ALABAMA – For months inside an Alabama ICU, Dr. Anand Iyer has worked to mitigate the “downstream” effects of COVID-19 to often heartbreaking results.
“Intubating older adults, putting them on the mechanical ventilators, watching them die. It’s terrible,” Iyer said. “That drives the push on the upstream, what can we do to bring a sense of urgency about ending this pandemic as soon as possible?”
The roll-out of vaccines across the country is welcome sight amid a life-altering pandemic and feels like a light at the end of a tunnel. But as vaccine doses slowly trickle down through at-risk populations, Iyer and others remain concerned about gaps in vaccine access.
Vaccine prioritization often flows from a single question: Who is most at risk from COVID?
But Iyer thinks we should consider another question: Who is the most at risk for missing the vaccine?
Older adults without a robust and proximate support system from friends and family will fall behind in the race to get the vaccine, a recent Kaiser Health News analysis found. Black and Hispanic older populations are even more at risk. A quarter of older Black adults lack internet access, followed closely by 21% of older Hispanic households, according the U.S. Census data. Many lack reliable transportation and are effectively homebound, even if they are able to navigate byzantine roadblocks to get a vaccine appointment.
“They are at risk for the worst outcomes for COVID,” said Iyer, a pulmonologist by training and a junior faculty member at the University of Alabama at Birmingham, where he researches medical and care needs for older adults in geriatric medicine.
“There needs to be a sense of urgency about solving these problems for this population.”
Vaccine clinics across Alabama over the past two months have often been filled at blink-and-miss-it speeds. Dozens of older Alabamians have called the Montgomery Advertiser in recent weeks looking for help navigating the system or searching for help getting to vaccine clinics. When millions of calls overwhelmed a state hotline in January, the state developed an online portal to search and sign up for county health department vaccine appointments.
“It sounds like a radio ticket giveaway back in the ’90s,” Iyer said. “You’re refreshing and refreshing with multiple screens up. I can do that as a millennial, but I don’t see that possible for our older population.”
Iyer estimates at least 10% of older and homebound adults — who may be “low-tech,” unable to drive themselves to an appointment or unable to stand in line at a clinic — will miss getting the vaccine, regardless of their eligibility and willingness to take it.
In Montgomery, city officials last week scrambled to put together a transportation service to a first-come, first-served vaccination clinic that rapidly moved through its dose allotment. Mayor Steven Reed said the city wanted to help provide “equitable” access to the vaccine for those who might be unable to drive or didn’t have access to a car.
“We heard from members of the community there were challenges for people to get to vaccination sites,” Reed said. “This was a way to assist in a small way those who want to be vaccinated but didn’t have the transportation to get there. We wanted to support an initiative to reduce the barriers for people trying to get the vaccine.”
A city-advertised phone line connected callers who needed rides with a locally owned transportation service in a program supported by a “joint city and philanthropic endeavor,” said Reed’s policy adviser Phillip Ensler. The city is working on finalizing a more permanent program to assist those in need going forward.
“We’re now working on the roll-out for something that is more sustainable for people to get rides to Walmart or ASU,” where vaccines are offered in an appointment system, Ensler said. “It got a good running start, and we have a lot of the necessary pieces in place.”
Map of Walmart, Sam’s Club vaccine locations in Alabama
Iyer is concerned about a lack of centralized data about who might be falling between the cracks of drive-in vaccination clinics and county health department appointments.
“There are many older adults who can do telehealth, who can do technology, they can do it,” Iyer said. “But there’s a whole number that can’t. I don’t know that number, I don’t think anyone in the state can tell us that number. Is it 10,000, 100,000? Is it half a million older adults? I don’t know, because I don’t think we are able to find that information out as easily as we would think.”
Like Montgomery, communities around the country are looking for solutions to help fill the gaps.
In Washington D.C., staff from Mayor Muriel E. Bowser’s office hit the pavement in some of the city’s most at-risk neighborhoods to act as “senior vaccine buddies,” knocking on doors and offering older adults help signing up for vaccine appointments. Elsewhere in D.C., the Edlavitch DC Jewish Community Center teamed up local college students with older adults in their community, letting the tech-savvy students navigate an often-confusing sign-up system.
One county in California went a step further, taking vaccinations mobile and deploying nursing “strike teams” into the neighborhoods, cutting through transportation and mobility issues.
Reed said Montgomery isn’t yet considering this approach, due to vaccine availability and storage issues, but city officials continue to look at “innovative” practices to ensure no one gets left behind.
“We’re not only looking at best practices, but we’re trying to create our own practices to address these issues right here in Montgomery to reduce the disparities that exist between those who are getting vaccinated and those who wish to be vaccinated,” Reed said.
