Race To Push Vaccines In California’s Rural, Isolated, Diverse Communities.
For Del Norte County, vaccinating a highly dispersed, predominantly rural population has been a challenge.
Homeless people—including many vets –living alone in the woods or on the streets of Crescent City have not been vaccinated and the death toll rose.
Del Norte, California’s smallest county in terms of population (28,000), home to Latinx farmworkers, as well as members of the Yurok and Karuk tribes, a tightly knit Hmong community, has one of the lowest vaccination rates in the state.
At the far northwest corner of the U.S. state of California, along the Pacific Ocean adjacent to the Oregon border, rural Del Norte County has 43.6% of the population fully vaccinated, as compared with 66% of all Californians.
With the highly transmissible Delta variant, infection rates are rising dramatically, overwhelming the county’s main hospital Sutter Coast. Watch the video.
In the month of August, 95 % of the people on ventilators were unvaccinated, 92% of the people in critical care were unvaccinated and 87 % of the people hospitalized with COVID-19 were unvaccinated. Younger and younger people are getting infected.
“With the recent surge in the last two weeks our hospital can’t meet the needs of the community,” said Melody Cannon-Cutts, Public Health Program Manager at Del Norte County Department of Health and Human Services, at a briefing organized by Ethnic Media Services on August 27th.
MIT professor Abhijeet Banerjee, whose research on the subject won the 2019 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, assessed the relative efficacy and cost-effectiveness of only improving the supply of infrastructure for immunization, versus improving supply and simultaneously increasing demand through the use of incentives.
His team found in their research in India that among the several challenges to the uptake of vaccines, their availability was the least of the problems. In India, immunization services are offered free in public health facilities, but the immunization rate remains low. They found that immunization rates for children in rural India jump dramatically (from 5 percent to 39 percent) when their families are offered modest incentives for immunization, such as lentils.
“We conducted a randomized, controlled study of immunization camps in rural India to assess the efficacy of modest, non-financial incentives on immunization rates of children aged 1-3, and compare it with the effect of improving the reliability of the supply of services. Improving the reliability of services improves immunization rates, and small, non-financial incentives have large positive impacts on the uptake of immunization services in resource-poor areas,” said Banerjee.
A year later Del Norte implemented some of the findings of Banerjee’s research. The county has improved the reliability of services and has set up small, non-financial incentives through outreach.
Miguel Pelayo-Zepeda, the community outreach organizer in Del Norte, spoke of the success of their pop up clinic at the La Joya Deli where English as second language classes, immigration services, and health care services were bundled with the tacos.
“As we handed tacos out we told them of the weekly vaccination clinic,” he said at the briefing.
His greatest success was at Alexander dairy farms where he works as a farmhand. A team of nurses came to the dairy farm to vaccinate the workers during their lunch break. They got farmworkers from the other ranch to come over well.
“Latinx farmworkers working in the fields of Smith River picking lily bulbs had a very busy season. We had to work around their schedules,” said Miguel.
The Del Norte Healthcare District also announced cash incentives to encourage vaccinations.
“Del Norte Vax to Win!” holds weekly drawings of $500, $250, and $100 in two separate categories. The first category is for NEWLY fully vaccinated (second shot received within the last 7 days) only. The second category is for previously fully vaccinated individuals. Newly vaccinated people who did not win in the first category will get another chance to win under the “previously fully vaccinated” category for the remainder of the drawings. Must be 18 yrs old to win. Additionally, they are offering youth a gift card of $15 for each shot of vaccine.
As the month of September rolls around and schools reopen, vaccination rates are going up.
“We are at 43.6% fully vaccinated this week. The prior week we had 42% fully vaccinated. Partially vaccinated are at 8.9% and the prior week was 7.8 %,” said Dr. Aaron Stutzan, emergency medicine physician in Crescent City, California.
“Through its Vaccinate with Confidence initiative, CDC continues to support rural jurisdictions and local partners in their efforts to improve access to, and bolster trust and confidence in, COVID-19 vaccines,” said Bhavini Patel Murthy, MD and Neil Murthy of Center for Disease Control.
“Disparities in COVID-19 vaccination between urban and rural communities can hinder progress toward ending the pandemic.”
Ritu Marwah is a 2020 California reporting and engagement fellow at USC Annenberg’s Center for Health Journalism.