providers from Providence Health & Services and Legacy Health meet multiple times a week with community leaders to learn how to best serve people of color, both in immediately administering vaccines, and laying the groundwork for future need-based collaborations. OHA and major health care providers now share information like best practices and different strategies heading into the traditional flu season at a far more frequent and transparent rate than before the pandemic. This ensures coverage gaps get closed and resources are used most effectively.
OHA takes the lead on working with organizations most likely to serve houseless individuals, whether that means sending vaccination teams to clinics and shelters or sending outreach volunteers to encampments. Kaiser Permanente is working with Medical Teams International, a nonprofit, to serve hard-hit rural Oregon counties to bolster vaccination rates. Potter said Medical Teams InternationaI and Kaiser Permanente have teamed up to bring vaccination clinics to workplaces where employees might need access to English translators or have difficulty scheduling time off, such as construction sites.
“At least since the vaccine has been available, we’ve been in the communities both offering the vaccines, but also trying to talk through people’s questions,” Christopher Evans, a member of OHSU’s Vaccine Equity Committee and infectious disease specialist, said. “People have healthy questions, so we’re answering them to the best of our ability so they can make the best decisions for themselves and their families.”
Community partnerships for under-vaccinated demographics and ZIP codes will continue for the foreseeable future, but healthcare leaders are now planning on their next mass-vaccination efforts. The Food & Drug Administration’s full approval of Pfizer’s vaccine theoretically lays the groundwork for administering booster shots for senior and immunocompromised individuals, as well as vaccinating children under 12 years old. Over the past six months, health systems fostered stronger relationships with leaders outside the medical community — or forged entirely new ones.
“There’s a lot of different moving pieces, and to paraphrase from a colleague, ‘we’re building the airplane and flying it at the same time,’” Evans said. “We’re learning along the way, but it’s great that the folks I’ve had the pleasure and privilege to get to work with are bright minds who are really committed to making sure all communities are served by vaccine access.”
Online misinformation has proved a formidable foe in the quest for total vaccination, but it’s far from the only factor that kept people from visiting mass-vaccination sites earlier this year. Community leaders know their members don’t fit easy stereotypes of the unvaccinated as willfully ignorant, and that they can do something before someone falls down the livestock deworming rabbit hole.
“There is the fear that Black folks haven’t seen a lot of success when it comes to the American medical system and how it treats Black folks, but also Black folks just don’t have access to vaccines like their counterparts do,” said Coco Jem Holiday, a drag queen known as the reigning Sweetheart of Portland. “They can’t take off work, or don’t have the luxury or privilege to have a sitter take care of their kids while they get vaccinated, or they don’t have the luxury of being sick for two days.”
“I really wish we could all get together and get vaccinated, and get healthy and safe again.”
OHSU partnered with the Sweethearts of Portland, a philanthropic organization and drag pageant, for an Aug. 14 vaccination clinic at Local Lounge, a Northeast Portland queer bar, as well as an earlier clinic in July. While OHSU is working on numerous initiatives with different groups, the Sweethearts have a unique history of helping address public health crises.
The Sweethearts of Portland was founded in 1989 by the drag queen Velvet Monet at the dawn of another public health crisis, when more than 100,000 HIV diagnoses were reported in the United States. The Sweethearts primarily raise money for local organizations benefiting LGBTQ+ youth, as well as HIV and cancer patients. HIV has been more manageable for decades, and the COVID-19 vaccine benefitted from HIV/AIDS research, but stigma and misinformation about both illnesses proliferate to this day.
Holiday, who moved to Portland in 2019 from Denver, has a long history of activism and community outreach. Additionally, her role as Local Lounge’s events promoter helped connect OHSU with a popular yet intimate venue and active online following. Leading up to the Sweethearts’ second clinic at the bar, Holiday told Street Roots she’d consider the event a success even if just two people of color got vaccinated.
“It’s not even necessarily the awareness, as much as it is saving lives at this point, helping with herd immunity and being part of Portland’s story to create a safe community for our neighbors and our siblings,” Holiday said.
OHSU vaccinated 12 people at Local Lounge’s second clinic. When working in record-high heat and visibly hazy air from forest fires, as Holiday, Evans, and the OHSU/Local Lounge team did, the 12 vaccinations were an achievement. Freshly vaccinated individuals received Fred Meyer gift cards and Portland Trailblazers t-shirts and game tickets as incentives. Holiday was on hand to assist volunteers in raising awareness of the clinic from the sidewalk, which elicited supportive car honks along Northeast MLK, Jr. Boulevard. The DJ played pop music loud enough to lift spirits, but not loud enough to overpower medical technicians’ instructions to patients.
“I feel like I’m late to the party,” said Don Atkinson, who was vaccinated at the Local Lounge clinic.
Like many people, Atkinson waited to get vaccinated until he’d done research, and seen how others managed the vaccine’s side effects.
Another example of health care providers working through community leaders includes a high school student playing an integral role.
Ro-Suhana Hafiz is a sophomore at Reynolds High School in Troutdale, and the first president of the school’s Islamic Student Union, a club where Muslim and non-Muslim students meet to learn about the world’s second-largest religion. Because the pandemic moved her freshman year to remote learning, this is Hafiz’s first in-person year of high school. Speaking to Street Roots the night before her first day of classes, Hafiz was excited and nervous; that familiar mix of back-to-school jitters with anxiety about getting herself, or her family and friends, sick.
“It’s not like (social distancing) happens all the time, because there’s some times where you can’t distance yourself from others, especially if you’re in a school with a thousand students,” Hafiz said.
Although Reynolds High School transitioned back to distance learning a week later due to new COVID-19 cases, Hafiz helped organize a series of vaccination clinics starting in June.
OHSU contacted Hafiz and the Islamic Student Union’s faculty advisor, Nina Khanjan, in June to host two vaccination clinics at Reynolds High School over the summer, and a third on Sept. 19. The summer clinics vaccinated more than 200 people between them, thanks in part to Hafiz and Khanjan’s door-to-door outreach in the high school’s neighborhoods. Hafiz and Khanjan believe the third clinic may be its most successful, as students have had a chance to talk to each other in person about the vaccine.
“We are just all about our community being safe and having easy access to vaccines if they want it,” Khanjan said.
Khanjan’s husband, Matthew Darby, is a dialysis technician at Fresenius Kidney Care. Darby’s ward has the opposite problem of being overwhelmed. Darby said many of his patients are cancelling personal plans and postponing treatments and surgeries due to the delta variant’s surge, which could still negatively impact their health.
“Sometimes they have a surgery that is deemed non-urgent, so they’re maybe waiting on something that is impacting their health and happiness day-to-day,” Darby said. “I’m being told ‘We’re going to wait a month or two because hospitals are full.’”
Hafiz advises anyone with questions about the vaccine reach out to contact a health care provider they trust, as well as the county’s coronavirus experts, rather than rely on information that sounds too weird to be true.
“I really wish we could all get together and get vaccinated, and get healthy and safe again,” Hafiz said.