Public Health Experts Discuss Strategies for State to Reach Herd Immunity

June 04, 2021

The Massachusetts Health Policy Forum with red diamond logo

Massachusetts is a national leader in the race to get the Covid-19 vaccines to more people, but with a third of the population still unvaccinated, the state has decided to shutter regional mass vaccination sites while redoubling efforts to reach those who doubt the efficacy of the vaccine, as well as those most vulnerable to this deadly virus.  

At yesterday’s virtual Massachusetts Health Policy Forum (MHPF) at the Heller School, Brandeis University, on Vaccine Hesitancy in the Commonwealth: Tailoring the Message to Move the Needle, MHPF Board Chairman Philip W. Johnston noted, “While this state has one of the lowest vaccine hesitancy rates in the nation, more work is needed to reach herd immunity and a new normal state.  Now is the time to focus on the best strategies with particular attention to outreach in the Black and Latino communities, among conservative Republicans and individuals living in the more rural areas of our state.”

Marylou Sudders, Secretary of the Executive Office of Health and Human Services (EOHHS), explained that the state is now “hyper-focused on reaching people where they are” with a ground game akin to a political campaign, focused on door knocking to find people who want to be vaccinated but have been unable to gain access, while persuading those “vaccine delayers” who remain reluctant to get vaccinated.  According to Sudders, the state has invested more than $30 million to help the hardest hit communities reduce barriers and “find a pathway to the vaccine” through local initiatives such as pop-up or mobile vaccination sites, in addition to bringing the vaccine directly to people who are homebound, frail or without transportation.

The pandemic has disproportionately impacted communities of color, due to the clinical impacts of social determinants of health that place them at a higher risk, according to MHPF keynote speaker, Dr. Anna Maria Siega-Riz, dean of the Departments of Nutrition and Biostatistics and Epidemiology at the School of Public Health and Sciences at UMass Amherst.  While approximately 3.5 million Massachusetts residents have been fully vaccinated, there are “areas where we need to do better,” she said, citing approximately 3 percent of the population that want the vaccine, but can’t afford it, or are unable to take time off from work to be vaccinated.  More focus should be on getting the vaccine to the working, middle class, according to Dr. Siega-Riz, who also noted that while Massachusetts overall has one of the lowest rates of vaccine skeptics, that cohort still accounts for seven percent of the state’s population, with higher numbers in certain portions of the state. 

Getting the vaccine to the most vulnerable residents in congregate housing, prisons and shelters and those in the hardest hit communities, continues to be front and center to the state’s approach based on equity and reducing barriers to access, according to Dr. Monica Bharel, MA Commissioner of the Department of Public Health. At the start of the vaccination distribution program, the state launched a multi-language public service campaign known as Trust The Facts, in which a diverse group of trusted community leaders urged all residents to get vaccinated.  Surveys conducted during the past several months also proved valuable as the state continues to address perceived barriers to accessing the vaccination, while Dr. Bharel noted that a desire residents to “get back to normal” remains their greatest motivation.

Data from the state’s vaccination equity initiative identified 20 communities that have been hardest hit by the pandemic. Much like a political campaign, the state is working in tandem with local boards of health from those communities to organize local residents and trusted leaders who are knocking on doors, visiting local businesses and identifying people who need to be vaccinated.  “We are building confidence within these communities so that people will make the best decision,” Dr. Bharel said.

In Worcester, community initiatives focused on outreach to the city’s diverse neighborhoods were developed before vaccine distribution began, according to Dr. Matilde Castiel, Worcester Commissioner of Health and Human Services.  In coordination with the University of Massachusetts Medical School, Worcester’s Covid-19 task force enlisted the help of trusted community and healthcare leaders to help bring the vaccine to the city’s most vulnerable and hard-to-reach population.  Taking time off from work and a lack of transportation were two common barriers to getting residents vaccinated, she said, so the city worked closely with Lyft, a ride-sharing company, and community leaders who offered to take people to the vaccination sites.  “We opened mobile and pop-up vaccination sites, including on Main Street,” Dr. Castiel said, “because the most important piece of our strategy was to go where the people are.”

Education and trust, she added, are also important features of the community initiative. Places of worship have been critical in persuading parishioners to be vaccinated and word of mouth is helpful as well, according to Dr. Castiel, whose mother would not take her advice to get vaccinated, but was later convinced by her next door neighbor.  

Thomas Mountain, a longtime MA Republican Party official, continues to do his part to convince a high percentage of reluctant Republicans to get the vaccination.  Once “nonchalant” about his chances of contracting Covid-19, Mountain said he eagerly accepted an invitation to attend a White House holiday party in December, where masks and socially distancing were not mandated. Shortly after his trip to Washington, DC, Mountain was diagnosed with Covid-19 and was hospitalized twice, refusing all attempts to place him on a respirator. He is still dealing with post-Covid health issues.  “I saw the light,” he confessed, adding that Governor Charlie Baker has encouraged him to get the word out about his dire encounter with the virus.

His message, he said, has been rebuffed by many of his GOP friends and colleagues he describes as “zealots,” who have initiated a movement to spread the word about the need to reject the Covid vaccination. This anti-vaccination attitude is more about their disdain for the current President and the disconnect between what the former President did to accelerate the development of the vaccine and their opposition to the current President, he explained.

 “Among middle aged men and women the one word they fear is the word cancer. So I tell them, if a cancer vaccination came out tomorrow, you would get it. You would get the cancer vaccination, but not the vaccine for Covid, which is very lethal and also contagious, Mountain said. “I tell them that if they don’t get the vaccination and the virus is still around, you can still get it and you can spread it among yourselves. You will suffer.  I was careless about Covid and still I am not completely healthy.”

For more information on this event, please visit the Mass Health Policy Forum website.