CHELSEA — The crew had been out on the streets for more than an hour before they found a man who needed a shot.
The five young people in torn jeans and mint- and cantaloupe-colored T-shirts had already accomplished a lot on this bright late-September day. Stopping stroller-pushing moms on the sidewalk and knocking on the doors of triple-deckers, they told people about the food pantry, the English classes, the sports and music lessons for children, the upcoming block party, where to get help with a leaky oil tank — even how to register to vote.
But until they came across Gato, sitting at the open door of a shed under the staircase to his home, the promotores de salud — community health workers — did not have occasion to talk about the vaccine against COVID-19, an illness that had stormed this small impoverished city with notorious ferocity.
“Have you been vaccinated, Gato?” asked Natalia Restrepo, the 29-year-old engagement coordinator for La Colaborativa, the community service group that hired and trained the promotores.
“No,” he said. Restrepo knows Gato; he’s friends with her husband. But she did not know this troubling fact about him.
He was a member of the unvaccinated minority. According to state data, 74 percent of Chelsea residents are fully vaccinated, above the state average of 67 percent. That happened even though Chelsea’s population is dominated by groups traditionally hard to reach — immigrants, poor people, Latinos.
Chelsea’s vaccination rate far exceeds that of some peer cities like New Bedford, Springfield, and Lawrence, where barely over half the population has been vaccinated.
And new COVID-19 cases in Chelsea have plummeted to below the statewide average. Chelsea has made itself into a vaccination standout, the result of a person-to-person campaign by multiple community groups.
“The Chelsea experience is one we really need to learn from,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association. “It’s one where we can see the value of efforts that are locally designed, locally led, and developed by the people most familiar with the community and most trusted by the community.”
Chelsea’s progress — city officials caution that the work is far from complete — has a lot to do with folks like those who coaxed Gato in Spanish when they heard he hadn’t gotten the shot.
“Why should I get vaccinated?” said Gato, a 54-year-old whose real name is Jose Javier Mejilla. “I don’t have COVID.”
Gato said he hadn’t been out much lately, not since he lost his job after his boss died. Originally from El Salvador, he’s among the 68 percent of Chelsea residents who are Latino and the 45 percent who are foreign-born. And despite the city’s overall high rate, Chelsea’s Latino community has lagged in getting the shot.
Anais Roa, a 19-year-old with feathery blond hair down her back, urged him: “Even if you don’t have COVID, you still need to get the shot. It’s very important, sweetheart.”
After several minutes of jovial banter, Gato agreed to visit the vaccine clinic at the senior center.
The pandemic had raged like a wind-whipped fire in Chelsea, a 2.5-square-mile city across the Mystic River from Boston, bringing fevers and hacking coughs to apartments and houses packed with grandparents, mothers and fathers, sons and daughters — a mysterious sickness that rode home with folks who took the bus to jobs serving food or cleaning hotels or hospitals.
In April 2020, according to a new report from the environmental group GreenRoots, the COVID-19 infection rate in Chelsea was one of the highest in the nation, 57 per 10,000 residents, higher than the worst days in New York City, six times the statewide infection rate. Researchers at Massachusetts General Hospital found that by April 2020 one-third of the city’s residents had acquired antibodies to the virus, indicating they’d been infected.
“This virus was very real to people in Chelsea,” said Thomas G. Ambrosino, the city manager. “Most of our residents knew someone who got very sick from this virus. Many knew family members who died.”
But sickness wasn’t the only source of pain: By June 2020, with the economy flattened by the pandemic, one in five Chelsea residents was out of work. The promotores talking to Gato had all experienced it.
Restrepo, who used to work at HomeGoods, remembers hiding from her landlord, months behind on her rent. Axel Velasquez, 28, had lost his factory job when a promotore came to his door asking if he needed anything. He said he needed a job, and soon he was working for La Colaborativa.
A lifeline for immigrants
Founded in 1988 to serve a new influx of Latino immigrants, La Colaborativa did much more than offer employment. It set up a food pantry, delivering food and medicine to those in quarantine. “We became the survival center,” said Dinanyili Paulino, the chief operating officer.
Gladys Vega, the CEO, recalls encountering an 11-year-old in the food line. The girl had been left to care for her 6-month-old sibling when their mother was suddenly hospitalized with COVID-19.
“We adopted that girl for three weeks,” Vega said, making sure she had diapers and food, and neighbors checking in on her.
So when it came time to vaccinate, Paulino said, community members wondering whether the vaccine was safe turned to La Colaborativa — “the people that have been with them from the beginning.”
Vega, a black-haired dynamo named a 2020 “Bostonian of the Year” by the Globe Magazine, started as a receptionist at what was then called the Chelsea Collaborative. A Puerto Rican who came to Chelsea at age 9, her family so poor that she had little to eat beyond the breakfast and lunch served at school, she worked to refocus the agency’s mission on needs identified by the community.
“Everything that we do, we do neighbor to neighbor, by having door-to-door conversations with our friends, with our neighbors, with our family members,” Vega said.
When the COVID-19 vaccines were approved in late 2020, the organization trained mothers to form a cadre of promotores, who teamed up with doctors from Massachusetts General Hospital going door to door to talk about the importance of vaccination.
Dr. Julia R. Koehler, an infectious diseases specialist at Boston Children’s Hospital who joined the effort, said that people were much more likely to open the door once they heard La Colaborativa was knocking.
Then, she said, “If somebody said, ‘What do you know? You’re just a neighbor,’ they could turn around and say, ‘Here’s the doctor,’ and find a person in a white coat with a hospital ID lanyard.”
‘We were mad’
Despite such preparations, despite the severity of COVID-19 in Chelsea, the vaccine itself was slow to arrive.
With supplies tight and unpredictable at first, the state initially focused its efforts on such mass vaccination sites as Gillette Stadium. Getting a vaccine required a computer to sign up and the time and means to get there. In Chelsea, where few had the technology and skills, and one-third don’t have a car, the vaccines were essentially out of reach.
Advocates were outraged, and undeterred.
“Our residents are the service workers. We were and are the most vulnerable members of the community but the last ones to be in the priority list to get vaccinated,” Vega said. “We were mad, we cried, we did everything.”
That included marshaling media coverage of the hardships in Chelsea, making it hard to ignore.
“Those women knew what their community needed,” said Dr. Regina LaRocque, an infectious diseases specialist at Massachusetts General Hospital who helped with the door-knocking and advocacy. “They understood what COVID was doing and they loudly insisted that the state not look away. They loudly insisted that Massachusetts General Hospital not look away.”
The first big vaccination clinic in Chelsea opened on Feb. 4. The doses didn’t come from the state. Instead, the East Boston Neighborhood Health Center received them through a federal program and agreed to set up a clinic at La Colaborativa.
Offering the vaccine at their headquarters, Vega said, “sent a strong message that, if we are welcoming the vaccination, that means that you as an individual should get vaccinated.”
Doses from the state started flowing to the city in March. A vaccination clinic held at the Chelsea senior center in early April attracted so many people that the line wrapped around two blocks, said Flor Amaya, the city’s public health director. Through April and May, Chelsea received additional vaccine from the Federal Emergency Management Agency for mobile vaccination clinics.
But advocates understood that making vaccines readily available would never be enough.
Many of Chelsea’s immigrants are undocumented. They are often afraid to have any contact with government entities or believe they are not eligible for the shot without papers. Some, like Gato, just haven’t grasped the importance of the shot or are too busy with jobs and children to deal with it. Some aren’t necessarily opposed to vaccination but want to know more about it and need to talk about it. And some are scared away by misinformation.
La Colaborativa was not alone in seeking to draw people in. Nearly every community organization in Chelsea had a part, including GreenRoots, the environmental group; Roca, which works to reduce violence among young people; the Chelsea Black Community; and religious groups.
Pastors extolled the vaccine from the pulpit. Father Edgar Gutierrez-Duarte said he told his parishioners at St. Luke’s-San Lucas Episcopal Church that the vaccine was the miracle they had prayed for when people were dying.
“Now God delivered and we are suspicious of God?” he recalled saying. “We asked God to perform miracles out of nothing, when in reality God performs miracles through science.”
The church held vaccine clinics in April at the parish, sending another powerful message.
At Roca, the staff struggled to counteract the effects of social media misinformation on their young clients, many of them newly arrived immigrants with traumatic pasts. They read that vaccines would make them sick or sterile, both blatant falsehoods.
Caren Zambrono, a 21-year-old who came from Honduras in 2019 while pregnant, struggled with the decision. Her youth worker at Roca, Patricia Merlos, talked it over with her many times.
“She made me think and explained to me that I’m a mother first and I have to care for my daughters, or at least protect myself to protect them because they’re too young to get vaccinated,” Zambrono said in Spanish. When Zambrono finally agreed to get the shot, Merlos accompanied her to the vaccination site.
Mobile clinics also reached the young. A Massachusetts General Hospital van, initially used for COVID-19 testing, pivoted to vaccines in May, with a special focus on adolescents. The van showed up at ballgames, festivals, and back-to-school events, and teens lined up to get inoculated.
“There are a number of different lessons that can be learned here, especially around adolescent vaccination,” said Dr. Elsie Taveras, chief community health officer at Mass General Brigham. “The first is boots on the ground. Go where the patients are. Flip the model of expecting patients to come into our brick-and-mortar facilities.”
Nearly three-quarters of Chelsea’s teenagers have received their first dose. ”I can tell you as a pediatrician — those rates of adolescent vaccination are crazy,” Taveras said.
The state also stepped up with a Vaccine Equity Initiative that funneled resources into 20 hard-hit communities, including Chelsea. So far it has provided $32 million to local organizations for grass-roots efforts.
In Chelsea, according to data from the state, the initiative has distributed nearly $2 million to 17 organizations that serve the city. That included $58,305 to La Colaborativa and $53,906 to GreenRoots for door-to-door canvassing and other community activities.
But while vaccination rates increased in all the 20 hard-hit communities, the results were uneven. Chelsea, Framingham, Malden, and Revere have exceeded the state average in the percentage of those vaccinated, while Brockton, Fitchburg, Springfield, and New Bedford remain far behind.
Marylou Sudders, the state’s secretary of health and human services, credited Chelsea’s deeply rooted community organizations with its success. “They had that infrastructure existing in place,” she said.
That infrastructure, some say, was forged during another dark period in Chelsea’s history. Three decades before the pandemic, years of mismanagement left the city $40 million in debt and unable, literally, to keep the lights on. In September 1991, Chelsea was put under the control of a state-appointed receiver, who over four years redesigned the government.
Jay Ash, who was involved with the receivership and later served as Chelsea’s city manager for 14 years, said the switch from a mayor seeking reelection every two years to a city manager “took the politics out.”
“People have learned how to work together better and dare I say trust each other more,” said Ash, who is now chief executive of the Massachusetts Competitive Partnership, a large-business group, and previously served as the state’s secretary of housing and economic development.
The receivership process “built the community bandwidth to work together,” said Molly Baldwin, who founded Roca, the youth services group, 33 years ago and continues as its chief executive. “We know that government can work. We know communities can work.”
Though proud of the record so far, city officials caution that the work is hardly done.
Ambrosino, the town manager, thinks the state has undercounted the city’s population, resulting in possibly inflated percentages of those vaccinated. (The state stands by its numbers.) Amaya, the public health director, points out that the vaccination rate among the city’s Latinos remains lower than most other ethnic groups. Only 61 percent are fully vaccinated, although 69 percent have received their first shot.
“We have the hardest time vaccinating the group that is the majority of our population,” Amaya said.
And now the impending availability of vaccines for young children and the need to provide boosters to those most at risk brings new challenges.
On a recent October afternoon, Mass. General’s aqua-colored Community Care Van cast a lengthening shadow in the parking lot of La Colaborativa’s food pantry. The smell of popcorn wafted through the air as kids gathered to have their faces painted and watch balloons get twisted into animal shapes.
Meanwhile, their parents lined up to collect fruit and vegetables and prepared meals. Some also lined up for shots; the medical mission seemed to blend in with the festivities.
Dr. Priya Sarin Gupta, medical director for mobile health services at the MGH Kraft Center for Community Health, has been regularly taking the van to Chelsea, as well as other nearby communities.
Gupta’s patients that day included 13-year-old Emily de Leon, who said she wants to help people and stop COVID-19, and Bladimiro Sanchez, 66, who came for a booster shot. He found out about the van when some folks from La Colaborativa gave him a flier outside the post office.
Ermelinda Pena, already fully vaccinated, had come for food and rental assistance. But she also wanted to seize the opportunity to get a shot for her 15-year-old daughter, Monica, who’d had doubts but eventually agreed.
At a table set up outside the van, Monica pushed up her sleeve. Gupta plunged the syringe. The work continued.
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her @felicejfreyer. Bianca Vázquez Toness can be reached at email@example.com. Follow her @biancavtoness. Diana Bravo can be reached at firstname.lastname@example.org.