As a physician who ran mobile eye clinics for several years, I’ve been watching the agonizing COVID-19 vaccine rollout in Massachusetts with a sinking feeling, eagerly awaiting signs that government officials have a strategy to reach the most vulnerable and under-resourced populations. Instead, there has been a patchwork of vaccination clinics, poor communication, a byzantine online booking system, and astounding racial inequity. White residents in Massachusetts are getting vaccinated at 14 times the rate of Black residents and 16 times the rate of Hispanics. In contrast, the national mortality rates for Black and Latino people are 1.9 and 2.3 times those of white people, further compounding the issue of vaccine inequity.
We can do better to achieve vaccine equity. A proven strategy that can be deployed quickly would be to turn available public transit buses into mobile clinics.
Mobile clinics have long been used as an effective method of bringing critical services to communities in need by meeting people where they work and live. Mobile clinics serve 5.2 million to 7 million people in the United States annually, with wide-ranging services from dentistry to mammography. The mobile model, combined with community engagement, has the potential to increase vaccination rates by decreasing barriers to access and positively influencing group behaviors.
Public transit buses are a widely available and familiar government resource that engenders trust and can be rapidly converted into mobile clinics. I call this repurposing of transit buses into mobile clinics Transit Vaccination Clinics. The typical 40-foot transit bus can accommodate three vaccination labs while allowing for proper social distancing. There are two entrances, permitting a one-way flow of patients. A portable generator and electrical outlets are the main modifications necessary to make the bus “vaccine ready” to support a small pharmacy refrigerator.
One clinic could vaccinate 270 people over a 9.5-hour day. As vaccine distribution ramps up, this number could increase to 390 vaccinations with the addition of an extra four-hour shift; 100 TVCs could perform over 7 million vaccinations over a six-month period. The costs to outfit a TVC are low, about $17,000 per bus, which makes it a financially feasible solution.
Collaboration between the public and private sectors is required in order for Transit Vaccination Clinics to work. State or local governments could convert available buses into vaccination clinics and then assign them to hospitals, health maintenance organizations, and community health centers. Each health care entity would serve as the coordinating hub for vaccine management, staffing, and other operational concerns.
The key to success is government’s involvement in identifying communities in need and facilitating an effective registration process. A digital outreach strategy of booking online appointments cannot be the main tool with minority and disenfranchised communities, where broadband often isn’t reliable and computers aren’t financially accessible. Much as with political campaigns during election season, there should be door-to-door canvassing for vaccine sign-ups. These conversations are part educational (to encourage vaccine adoption) and part navigational (to sign up individuals).
In communal settings such as workplaces and religious institutions, a coordinator from these spaces could serve to educate, gauge interest, and organize sign-ups in coordination with government entities. Vaccination call centers could be used to fill the gap between a completely virtual website and an in-person sign-up experience.
The state’s vaccination strategy needs to be reimagined to make vaccine equity more than a catch phrase. Communities have been operating in good faith and following the guidelines they have been given in terms of vaccine prioritization.
But the solutions are not designed with the needs of disenfranchised and vulnerable populations in mind. Main vaccination outlets include hospitals, doctors’ offices, retail pharmacies, and mass vaccination sites. Each of these settings relies on one or more of the following elements: access to digital technology, ability to navigate complex and disconnected booking systems, transportation to vaccination sites, and established patient relationships with health care systems. People who are disenfranchised or have poor health care access may have difficulty navigating the vaccination maze. There is also an element of vaccine mistrust among minority communities regarding safety and long-term effects that must be addressed.
There must be more equity in vaccine distribution, and Transit Vaccination Clinics can serve a powerful role in bridging our disparities. Let’s not miss the bus on this opportunity to get all people vaccinated.
Dr. Shazia Ahmed is former chief medical officer of 2020 Onsite, a mobile vision care company.