Let’s talk: COVID vaccines for all

Avril Benoît:

Thanks so much for joining us. I'm Avril Benoît, I'm the Executive Director of Doctors Without Borders here in the United States. Doctors Without Borders is known internationally as Médecins Sans Frontières, so the acronym we get from that is MSF and over the course of this webinar we are going to be using that every once in a while. Just so you know that it means the same thing.

So this is another episode in a series that we're calling Let's Talk Vaccines. So as the pandemic has rolled along, we thought we'd spend a little more time with each of these episodes to really drill down and find out what's going on with vaccination efforts around the world. Today, we're going to be focusing on vaccines and getting vaccines to the people who need them most here in the United States. So health workers and activists are calling for fair and equitable access to the distribution of vaccines around the world, of course, and we're very much part of that call. Here in the United States it's much the same because we know that no one will be safe until this disease is over for all of us, until we're all safe.

So, just before we get into this, here's how the webinar's going to work. We will have this discussion for around 45 minutes and wherever you're joining today, you can submit questions for our panelists. If you're watching on live stream, YouTube Live, Facebook Live or Twitch you can send your questions in the comments or chat section and our team will pull them out and send them on to me and then I will be able to present those to our panel.

We're going to prioritize questions directly related to this discussion. So, it's not for medical advice specifically for you, but on this question of getting vaccines to everyone who really needs them. We also have live captions for this event, so you can view them on a separate URL, or you can watch on YouTube where you can click on that, that says CC, to catch the live captioning going on and thank you to those working on that. We'll add the links to both of those in the chat so that you have those available.

Joining us today is Dr. Torian Easterling, First Deputy Commissioner and Chief Equity Officer at the New York City Department of Health and Mental Hygiene. Welcome to you Torian. Good to have you with us.

Dr. Torian Easterling:

Thank you for having me.

Avril Benoît:

Also joining us today, Carla Sofía González. She is a nurse and co-founder of Puerto Rico Salud, MSF's partner organization in Puerto Rico responding to inequities in vaccine access. Good to see you, Carla.

Carla Sofía González:

Good morning. Nice to see you and be with you today.

Avril Benoît:

And Dr. Kerry Dierberg, project coordinator for MSF's COVID-19 Operations in Brooklyn, in New York City. And in this role, she's leading a team responding to inequitable access to COVID-19 vaccines in coordination with MSF's local partner, the BMS Family Health and Wellness Center. Kerry, how are you doing today?

Dr. Kerry Dierberg:

Hi, everyone. Good to be here.

Avril Benoît:

And I was with Kerry just yesterday, helping to get the site set up for this completely new offering, just to be able to scale up access to vaccines. And we're going to hear a little bit more about that in a moment. But I thought I could start with you, Dr. Easterling. New York was one of the early epicenters for COVID-19 in the US and we all understand at this point that we need to get shots in the arms as quickly as possible to avoid another year like 2020. And we still have pretty high rates of transmission in New York, high rates of hospitalizations. We want to also really focus on this equity issue. How are you and your team working on this vaccination distribution plan for such a large city?

Dr. Torian Easterling:

Well, thank you so much for the question, Avril. And thank you to MSF for hosting this really important discussion and for having me and this esteemed panel. We're approaching, as we have done with our COVID transmission response, to make sure that we're keeping equity front and center. The conditions that we know have existed BC, Before COVID, continue to exist and will exist even after this pandemic. And so, one, we have to acknowledge the historical and the contemporary injustices, particularly around healthcare access, but we know that it's much larger. There are the social and economic disability that have existed and leading to a lot of the inequities that we see. So we have to continue to acknowledge it, keeping it front and center in our discussions and embedding it into our planning.

We've developed an equity action plan for our overall COVID response, and we're still moving forward with our COVID response because we do have variants of concerns and variants of interests that are circulating in the community. More than 70% of the cases that we're seeing in New York City are variants. So not the classic COVID virus, SARS CoV-2. So we have to keep our foot on the pedal with our prevention strategies and our testing, keeping our testing equitable, and we do have a citywide strategy of bringing testing resources into neighborhoods.

But as you mentioned, you need an equity plan around our vaccine rollout. So that's thinking about how we're allocating supply, where those supply are being matched up in neighborhoods, how we're thinking about eligibility? Even as the governor is expanding eligibility, we need to keep our eye on the priority groups. Those who continue to be most at risk of severe illness for COVID-19. So certainly are elderly, thinking of underlying chronic conditions.

But because of structural racism, we know that there needs to be race-explicit strategies that are really making sure that we're thinking about communities of color and how they've been disproportionately impacted. So really, all in all, we have to just keep our eye on all the different ways that we can get vaccines into communities and support informed decisions.

Avril Benoît:

One of the ways that we in the public can see who's been vaccinated and not is by zip code. And according to different neighborhoods across New York City, we see that there are certain neighborhoods where there seems to be very high levels of vaccination and other neighborhoods much less so. Can you describe that for those who are outside of New York and maybe not following this kind of issue on a daily basis in the local media? What do you see when you look at that zip code map, or the distribution, and what is that telling you, what are those numbers telling you about inequity?

Dr. Torian Easterling:

Well, it's telling us what we've always known. I think listeners are really hearing your question clearly and the response that we've known that these inequities exist. And, folks who've been doing this work, activists and advocates, have been calling up for government to really respond in closing the gap in birth inequities and chronic disease and in housing and stability and food sovereignty. So, these are the same neighborhoods that when you look at health outcomes, economic outcomes, educational outcomes and any other outcomes, these are the neighborhoods that are not invested, have been disinvested for a very long time.

One of the things that we've done is look at... Very similar to the CDC Social Vulnerability Index, make it very clear that we know that there are factors that have led to higher rates of COVID-19. So, your health status, you also have to think about things around poverty, thinking about housing status as well, occupation status. And when we match up those metrics, the neighborhoods that we've known and we've seen to have poor health outcomes are also the same neighborhoods that have been disproportionately impacted by COVID-19 in New York City. South Bronx, North and Central Brooklyn, Northern Manhattan, Lower East Side, because you do have a cluster of Asian-American population that you really have to engage, southeast Queens and certainly parts of Northern Staten Island. So we know where we have to go, it's what we have to do to respond to close the gap.

Avril Benoît:

Well, let's swing over to one neighborhood. Kerry Dierberg, describe to us why MSF or Doctors Without Borders is working in that part of Brooklyn right now.                                                                     

Dr. Kerry Dierberg:

Sure. So BMS or the Brownsville Family Health Center essentially provides primary and preventative health care to the Brownsville and East New York community. This is a federally qualified health center that provides this care regardless of an individual's ability to pay for that care. The neighborhoods in Brownsville and East New York have high poverty rates, some of the highest in the New York City metropolitan area. They have very high rates of chronic disease, such as cardiovascular disease, diabetes, obesity. That also contributed to them to having very high rates of COVID and high rates of mortality from COVID-19 over the past year. Even now they continued to have test positivity rates that are substantially higher than we're seeing on average across New York City. So this community has been historically underserved. BMS is here for that reason and has been here for many decades to try to provide and bridge some of that gap.

So in that context, MSF supported BMS last year with getting COVID testing up and running, particularly when we were at the height of our first wave here in New York City last spring and early summer. So as BMS has been trying to do vaccination over the last couple of months, they've been very limited by staffing and space and other resources they need to really provide the access they want to this community where there has been very limited vaccination availability to the population. So MSF is supporting with helping them with the logistics of both the vaccination at their current clinic sites and then to be able to expand with some additional resources in vaccine that they've gotten here in New York City.

Avril Benoît:

One of the things that seems so surprising is that, we've had vaccination sites in other parts of New York City for a couple of months now. What is the reason that it hasn't scaled up in neighborhoods like East New York and Brownsville until now?

Dr. Kerry Dierberg:

I think part of it was really ramping up some of the funding and the ability to ensure some of the vaccine supply, which I think we've experienced all over the city. I think there has been a much more limited capacity to be able to deliver vaccine. Also, there has been inadequacy in terms of space and staffing even to be able to administer at really high rates within the current FQHCs, such as BMS, in terms of what they have. So they have been providing vaccine since early January, but have been really limited in terms of their capacity to scale that up.

Avril Benoit:

Well, I'm glad we're able to help. Obviously, there's plenty of work to be done all over the city, but in this short little assistance that we're providing I'm really appreciative for all the collaboration that we've got there and that you can be there to help out as well. Let's shift over to Puerto Rico, now. Carla, you have been working there for quite a long time, but you only just started your organization, Puerto Rico Salud, recently. Can you tell us about your organization and what you're focused on right now?

Carla Sofía González:

Well, Puerto Rico Salud started after departure of Medicos Sin Frontera, MSF. MSF came to Puerto Rico to help our communities to help after Maria after the earthquake. And then we came in the COVID, and we came here to monitor everything of the COVID and I started working with MSF. And after that they approached to us, they will help us to keep our mission. Our mission really important, in Puerto Rico Salud it can go to communities that no one else can impact. It's really hard for our communities in Puerto Rico. We are an island, we’re really small but there are some places, that is really hard for us to get there. So that's our mission for Puerto Rico Salud we are going to communities and we're taking the vaccination to the community as well as when MSF came to Puerto Rico, they helped with the COVID monitoring and they came here to help with everything during the COVID pandemic time. So now they came here and they are supporting us to help us with those communities and get the vaccine to the people.

Here in Puerto Rico it's really hard to get vaccination, it depends on where you live, or what town do you live and there, there are not a lot of places doing vaccinations. The health departments are doing vaccinations. Yesterday we have more than one day we did more than 10,000 people, the health department here in Puerto Rico. So the vaccination is coming along really good here. We already have vaccinated more than 1 million of people in Puerto Rico. So that's a lot for us. But the only thing that we're struggling right now is the phases. A lot of people think that, they have to open all ages, there is a lot of talk. Because there's older people, there's a lot of people that doesn't want to get vaccinated, but then, there is a lot of young people or professional people that they want to get vaccinated. So that's the deal that we're, struggling right now, we just have to face it, we have to do it by phases. Because the government is the ones that looking for us. So that's one of the struggles that we're having right now, but Puerto Rico Salud their mission is, MSF is to go to communities, that is really hard for those people to get help, medical help, or any help that we can go in and give to them. That's where Puerto Rico Salud is right now.

Avril Benoît:

Here. I was talking on mute. I should be the last person to make that mistake, so we've got questions already coming in from our live audience right now. And also some that came in, through the registration that people had done ahead of time. And while I've got you here Carla, just talking about this. One of the questions that came in ahead of time from Julie was how does Doctors Without Borders, and in this case also, your organization Puerto Rico Salud, get the vaccines to people far away from big city vaccination sites, cause your also trying to reach those that are further out aren't you?

Carla Sofía González:

Yes. The mission from MSF came, this time again to help us. We get the vaccination, it's a collaboration with other identities like the Nursing School of Puerto Rico and the health department. They are the ones that are giving us the vaccinations then we have to team up with Puerto Rico Salud. And we got to do in the morning, we have other towns we're going to impact. We have our leader of the communities, community leader and we have, we made our own center. That in during the morning they leave, they go to that town, vaccinate there people, they vaccinate their care giver, they vaccinate everyone in that town so we can start protecting small towns by small towns, and then the spreads going to be lowering. This week Puerto Rico has been increasing the COVID, COVID statistics have been really high, so that's one of the things we, why we start doing next Monday. We're going to start vaccinating more than 300 to 500 persons daily in the different communities, so we can start small towns but making an impact and decreasing the COVID.

Avril Benoît:

Well, I really wish you well, that's an ambitious plan. It's a lot to try to get done. All right. So let's go to some of the questions that have come in from our audience, watching the webcast live. A question from Ruby on live stream. Does the US's population population-based allocation further inequity. So why didn't places with more deaths just get more vaccine and why shouldn't places with more transmission rates, right now be allocated more vaccine just like that. Torian Easterling. Why is that happening?

Dr. Torian Easterling:

Well, we knew very early on, based on a CDC guidance, the populations are going to be prioritized in the US, and I think the larger point based on the first question is how are we sort of thinking about other countries and making sure that they're getting backstage and they get the resources. And I think that is an appropriate questions. A I think we're going to have to address this question really, because this is a global pandemic and we want to end this pandemic. It's really about how we're vaccinating, getting to herd immunity across the world and really slowing down the spread. Because we do not want variants to continue to mutate, and so I think it's really an appropriate question. And really does think about, what, what additional steps need to happen to really resource other territories and other countries as well?

Certainly in, in New York City, as we've been thinking about allocation, prioritizing communities with, who've been disproportionately impacted by COVID-19 has been part of our strategy. I talked about CDC, so vulnerability index using that as a guide, we developed a methodology and we looked at those neighborhoods that have been disproportionately impacted and really directing our resources, the limited supply that we've had since December into those neighborhoods. And so even when you look at the map and we've grown our sites over time incrementally, you'll see that majority of those sites are in neighborhoods that have been disproportionately impacted and had high COVID cases and deaths.

Avril Benoît:

Is that something that's happening across the U S that you've got that, that kind of laser focus?

Dr. Torian Easterling:

Yeah, we've certainly seen this in other States as well. We know that Vermont has been leading with this approach as well, looking, using the CDC social vulnerability index. We've seen this in DC. We've seen this in Boston seeing this in San Francisco as well. And I think, matching up the intentions, right? Who needs to get vaccinated with the supply because certainly across each state supply has looked differently. And in governors and, and local municipalities have had to advocate for more supply so that we can match up sort of the population that we know are in those areas that have been disproportionately impacted. So, that rollout has been different in how those States have expanded their eligibility has also played into a count as well. So it's been supply, but there's also been eligibility, as we've been thinking about how, how you can really get to the root of, these structural inequities as well.

Avril Benoît:

Yeah. It's a question that's also coming up from Carly on live stream from a public health perspective, we just don't have the infrastructure resources to prioritize populations that need vaccines the most. How can we plan for better resource distribution in the future? Carla, would you like to tackle this one?

Carla Sofía González:

I think that, that's one of our things that we’re doing, we’re taking the vaccination where it’s needed. It's not an easy plan, it means a lot of logistics. We start next week, we have to have our community leaders and other communities know where the people live, then know when there's going to be at home. It's really logistics thing, maybe I don't know in the States its more difficult here Puerto Rico, we can do small groups, we have six nurses, we divide to teams of three, and then we leave every morning, but I don't anyone doing it on this scale, it's going to be helpful doing it in small. But that's why, when you're a foundation, a lot of people doing the same project a lot of organizations doing the same thing, then we can impact a lot of people so, for me it's a lot of logistics.

The community has to do their part also, their leader of community, we started to tell everyone that we were going to start our project, so community leaders started to get to me, so it's two part, of people who need to be on the part to get the community vaccinated, so for us. It can be done, it can happen, we're going to be doing on the communities also so. It can be done but it's a lot of logistic and effort. A lot of organizations that are together, that's why we thank a lot MSF for giving us the opportunity to make this, project here in Puerto Rico because there is not a lot of people making them and we really need it.

There are a lot of accessible places to go here in Puerto Rico, we have Walgreens we have CVS, we have a lot of places around the city. So a lot of people that want to get vaccinated they have access. But there are a lot of people that want to get vaccinated and then they'll have access.                                      

So it's really important to the government to take action but after the government, our organization and different communities, Puerto Rico Salud started from COVID-19, we professionals working on hospitals, we were professionals working on other places and we decide that this is the moment. Sorry. We decided this is the moment that we have to make a change, that this is more than 100 million of people having COVID in the whole world, so it’s something that we have to take action. So, my answer on that question is that, it can be done but it needs a lot of effort from organizations from the same from health care givers. Because here in Puerto Rico a lot of the vaccinations, have to be, you have to be a volunteer. You don't get paid or nothing so the health care giver also wants to help, sometimes we have clinics with 500 and we only have a couple of health care givers, so I think it’s a compromise that has to be done by a lot of people, so we can get this done more quickly and more efficiently.                                                                                                                                

Avril Benoît:

Yeah. Relying on volunteers is a complicated model. We actually have a question here, Kerry, from Kayla, who's watching on live stream and it tends to college in upstate New York. How can university and grad students play their role in helping with the vaccine rollout as well as with Doctors Without Borders, now what are the kinds of things we need and how can, how can somebody help?

Dr. Kerry Dierberg:

I think that's a great question. And one of the things that places like BMS that we're working with or many other health centers have really struggled with is that getting vaccine is only one component of actually getting vaccine to people. And in order to do that and facilitate organization's ability to do that, you need people to help actually get vaccine to people and do all of the administrative and other logistical components of getting a vaccine site set up and making it run smoothly. And so that you can increase the number of people also that you can vaccinate per day. And for example, here in Brownsville and East New York, we have had some volunteers from MSF and, and other volunteers that actually help with some of those administrative roles in the patient flow through clinics, helping people fill out their forms and understand their consent forms, help with translation, if that's needed, particularly for people who are speaking Spanish or many other languages spoken in these communities to really help with the overall functioning of a site and getting a more vaccine to people. And I think that that's a really key place that anyone with any background can support in.

Dr. Torian Easterling:

And I would just add just to Kayla, right now, very soon Kayla is going to be eligible, depending on Kayla's age, but a college student, most likely very soon. And I would ask Kayla to first think about our elderly and see how Kayla can help our elderly get vaccinated. And so if that's someone in your family, someone that is a distant relative, making sure that they get vaccinated. Because quite often, Kayla has, to Kerry's point, has the means to be able to navigate the websites, the call centers, and may have time to really help our senior citizens to do that. And so if our college students can just make that message very clear to their grandparents and to the elders in their family, I think it will go a long way to really make sure that we're prioritizing our seniors.

Avril Benoît:

Yeah. In my neighborhood in the Lower East Side, actually, there are volunteers, just the digital volunteers, helping folks to sign up and refresh, refresh, refresh the browsers so that they can get those appointments. We've received a few questions, not just today, now live, but also the ones that were sent in in advance about something reasons that people choose themselves not to get vaccinated.

So we'll start with this angle, and then we're going to switch over and talk about this notion of the vaccine hesitancy, both for health workers and also for people who are just in the community. But the question here is from Facebook. May is asking, "A lot of people are reporting side effects from the vaccine. Even though people recover within a short period of time, I'm afraid that this news will be keeping people from getting the vaccine. How can we build vaccine confidence to ensure everyone is safe?" And by the way, can I just say, May, I got my second dose today. So far, I don't feel anything, but who knows how the next 24 hours are going to go. Dr. Easterling, what do you tell people when they say, "I'm not so sure about those side effects."

Dr. Torian Easterling:

Yeah. I think we have to more normalize that these questions are okay to ask. And there are going to be so many questions about vaccines, and there are a lot of people who are coming to this conversation for the very first time. They are taking a vaccine for the first time in their adulthood. We know and have heard this, having volunteered at a number of our vaccine sites, interacting with our elders, with New Yorkers across who are coming to the country and been here for 15 years, they're coming get their vaccine for the first time. And quite often what they're saying is, because someone in my family or someone in my neighborhood inspired me, or I've seen them get their vaccine, take both doses that nothing was wrong with them, that was the linchpin that helped them make the decision. And I think that's going to be important.

We have to make sure that someone who you're close to or someone you know relatively well, it's communicated that the vaccines are safe. And yes, you can have some symptoms, and we know these to be true. This is not just limited to COVID-19 vaccines. We know that all vaccines, there is some level of side effects or symptoms that can show up, fever or low-grade fever or a soreness in the injection site, or even feeling body aches and chills, but they go away in one to three days. The good thing is that you're going to feel as though you're protected and you have that immunity against the virus, and that's really important.

Avril Benoît:

Okay. This one's for you, Kerry, from Brynn, wrote in, "What's being done to address culturally specific vaccine hesitancy?"

Dr. Kerry Dierberg:

Well, I think there's a wide array of things that are being done in different communities and different cities. I think there's a huge effort here in New York City to address this, given that we have people from all over the world with multiple backgrounds speaking multiple different languages. I think that one, it's important to ensure that we are getting education and awareness, other sensitization activities out there in the channels that people are looking for information in. Not everybody's going to the CDC website to get news or to the New York Times. So to get information about vaccine and why it's important and how you can access it in some of the local media channels or on social media and utilizing the networks of community-based organizations, faith-based organizations that have also built trust within the community and that may get at some of the more culturally specific questions and concerns around vaccination.

And then I think there's the language component as well. We are making sure that not all of the information we put out isn't just in English or just even in English and Spanish, given the wide array of places that people are from and languages spoken in this area. And so BMS is a great example of really trying to use its networks within the Brownsville and East New York communities through other community-based organizations locally, through their network, within their patient population, as well as a lot of the faith-based organizations around these communities that they're very closely linked with and have been for many decades.

Avril Benoît:

Your answer, I think, also speaks to Molly's question on the live stream about organizations engaging local community members and community leaders in the vaccination efforts. But can we go back to all this talk about vaccine hesitancy among racialized groups, communities that are Black and Brown identified? And this has received a fair amount of attention. And on the other side, I hear you speaking of the lack of services and just some basic fundamentals that have been slow to get into those communities. Kerry, I mean, is there something to it in terms of this vaccine hesitancy and like, oh, well they're just wary?

Dr. Kerry Dierberg:

I think we have vaccine hesitancy amongst every group of people, however you want to group them, in the United States and elsewhere. I have fellow healthcare workers that I work with in other settings that have not been vaccinated and have concerns about vaccine. I have friends who are vaccine hesitant or have just questions about vaccine and aren't quite sure that they're ready to get the vaccine.

I do think that it's been in the media a lot that there is a higher rates of vaccine hesitancy amongst the Black and Brown communities. I do think that there's a component of that that's contributing towards the lower vaccination rates that we're seeing in some of these communities. But I don't think that that's the only answer. And I think to your question, which is that it's also about ensuring that people are getting the education in the ways or the information they need to make an informed decision through the channels that are they most trust and that they most access and ensuring that they have someone that they trust in to ask questions and build that confidence that they can see more and more of their community members getting vaccinated and help building that confidence. And I think that that is definitely a component here in the East New York and Brownsville communities, for example.

And then I think there's that other aspect of, it's not just that I don't want to get a vaccine or that I don't know about the vaccine, it's that the practicalities of getting to that vaccine are just something that are a huge challenge for me, whether it's that the vaccine site is not close enough to my home, or it's only open during the hours that I have to be at work and I can't afford to take a day off of work or a lot of the appointment scheduling that's happening here is all online, for example. And so if I don't have access to the internet or I don't have a smartphone to be able to easily access all of that information and registering on sites and being online all day waiting for the next appointment, that really impedes your ability to access even the appointments that are available. And so I think we have to overcome a lot of those challenges as well for some of these communities in order to be able to make vaccine available.

Avril Benoît:

And Torian, I think we've also seen that opinions have shifted since the very beginning, haven't they? The latest nationwide poll that I read had, in fact, other groups, it was white conservative males and evangelicals were more likely to be vaccine hesitant right now at this point in the vaccination efforts. And so things are definitely shifting. What are you seeing on this issue? And how do you address those who say, "It's all a question of vaccine hesitance."

Dr. Torian Easterling:

Yeah, no, I mean, I so appreciate the Kerry's comments because I do think what I understand and how I've been reading the situation is that people, they have hope and they want to get out of this pandemic. And having hope is trying to fully understand what's the best path to get out of this pandemic, but also keep myself safe. And so we always knew that there were these three categories. There were people who were just ready, they were primed, and as soon as vaccine were available, that they were going to step in line. Then you have a very large contingency of individuals who are just watchful waiting. And particularly, this is where you find particularly black and brown communities, because information has been not always direct and not always factual. And we also know that anti-vax organizations have targeted communities of color for intentions of really trying to confuse people.

And yes, I think that there's this third category of individuals who truly are saying, "I'm not going to get the vaccine." And for political reasons, very politicize how things would just unfolded with this vaccine rollout, we are seeing that they're particularly more Republican and they're leaning more toward white males. And so we need to really unpack why folks are watchful and why they're waiting for a vaccine. And it's not only just thinking about historical issues, but contemporary issues. A year ago, we saw how allocation was happening and ventilators in the healthcare system and decisions being made in the emergency room. And so the questions that nurses are asking is, "Why do you care about me now in March 2021? What happened in March 2020 when I was looking for PPE?" And so we have to be able to respond that there were mistakes that were made.

There were decisions that were made. There were allocation decisions that necessarily did not fall in your favor. And then also be able to hold the truth that right now, we still want to make sure that you're vaccinated and you're safe and your families are safe. And so we have to have a really honest and transparent conversations that yes, there is truth about the past and what happened last year. But here's another conversation that we can also move forward with. And so it was not actually denying, but also just trying to find a path forward as well.

Avril Benoît:

Carla, one of the questions that we received ahead of time was from Robert asking how best to overcome vaccine hesitancy on the part of health workers. Can you speak to this? Is that something that you've seen in Puerto Rico and how have you managed to overcome it? I'm not hearing you, there seems to be a sound problem. Okay. So while you get yourself set up, Carla, don't worry it. Work on your mic issue. And maybe Torian Easterling, you can speak to this as well because you have the bigger picture of how this has affected health workers. Because that is baffling, especially honestly, those who work in the long-term care facilities, that they should be hesitant themselves just guts the families whose loved ones are in those facilities.

Dr. Torian Easterling:

Yeah, certainly, but because of our work around vaccines at the New City Health Department, this isn't all surprising because every year we're doing our flu vaccine campaign and certainly we've seen the work that we need to do to build vaccine confidence just around the flu vaccine. We've had the most successful flu vaccine campaign in 2020, largely because we were in the middle of the pandemic. And so still, certainly in our healthcare workers, there were questions or concerns that were raised. And so we anticipated, even though our healthcare workers were going to be prioritized first in phase 1A, we anticipated that there was still going to be a lot of work that needed to be done around building vaccine confidence. And so there's still this question around, why are you prioritizing me? Why am I the first in line?

And being able to answer those questions, are the vaccines safe? Are they effective? Are they going to keep our family safe? And so I think those are a lot of the questions that we've had to address. When you unpack and really look at the roles, so physicians and you have to think about nurses, and then you have to think about the physician assistants and your techs, and then also custodian staff, you certainly see differences in who is accepting of the vaccine. And it really speaks to the work that needs to be done to really support conversations and build that confidence. And certainly, we see it, it's different by race and ethnicity, and then also it's different by staff, who's accepting of the vaccine and when.

Avril Benoît:

We're just trying to get Carla back up. She's trying different techniques so that we can hear her again. Another one for you then, Kerry, is from Debbie on live stream. Let's talk a little bit about people who are homeless, who are living in shelters perhaps, living in precarious housing and what have you, what's being done to ensure that they receive the vaccine?

Dr. Kerry Dierberg:

Sure. I can try. I think Dr. Easterling will probably have something to add here, but there people who are in the prison system, who are living within shelters, in other congregate settings, puts people at higher risk for COVID-19 because of the nature of the way people are living and in close proximity to one another. So this has been a group of people that have been prioritized for vaccination and a lot of effort happening to try to bring vaccine closer to those settings so that people can access and not needing to kind of get out to a separate site to get a vaccine. And I know that that's happening, say, at Rikers here in the New York City area, as well as several homeless shelters around the metropolitan area also.

Dr. Torian Easterling:

Yeah, yeah. We're trying to use the Johnson & Johnson doses in an intentional way, so not only our home bound individuals, but also thinking about individuals who are unhoused and really doing outreach and engagement. And there still needs to be a conversation. We're not just saying, oh, because you're an unhoused and you have to take this vaccine. There has to be a decision that's made and certainly that that power of authority is really on the individual to say whether or not they want that vaccine. And then working with our colleagues at the Department of Homeless Services, really engaging in all of our congregate settings. So as Kerry has mentioned, we do have dedicated sites now that we've been working at to really engage individuals who are unsafely housed and making sure that they have access to appointments. And we've been working closely with our colleagues at New York City Health and Hospitals. We have both worked with Department of Corrections and making sure that individuals who are currently incarcerated are being supported with conversations and then getting vaccinated. First starting with individuals with underlying chronic conditions and then being able to engage others.

Avril Benoît:

Well, I can bring my last couple of questions to you, Carla González in Puerto Rico.                                                                                  

Carla Sofía González:

Hi.

Avril Benoît:

On this question about-

Carla Sofía González:

Sorry.

Avril Benoît:

Yeah. No, quite okay. We're actually almost at time, but tell us about the challenges you have, Puerto Rico Salud to reach the homeless. And also if you could speak to the hope of the Johnson & Johnson single dose kind of facts here.

Carla Sofía González:

Okay. I'm going to talk a little bit about the hesitation here with the health worker. It's been a really good impact. They've been really pro-vaccination. So we have not been having a lot of problem with that community. There's a lot of people that want to get vaccinated in Puerto Rico, but there's also some people that do not want to get vaccinated, but we can divide them on different communities because on one community, you can find both things that they want to get vaccinated or not. I can even more younger the person, maybe there are a lot of hesitation, but we say that it's a lot of bad information that they're receiving, it's not good education. So that's one of our things that we're doing a lot of our social media, it's a lot of education. Yes, there are some side effects, but it's normal. It's your body working with the vaccination.

So for us, that's why we tell every person that we are doing the vaccination, we tell them if you feel the symptoms, that is normal, I've had my two doses and I did have some symptoms. So I tell them it's normal because it's your body responding to something. So for me, and I know for a lot of people, it's a lot better than having the disease, right? So the hesitation here in Puerto Rico for, for us, it's more of education. Those people that don't get the right education, but a lot of people get fake news, a lot of fake information is happening here in Puerto Rico, but once they start getting information, I know a lot of people change their minds. So that's one of the things that I want to talk about it. The Johnson & Johnson dose is really important for us as it is our organization because we don't have to program two times on the site.

It's been really difficult. The last week, we have been doing some of the specific communities, but with Moderna, and it's really hard for us making a second approach to the community. So for us, it's really, really important to the health department gets partnered with us and help us to get the Johnson & Johnson does because if we just go and make the vaccination, one dose, and we call the patient, we're calling them two weeks after to see how are they and how everything has gone. So we're doing that on follow-up. Homeless people, here in Puerto Rico, there are a lot of organizations that work with homeless people.

So we have been able to talk to those organizations and we already have made alliances. So we're going to be on April, we're going to be impacting more than 1,000 homeless people in Puerto Rico with the vaccination. So we're really on a good track with that kind of community. Once again, Puerto Rico Salud, our statement or what I every day say, we're going to go where no one else will go. So there's a lot of sites that people can go. I don't want that community. I want the communities that they want to get vaccinated while they are not able to get it. So that's where Puerto Rico Salud comes and thanks to MSF, we're going to do that impact.                                                         

Avril Benoît:

Well, we're really happy that you're there to do this work and support you 100%. And Kerry Dierberg, also happy that you're able to work in Brooklyn and East New York to support the BMS health center to be able to also scale up and accelerate the vaccination efforts. And Torian Easterling, really good luck to you. You've got a massive job and we're counting on you and other officials in the public health sector to be able to facilitate pulling us through this. Thank you all for joining us today. I really appreciate your time.

Dr. Torian Easterling:

Thank you for having us.

Carla Sofía González:

Thank you for having us.

Avril Benoît:

Torian Easterling, New York City Department of Health and Mental Hygiene, Carla Sofía González from Puerto Rico Salud, and Dr. Kerry Dierberg from Doctors Without Borders, our project coordinator in New York for a fascinating conversation. Thanks so much again. And our next webinar in this series is going to be live on Thursday, April 29th, when we'll tackle the global equitable access to COVID-19 vaccines. Another major topic for us here at Doctors Without Borders. So thanks again, apologies if we didn't get a chance to get to your questions, but there were a lot of terrific ones coming in and you can email us for any further follow-up. Love to hear from you. Our email address is [email protected]. You can also visit our website. In the US, it's doctorswithoutborders.org and our international website is msf.org. Look out for us on Facebook, Twitter, Instagram, and beyond. I'm Avril Benoît signing off from New York City. Bye for now.