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As booster shots lag, community groups get creative in closing vaccination gaps

Chinomnso Okorie packs up the leftover COVID-19 testing kits and other medical supplies in front of the Bayview Safe Sleeping village, where Bay Area Umoja Health had a pop-up to help vaccinate and boost underserved populations, on Wednesday, May 11, 2022. | Camille Cohen

As San Francisco heads into yet another wave of the pandemic driven in part by a new strain of the virus, community groups are redoubling their efforts to administer booster shots, one of the most critical steps experts say the public can take to protect themselves from serious illness.

Around 84% of San Francisco residents have completed their first series of Covid vaccinations, compared to 67% of Americans and 72% of Californians, a testament to the work done by the city’s public health officials and community groups. 

But while the initial series of vaccinations saw more than 70% adoption across all racial and ethnic groups as recorded by the city, the percentage of residents who have chosen to get a booster shot has seen a significant divergence along racial lines. 

The number of vaccinated residents in San Francisco is currently at 72%. White and Asian residents both saw booster adoption rates of 77%, but booster adoption for Black and Latino residents currently sits at 61% and 58%, respectively. 

Case in point, Bayview Hunters Point had among the highest levels of initial vaccine adoption of any neighborhood in the city, thanks in part to the efforts of community groups like the Rafiki Coalition, a San Francisco health equity nonprofit. But when measured by the percentage of vaccinated residents who received a booster dose, the neighborhood ranked near the bottom of the list. 

Two years of the pandemic and conflicting statements from public health officials, vacillating policies around the pandemic and initial messaging that vaccines could prevent infection rather than serious illness and death have all contributed to that split, according to Monique LaSerre, the executive director of the Rafiki Coalition. 

“I think it’s due directly to the mixed messages, it’s very hard to discern what’s the right thing to do and what’s the smokescreen from what’s really going on,” LaSerre said. “We have dramatically changed our messaging to be as specific as we can about what’s going on and what we know at the time.”

Part of the problem could be the issue of Covid fatigue or a case of wishful thinking that could leave those most at risk behind. 

Dr. Rhoads packs up leftover booster shots, which will be thrown away after her team didn’t find enough people who wanted to be boosted against the COVID-19 virus in front of the Bayview Safe Sleeping village on Wednesday, May 11, 2022. | Camille Cohen

A recent SF Standard poll found that a majority of the city’s voters said they are returning to their life prior to the pandemic. However, when looking at respondents who were 65 years and older—a group at high risk for the pandemic—57% said they are either very concerned or still concerned about the pandemic and limiting activities as a result. 

LaSerre said the drive to move past the pandemic has meant less focus and funding for the pandemic response at both the local and federal levels. The Biden Administration’s request for additional Covid funding has stalled in Congress, leading to some concerns about vaccine availability if a pandemic wave continues and additional booster shots are needed.

“What I’m concerned about is that recent developments have all been about getting back to business, rather than treating the most vulnerable,” LaSerre said.

In terms of the science, the benefits of a booster dose are clear. A study published last December in the New England Journal of Medicine found that participants who received a booster at least 5 months after a second dose of the Pfizer vaccine had a 90% lower mortality due to Covid than participants who did not receive a booster.

Peter Chin-Hong, an infectious disease expert at UCSF, said a booster shot functions as a “reminder” for an immune system that has been primed by the first series of vaccines, which leads to longer lasting protection. 

He believes that part of the confusion about the utility of boosters may be related to roll out of additional boosters to the public, which can call into question the long-term efficacy of the vaccines.  

San Francisco’s Department of Public Health touted its relative success in its vaccination drive, while acknowledging “disparities on booster rates by race/ethnicity.” DPH said it will continue to work with community partners and rely on tactics like mobile vaccination teams and school-based vaccination sites to close those gaps.

“We are confident that with similar low-barrier approaches and engagement strategies we will continue to improve vaccine uptake in many of those same communities,” the department said in a statement. 

Still, booster adoption has continued to level off in San Francisco, leading community health leaders to weigh novel approaches to reduce the disparities. Booster adoption in the city is directly correlated with the age of residents, and community groups are thinking of ways to engage younger San Franciscans in the public health effort. 

LaSerre said using social media to spread public health messaging to younger populations is a key focus of her strategy around boosters. That fits in with Rafiki’s efforts to combat myths and misinformation about the pandemic, which have spread quickly on social media platforms.

One new tactic that LaSerre said Rafiki plans to roll out in the summer is incentivizing vaccination through community services like haircuts, gift cards or even direct cash payments. Although that comes with its own ethical qualms, she said the benefits of protecting the community outweigh the risks. 

“That sounds really unfortunate, but I’ve seen it be effective in New York and other places,” LaSerre said. “Frankly I’m more scared about the impacts of Covid and long Covid than I am about the moral issue of paying people for their bodies at this point.”

Fabian Avila, the Covid health coordinator for the Instituto Familiar de la Raza, a health nonprofit focused on supporting the health of the Latino and indigenous communities, said they have tried to tailor messages toward youth who can act as ambassadors to the rest of their families about the importance of protective measures. 

“With our generational differences, we try to motivate the youth to be the leaders within their families or within their own communities to advocate for those family members who are vaccine hesitant,” Avila said.

The Instituto Familiar de la Raza also has looked at how to incorporate wellness incentives for vaccinations, like free massages for community members who have received a shot.

A woman grabs a snack from Bay Area Umoja Health's pop-up on Wednesday, May 11, 2022. | Camille Cohen

John Swartzberg, an infectious disease expert at UC Berkeley, echoed the point that the initial booster is the most critical for protection from serious illness and deaths, but said there’s a limit to the current approach of continuing to roll out additional booster shots.

“All these boosters are doing is trying to keep people healthy and alive until we can get something better. This is not a sustainable solution,” Swartzberg said. 

While updated vaccines keyed to the Omicron variant are likely to be released in the coming months, Swartzberg is optimistic for an even more comprehensive solution.

He believes a pan-coronavirus vaccine could be developed in the near future that would be able to work against both current and future variants of Covid, along with other coronaviruses like those causing MERS, SARS and the common cold. 

This theoretical vaccine could work by impacting both the spike protein used as a target in the current Covid vaccines, as well as additional parts of the virus.

“We’ve learned so much in the last two years about how to neutralize coronaviruses, we’re at the cusp of having something like this,” Swartzberg said. “It will take robust investing, but it will pay tremendous dividends. It would be a wonderful world to live in where coronaviruses don’t pose a significant problem anymore.”

Kevin Truong can be reached at