At a noisy summer block party in Providence one recent afternoon, community health worker Rosa Roman tried to interest a middle-aged handyman in a free tetanus shot. But he was scared.
The man, who gave only his first name, Armando, 42, is from Puerto Rico. He said he spent the last 20 years living in Florida. And what he knows about vaccines, he said, comes from Fox News and social media.
“The people that got vaccinated for COVID,’’ he said, “I hear the people now, they’re dying.”
Those “reports” are false – and dangerously misleading. And research shows that this type of vaccine misinformation is especially pervasive in Spanish-language digital and social media.
But Roman, the health worker, did not try to correct Armando. Instead, she explained that the vaccines they were offering that day – Tdap , MMR and Hep B – were to protect against other diseases, such as tetanus, diphtheria, pertussis (whooping cough), measles and hepatitis B.
“Okay, let me think about it,” Armando said.
“No problem,’’ she replied. “Take your time.”
As he turned to walk away, Roman’s co-worker, Yesenia Hawes, called out in Spanish: “If you change your mind, we’re here until two o’clock. All we’re trying to do is get you healthy!”
Nearly four years after the first COVID-19 shots, large swaths of adults in the U.S. are still awash in misinformation about vaccines, according to surveys by Kaiser Family Foundation. And that’s making it harder to inoculate people against other conditions.
Nationwide, routine vaccination rates have declined since the pandemic, whether due to vaccine hesitancy, disruption in routine healthcare or an increase in the uninsured rate. And it’s taking a toll on public health. Measles outbreaks have been reported in states including Florida, Illinois, Michigan, Ohio and Oregon.
And yet a recent Gallup poll found that fewer than half (40%) of Americans say that vaccinating their children is important, down from 58% in 2019.
Now, with new COVID shots available this month in Rhode Island, the painstaking work of persuading a reluctant public to accept another round of vaccinations begins. And this time may be harder still.
Much of the federal money that flowed to states to promote vaccines during the pandemic emergency has dried up. Rhode Island this year received about $25,000 in federal funding for community organizations to promote vaccinations, about a fifth of the nearly $128,000 in 2022, according to state health data.
And the federal Bridge Access Program that provided low-income Americans with free vaccines ended in August, leaving many uninsured patients to pay up to $200 for the COVID-19 vaccine.
Rhode Island is one of only four states – including Alaska, Oregon and Vermont – that provide all routine vaccines recommended by the Centers for Disease Control and Intervention for free to adults as well as children, regardless of insurance status, according to the National Academy for State Health Policy (NASHP).
And in the pandemic’s aftermath, the need among the newly uninsured has grown. Providence-based Clinica Esperanza has seen a flood of new patients. During the past 12 months, the clinic had seen about 780 new patients as of the first week of August, a 40% increase, said Morgan Leonard, the clinic’s executive director.
Leonard attributes much of the increased demand to people losing Medicaid coverage, or Medicaid unwinding, after the expanded eligibility ended in May 2023. Nearly 96,000 Medicaid patients in Rhode Island had been disenrolled as of last month, according to the nonprofit Kaiser Family Foundation.
And the need for vaccinations persists. It’s especially acute among the people served by Clínica Esperanza (or Hope Clinic). Based in Olneyville, one of Providence’s poorest neighborhoods, the clinic serves primarily Spanish-speaking uninsured and underinsured adults, including many who are undocumented. Leonard said that the pandemic’s aftermath is similar to what happens after a hurricane. “It’s not just the hurricane and the cleaning up of the houses at this moment,’’ she said. “It’s also what happens after.”
At Clinica Esperanza, the recovery work includes finding people who need to be vaccinated. And that starts with tracking down people who haven’t been back to the clinic since they were tested for COVID-19 early in the pandemic and had opted into the clinic’s text message updates.
On this June afternoon, the job fell to Petranea “Petra” Smith. Cradling her open laptop one arm, she wound her way through the halls of the busy clinic, searching for an empty office with a phone.
Smith, 23, is a graduate student at Brown University School of Public Health and the mobile clinic’s project manager. When the pandemic hit, she was a sophomore at McGill University in Montreal, studying neuroscience. During the lockdown, she returned home to Rhode Island and took a job as a case investigator at the state Department of Health. Her fluency in Spanish allowed her to help connect Spanish-speaking residents who tested positive for the virus to health services. (Brown recently published a profile of Smith, who is a member of the university’s Health Equity Scholars program.)
Smith finally located an empty office, settled into a chair and began scrolling through a list of about 150 people who haven’t been to the clinic in a year or more. She needed to update their list before they sent out alerts about the mobile vaccination clinics.
She tucked the phone’s receiver under her chin and began dialing.
“¡Hola! bueno dias, estoy llamando de parte de La Clínica Esperanza,’’
“Hello! Good morning, I’m calling on behalf of La Clinica Esperanza.’’
If the person was home, she tried to find out if they had been seen by a health care provider since their last clinic visit. Some people were reluctant to return to the clinic because they didn’t want to have to get the COVID-19 vaccine.
“I thought it would be more me talking and me giving a spiel about…what vaccines are and this is why it’s important,’’ she said. “But I found that it’s really a lot for listening to the person, because then if you listen to them, you get to find out what is the reason that they’re not getting vaccinated.’’
There was a 20-something naturopath who said he didn’t like anything artificial in his body, and an older man with a history of bad reactions to medications. Smith was on the phone with the older man for more than a half-hour.
“I eventually asked him if he wanted to come into the clinic,” she said, “not to get a vaccine, but to speak with one of our community health workers, one of our Navegantes.”
Navegantes, or patient navigators, are multilingual certified community health workers specially trained by the clinic to respond to the complex mix of cultural, social and religious issues surrounding vaccine hesitancy.
“They’re from the community we serve,” said Leonard, the clinic’s executive director. “They speak the same language, they eat the same foods, they attend the same churches, they shop at the same places.’’
By the end of the call, the man had agreed to visit the clinic. Before she hung up the phone, Smith scheduled his appointment.
She said that about one in five of the people she called that day had never been vaccinated against COVID-19. Some said they’d stopped coming to Clinica Esperanza early in the pandemic, when the clinic began requiring all patients to be vaccinated. (The COVID-19 vaccine is no longer mandatory for all patients, though it’s strongly recommended, Morgan, the clinic’s executive director, said.)
Listening to patients, Smith said, gave her a new appreciation for what it takes to help people make informed decisions about their health. “There are so many different reasons why people don’t want to get vaccinated,’’ she said. “And I think having, you know, just education about what vaccines are may not be enough.”
So she was unphased that morning in July when Armando, the handyman from Puerto Rico, declined a tetanus shot because of his fears due to misinformation about the COVID-19 vaccine. But what surprised her, she said, was how quickly he came around.
Just minutes after he walked away from the vaccination table, he was back again. He said he wanted to get a free tetanus shot after all.
Afterwards, he smiled and gave a thumbs up sign.
What made him come back?
“Because this is not for the COVID,’’ he said. “This is for, how you say this in English?”
“That one is T-dap,” Roman, the Navegante, replied.
As he disappeared into the crowds, the mobile clinic operation buzzed with activity.
“I’ve seen people come around a few times,’’ Smith said, “but very rarely have I seen them actually do a full 180 and agree to get the shot right there in that moment….It’s very satisfying.”
The mobile clinic is funded with a $252,000 grant from Merck, the pharmaceutical company. The 12-month grant funds vaccine outreach, Leonoard said, as well as follow-up visits at Clinica with patients they meet at the vaccine sites. The clinic received the Moderna vaccines for free from the state Health Department. And it expects to be offering the new COVID-19 shots as well.
Smith said she wants to bring the mobile clinic to neighborhood spots where locals congregate, including laundromats, hair salons and bodegas.
The goal is to vaccinate 530 people in zip codes 02907, 02908 and 02909 by the end of the year. So far, the mobile clinic has vaccinated 39 people.
It’s slow, painstaking work. But Leonard, Clinica Esperanza’s executive director, said they will keep going until they meet their goal.
The new COVID-19 vaccine is already available at pharmacies including Walgreens and CVS. (CVS does not participate in Rhode Island’s free vaccine program so people without insurance will be charged.) For more information about vaccine clinics in Rhode Island visit covid.ri.gov/prevent/vaccination.
Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org
