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In Nashua, Ensuring Equitable Access to the COVID-19 Vaccine Is A Team Effort

Community health workers prepare for a vaccine clinic next to a sign that says "Clinical observation 15 minutes after your vaccination" in English and Spanish
Casey McDermott, NHPR
At each of Nashua's weekly vaccine clinics, the city provides language support in Spanish, Portuguese, French and Swahili.

Inside one of Nashua’s community COVID-19 vaccine clinics, before patients arrive, nurses, public health workers and first responders are suiting up in scrubs and protective masks, sorting through paperwork and assembling supplies to administer the shots.

“I've been making masks at home for a year, just waiting for an opportunity to put my hand in and help,” said Dr. Ophelia Chang, one of several retired physicians volunteering at the latest clinic. “And this is the first time I felt like there's something I can really do to help save lives.”

There’s also a team of interpreters standing by, ready to help immigrants, refugees and other non-English speakers through the process — in Spanish, French, Swahili and Portuguese. Ira Munoz, who works for the city’s welfare department and provides Spanish language support at these clinics, said this kind of service is essential to help people feel more comfortable and to clear up any misinformation around the COVID-19 vaccine.

“There's always misinterpretation, as well,” she said. “So we try to clarify all those questions for them right away, right on the spot.”

(More COVID-19 vaccine resources from NHPR: Your Guide To Coronavirus Vaccines In New Hampshire / Tu Guía En Español Sobre La Vacuna Contra El Coronavirus En New Hampshire

This is all part of a statewide effort to get more COVID-19 shots into the arms of people who are at heightened risk for the coronavirus or might have trouble accessing the vaccine through the state’s standard registration process. New Hampshire has set aside 10 percent of its vaccine supply for this “equity allocation,” which is being distributed through community-based clinics run by regional public health networks.

Each regional public health network is taking a slightly different approach depending on the needs of its population.

A small group of people unpack supplies inside a vaccine clinic in Nashua
Credit Casey McDermott, NHPR
The team behind the latest clinic in Nashua included city health workers, retired physicians, first responders and other volunteers.

In Nashua, they’ve sent teams of public health workers into soup kitchens, domestic violence shelters, low-income senior housing facilities and more. But they’ve also hosted weekly standing clinics at a fixed site in a centrally located part of town, in a neighborhood where many people lack access to transportation, live in multigenerational housing or have other risk factors that the equity clinics are trying to help overcome.

Patty Crooker, who’s overseeing these clinics for the Greater Nashua Public Health Network, said they aren’t just doing this in Nashua. They’re also planning clinics in nearby Merrimack, Milford and Amherst, with a similar focus on identifying populations who meet the state’s equity criteria in those communities.

“We’re looking at our census tracts within the region that are most at-risk or at the highest vulnerabilities and identifying spaces around there that would be appropriate to hold a clinic,” Crooker explained, “and then talking to our partner organizations around that area to get people to come to that area for a clinic on a certain date and time.”

Bobbie Bagley, Nashua’s public health director, said the city is trying to avoid publicly advertising the exact location of their weekly vaccine clinic to ensure they can focus their limited supply on those most in need. Instead, Bagley said the city is trying to reach eligible patients through word of mouth and direct referrals from local social service providers, faith-based organizations and other groups.

Ahead of each clinic, city health workers try to register as many people as possible who meet the state’s equity criteria, but they also keep a limited supply of extra vaccines available for walk-ups, provided those individuals also meet the criteria for vaccine eligibility.

“We've had this nice relationship with our partners in the community that allows for us to be able to do this effectively and stay within, you know, the fidelity of what this rollout was supposed to look like,” Bagley said.

(Related from The Exchange: Exploring Equity, Health Disparities and COVID-19)

The work of reaching out to immigrant, refugee and non-English speaking populations starts long before these clinics open their doors. In addition to working closely with community organizations to identify people who might benefit from these clinics, Nashua’s public health team has also enlisted the help of individuals within different immigrant and refugee populations to serve as informal vaccine ambassadors, encouraging people to sign up and fielding questions about the process.

“Sometimes people aren’t sure where they should reach out to, so this is really great to have people, boots on the ground, out in the community, reaching out to folks,” said Kim Bernard, Nashua’s chief public health nurse.

For the most part, Nashua’s public health team said they’ve not seen as much vaccine hesitancy as they anticipated, as evidenced by the strong turnout at their clinics so far. This week, more than 200 people registered for Friday’s clinic, and staff expected as many as 50 to 100 more to show up at the door. Last week, they vaccinated a little over 200 people — almost double what they did the week before.

Lisa Vasquez, who’s been involved in many of Nashua’s public health outreach efforts around COVID-19, said it’s important for the general public to understand that these equity clinics are meant to supplement — not replace — other state-run vaccine efforts.

Credit Casey McDermott, NHPR
Those working the vaccine clinics say they're encouraged by the success of outreach efforts so far, as evidenced by strong turnout during the first few weeks.

“For, you know, members of other populations that might see this as people like cutting through the line and things like that, that’s not what's happening — these are parallel clinics,” she said. “Many of the people that come to this clinic are still over 65, are still having those pre-existing conditions, they just have other barriers.”

Southern New Hampshire, and the Greater Nashua area in particular, has been hit especially hard by the coronavirus. According to state data, the region has reported more than 12,000 cases and nearly 170 deaths since the start of the pandemic.

The vaccine clinics, Crooker said, have been a welcome contrast to the darkness and isolation of the past year: They’re bustling, and full of energy, smiles and people eager to do their part to help protect their neighbors from the virus.

“Somehow it's a celebration of this turning point, a bit, where we can really take steps besides social distancing and mask wearing and stuff,” she said, “to bring our community back to a place where they can not only be healthier but have some normalcy, return to their lives and not have necessarily the same amount of fear that they've had for the last year.”

Casey McDermott is an editor and reporter at New Hampshire Public Radio, where she works with colleagues across the newsroom to deepen the station’s accountability coverage, data journalism and audience engagement across platforms.

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