Moving the Needle on Vaccinations: A Conversation with New York’s Robin Hood Foundation | Deloitte US has been saved
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Jen Radin, principal, chief innovation officer, Deloitte Consulting LLP
As a New Yorker, I have been highly impressed with the city’s vaccination efforts over the past year. Last December, a nurse at Northwell Health in Queens became the first person in the US to receive a COVID-19 shot.1 Since then, more than 12 million doses have been administered in New York City. About 80% of eligible adults are now fully vaccinated, 7.3% are partially vaccinated, and just 13% have not been vaccinated.2 In New York, like many urban areas, Zip codes with significantly lower incomes tend to have lower vaccination rates than more affluent communities. In the Far Rockaway neighborhood of Queens, for example, just 55.7% of residents have been fully vaccinated; the vaccination rate in Midtown Manhattan is close to 100%.3
Difficulty in scheduling appointments, inconvenient site hours, misinformation about the safety of vaccines, and a general mistrust of the medical system, have kept some people—particularly those living in vulnerable communities—from being vaccinated against COVID-19.
The Deloitte Center for Health Solutions recently conducted a nationally representative survey of 3,000—adults from various geographies, income levels, and races/ethnicities—to find out why some people remain unvaccinated. Among respondents who earn less than $25,000 a year, 25% said transportation issues have kept them from getting a vaccine. "Inconvenient appointment times" was also seen as a major barrier among low-income respondents.
Robin Hood, the New York-based poverty-fighting organization, is working to boost vaccination rates in low-income neighborhoods throughout New York City, particularly in racially and ethnically diverse communities. The Deloitte Health Equity Institute is collaborating with Robin Hood—and with local Federally Qualified Health Centers (FQHCs)—to increase vaccination rates by removing barriers that affect the city’s most vulnerable populations. As part of our collaboration, we are also working to address other high-need issues in the city, such as maternal health and early childhood interventions.
10 questions for Robin Hood’s Sarah Oltmans
I recently had the pleasure of speaking with Sarah Oltmans, Robin Hood’s chief of grant strategy, about some of the lessons they’ve learned in their vaccination efforts, many of which can be applied in other urban areas. Here’s are highlights from that conversation.
Jen: The FDA recently granted emergency use authorization to vaccinate children—between the ages of 5-11—against COVID-19. What are some strategies for reaching the parents of those children?
Sarah: As your data indicates, ensuring access and convenience can increase vaccination rates. The city is really trying to meet children where they are by using schools as a place to get vaccinated. We are working with schools across the city to make that possible, in addition to collaborating with local pediatricians and the Children's Health Fund. For parents, a routine office visit with a pediatrician is a good place to start the conversation about vaccines.
Jen: Health care workers in New York are required to be vaccinated, and the vaccine mandate for municipal workers recently went into effect. Are mandates and other vaccine requirements having an effect on vaccination rates?
Sarah: The mandates have definitely had an impact in improving vaccination rates. When mandates were announced for health care workers, only about 60% were vaccinated, but getting staff vaccinated became a high priority for health care organizations, and now nearly 100% of health care staff is vaccinated. And it’s important to note that, in most cases, mandates for health care workers did not lead to significant layoffs.
Jen: It’s been almost a year since COVID-19 vaccines were made available to the public. Has the perception of vaccines changed in that time in the communities you serve?
Sarah: Initially, there was some distrust among the populations that we serve for a myriad of reasons. Although, we have definitely seen greater acceptance in the communities we serve, vaccination rates still lag in low-income communities, especially in communities of color. Conversations with health care providers—and with neighbors and friends who have been vaccinated without complications—have helped to remove some of that distrust. Some city-based organizations have launched extensive education campaigns. Smaller community-based organizations, along with faith-based institutions, are also working hard to make sure people are hearing from vaccinated people who have similar lived experiences. Those organizations have also been incredibly effective in getting information out and in influencing people to get vaccinated—particularly in communities of color and communities with higher rates of poverty.
Jen: We found that doctors are still the highest archetype of trust around vaccine information. Are you seeing that in your communities?
Sarah: Doctors are a very important source of information and have been great about combating misinformation. Sometimes it does take more than just one conversation with the health care professional before people begin to feel confident about getting the vaccine. Low-income populations are much less likely than other populations to have a primary care doctor. They're also more likely to experience interruptions in their health care coverage. As a result, they might not have regular office visits. For the populations we serve, we work very closely with FQHCs and community health centers. These are trusted places…not just the doctors, but also the clinical staff.
Jen: Do our survey findings line up with what you’re seeing in the city?
Sarah: Yes, and they provide a layer of detail that we don't always have. In your survey responses, however, transportation was cited as a barrier. In New York City—except for early on in the vaccine rollout—transportation has been not a major barrier. Fortunately, there are many locations throughout the city where people can get a vaccine.
Jen. That’s true. And it has gotten much easier to schedule an appointment online. But not everyone has access to the internet or a smart device. In some areas of the Bronx, for example, nearly one-third of households lack internet access. Does that pose a barrier?
Sarah: The city’s vaccination website has gotten better and there are a lot of vaccination locations. But the apps aren’t helpful to someone with a flip-phone who can’t get online. Some of our partners call their patients to talk to them about the vaccines and to help schedule appointments. Text-based apps have also been useful.
Jen: According to our survey results, people who live in urban areas were much more likely than suburban and rural respondents to cite ‘inconvenient hours’ as a major barrier. What have you experienced?
Sarah: A convenient location doesn’t matter much to someone who can’t get there while the doors are open. This continues to be a challenge, particularly for people who don’t have flexible work hours or who need someone to watch their children while they get a vaccine. What happens after the vaccine is administered is another concern. Imagine an hourly worker, or someone who has kids. What will they do if they feel sick for 24-48 hours after getting the vaccine? In that case, it’s not just the shot that’s causing the hesitancy…it’s also worrying about how their body will respond to it.
Jen: Social media and cable news are popular sources of information among urban respondents and young adults who are resisting or refusing the vaccine. Can social media be effective in countering misinformation?
Sarah: Social media, particularly among young adults, has been a major source of misinformation. While it is being used as an educational tool by some of our partners, this admittedly hasn’t been as effective as some of the misinformation campaigns. I think they have found that one-on-one conversations are more effective than social media in moving the needle.
Jen: If there were more funding around social media, do you think it could be an effective tool for instilling trust and influencing people?
Sarah: It could an effective added strategy, but it shouldn’t be the only one. Someone who is nervous about the vaccine might need to have an in-depth conversation with a care provider or with someone who has experiences like their own. But social media is a tool help health centers, community organizations, and local governments get their message out and to encourage people to speak with trusted sources in their communities.
Jen: How has your experience with COVID-19 vaccines changed how Robin Hood will approach future health emergencies or just your day-to-day operations?
Sarah: There has been a push to build out a more robust infrastructure for reaching people in communities throughout the city. Communities here are very diverse with many different languages being spoken in various pockets through the five boroughs. We’ve strengthened our relationships with community-based organizations and faith-based groups over the past year. These relationships will be important if we need to quickly launch a grassroots campaign in response to a future public health emergency. Having that type of infrastructure in place now will be beneficial for the long run in terms of public health, and crises in general.
1. 1st vaccination in US is given in New York, hard hit in outbreak’s first days, New York Times, December 14, 2020
2. COVID-19 Data, NYC Department of Health and Mental Hygiene, November 2021
3. Zip Code Vaccination Data, NYC Department of Health and Mental Hygiene, November 16, 2021