With new COVID boosters, Philly health workers are trying to expand their reach — but face new challenges

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For the past few years, Nilda Diaz has been shocked at the myths some people have told her about the COVID-19 vaccine: that the vaccine would stop someone from getting pregnant, that people would die from the vaccine.

She’s 24, and grew up in North and Northeast Philadelphia. She wanted to do something about these misconceptions by talking to other people her age from the same neighborhoods.

A year ago, she started working with a team at Esperanza, a faith-based nonprofit that serves Hispanic communities. They designed flyers and gave them out door to door, in person. She stressed that she’s not asking anyone to get the vaccine, only that they should have accurate information to decide for themselves.

It was hard work; she would be outside in the cold and sometimes people would respond negatively. But sometimes it worked, like one time, when she approached a man in a grocery store.

“And he said, ‘I don’t believe in this and neither should you.’ And he walked away and I said, ‘so let’s talk about it.’ And in the middle of the grocery store, we had an entire conversation that lasted about 10 to 15 minutes. And at the end, he understood pretty much a little bit more about the COVID vaccine and why it’s not harming him, but it’s helping him.”

And now that there is a newly updated COVID-19 vaccine, she’s gearing up to start those kinds of conversations all over again.

The Philadelphia health department has not always worked with community groups on vaccine campaigns, but during the pandemic, it quickly learned how effective they can be.

Jamile Tellez  Lieberman, the senior vice president of community engagement, research, and health equity at Esperanza, said this kind of work is what they specialize in, but there are new challenges with the new vaccine.

For instance, she said people broadly understand “vaccines to be a one and done thing that you get done once … and it 100% protects you against whatever disease it was or illness it was developed for,” so outreach workers need to explain why there is now an updated COVID-19 vaccine.

Esperanza has also run focus groups, and they’ve heard from some concerned parents: “they seemed somewhat … hesitant to get their kids up to date with … COVID-19 vaccines …versus other types of childhood vaccinations that were more common.”

A third challenge this time around is paying for the updated vaccine.

In the past, the federal government guaranteed access, regardless of whether someone has insurance by paying for the vaccines. But now the COVID-19 vaccine goes back to the commercial market, which means that for people with health insurance, the costs will be covered, but people in Philadelphia without insurance need to go to city health centers, federally qualified health centers, or pharmacy partners to get the vaccine free of charge. The federal government has a temporary access program with pharmacies to provide free access to the vaccine, but that will end in December 2024.

To get around the issue of cost, Montgomery County plans to have combined vaccination events where pharmacies will vaccinate people who have health insurance, and the county will vaccinate people who don’t, said Richard Lorraine, medical director of the Montgomery County Office of Public Health.

“No one should worry about coverage,” he said. “If they can come to one of these events, they will get a vaccine, we will worry about where it’s coming from and who paid for it.”

He said the county is also working with pharmacies and members of the Montgomery Council Immunization Coalition to coordinate vaccination efforts.

Philadelphia health commissioner Dr. Cheryl Bettigole said that from the last few years, the city learned how important it is to have the vaccine available across neighborhoods, including after work hours. The goal is to make access as easy as possible.

“The real reason I get my flu shot is that when I go see my primary care provider, the medical assistant asks me if I need a flu shot as soon as I walk into that room. And so all I have to do is say, ‘yes, I get my flu shot,’ done. If I had to go somewhere specifically to get it, I’d probably be late or miss it some years. And that’s what we need to do with these COVID boosters, especially for anybody who’s high risk.”

Since the pandemic, social scientists have also continued research on what makes someone decide to get vaccinated or not. One successful idea came from North Carolina: a pilot program gave a $25 cash card to adults who got their first dose of a COVID-19 vaccine or drove someone to get their first dose. That increased the vaccination rate by more than 40%.

Philadelphia’s Department of Public Health did something similar last year; as did Project HOME, an organization that works to end homelessness and poverty and also runs a federally qualified health center. Project HOME will continue to give gift cards to people who get vaccinated. They also have an existing program where people who need to travel for their health needs can get bus passes, said William Kurtycz, vice president of health care services.

Last year, the National Academies of Sciences, Engineering, and Medicine gathered social scientists to sum up what researchers have found about how to encourage more people to get vaccinated. Noel Brewer, a professor of health behavior at the University of North Carolina, was part of the panel. He said getting vaccinated is less of a weighty decision someone ponders over, and more like a quick decision at a doctor’s office.

“Probably the single biggest influence on vaccine behavior in the U.S. is a physician’s recommendation. There’s nothing like it,” he said.

Epidemiologist Saad Omer said the U.S. could benefit reimbursing doctors for their time spent talking to patients about vaccines. Since December 2021, pediatricians can get reimbursed for talking to parents about children’s vaccines, but there is no reimbursement for talking to adult patients.

“Often you want that physician or that health care provider to have an ongoing series of conversations … to persuade … that individual to get vaccinated because it’s in the individual interest, but also in societal interest,” said Omer, who is also the dean of the school of public health at the University of Texas Southwestern Medical Center. “By not doing that, we are being penny wise, pound foolish.”