No, the Unvaccinated Aren’t Just Being Difficult

On a July day in downtown Lowell, Mass., the first sunny Saturday of the month, people began to line up for a block party. Food trucks offered everyone a free empanada or egg roll. A D.J. played music. There were kid-friendly activities, too, like a touch-a-truck station with a fire truck and an ambulance.

The party wasn’t just a way to have a good time. The real motivation was to get people in the community vaccinated against Covid-19. Nestled between the food trucks were ones offering Pfizer, Moderna and Johnson & Johnson vaccines.

In the minds of the public health and community organizers who staged it, it was a roaring success. Sixty-four people got vaccinated within six hours. Hannah Tello, a community health data manager at the nonprofit Greater Lowell Health Alliance, noted that it was eight to 10 times as many vaccinations as what their mobile clinics had been doing; their most successful day before this administered 12.

The people who got shots at the party “were not people who were resistant,” Dr. Tello told me. Outreach workers went to a nearby park and invited the homeless people there to get free food and, if they wanted, a vaccination, and many took them up on the offer in such a low-stakes, nonmedical setting.

The party organizers also reached about 250 other attendees, many of whom had conversations about their concerns. Some were worried that the vaccines cost money, even though they’re free to all. They were concerned they would need some sort of documentation, which they don’t. One woman hadn’t gotten the shot yet because she has an intense fear of needles; she did it that day after 25 minutes of talking it through. “Her getting her shot is just as important as the people who lined up outside our clinics a few months ago,” Dr. Tello said. “No one is less deserving of having access.”

The country’s vaccination campaign has lagged since April, and that has allowed for a spike in cases, particularly in largely unvaccinated areas. Vaccinations have risen lately in response to the spread of the Delta variant, but rather than keeping its foot on the gas and throwing every idea, every resource at the problem, the White House has started to shift the blame onto those who still haven’t gotten a shot. President Biden grumbled that he has struck a “brick wall” in persuading more Americans to get the shot. Last week, taking aim at those he called “unvaccinated, unbothered and unconvinced,” he said, “If you’re out there unvaccinated, you don’t have to die. Read the news.”

There are plenty of Americans who have been inundated with misinformation about the vaccines. Many are staunchly opposed to getting it for a variety of reasons, from personal health concerns to conspiracy theories. But that doesn’t describe everyone who is unvaccinated — not by a long shot. And there are plenty of things we can do to reach them if we’re serious about spending the time and the money.

Instead, the current approach is to argue that access has increased and it’s everyone’s individual responsibility to get a shot — and if you don’t, it’s on you. Once again, we have taken the cruelly American, ruggedly individualistic tactic of making this about personal responsibility, not about a systemic response, just as we did in combating the virus itself.

“It’s not a public health strategy for any condition to just blame somebody into treatment and prevention,” said Rhea Boyd, a pediatrician and public health advocate. Telling the unvaccinated that they’re being selfish “really runs counter to all the work it’s going to take to convince those folks to be vaccinated, to trust us that we have their best interests in mind.”

It’s also shortsighted. If some people continue to struggle with getting vaccinated, the virus will continue to run rampant, threatening a rebound in economic activity and giving the coronavirus a chance to mutate yet again. The refrain we’ve heard throughout is still true: We’re not safe until we’re all safe.

Those who aren’t yet vaccinated are much more likely to be food insecure, have children at home and earn little. About three-quarters of unvaccinated adults live in a household that makes less than $75,000 a year. They are nearly three times as likely as the vaccinated to have had insufficient food recently. Many of them have pressing concerns they can’t just put aside because they need to get a vaccination.

Access is far more widespread than it was at the beginning of the year. Many cities now offer multiple venues for getting it without needing an appointment. But about 10 percent of the eligible population still lives more than a 15-minute drive from a vaccine distribution location. And even if there’s a site down the road, it usually requires taking time off work — not just to get the shot but also potentially to recover from the side effects — arranging transportation and figuring out child care.

“Missing out on a few hours of work seems very easy to us, but in fact it could be the matter of having food for the family versus not,” said Ann Lee, the chief executive of the nonprofit Community Organized Relief Effort. For these people, when they’re weighing whether to get a vaccination or potentially forgo some wages, “the wages are going to win out.”

Those who are unvaccinated are also likely to work in essential jobs like agriculture and manufacturing that don’t allow them to step away from work. They work long hours and may prioritize time with their families or communities when they finally get a break. People who have multiple jobs may find it impossible to schedule a shot in between all of their shifts.

And yet 43 percent of the unvaccinated say they definitely or probably would get it or are unsure, according to Julia Raifman, an assistant professor at the Boston University School of Public Health.

“We pretty quickly exhausted those who were easiest to reach and vaccinate,” Tara Smith, a public health professor at Kent State, told me. “This next phase is more difficult, but I don’t think it’s impossible to continue to get more people vaccinated. We just have to get creative.”

A block party doesn’t work in every community, particularly more rural ones. For those places, an event could be staged at a church or a county fair. Anything that allows people to discuss their concerns with experts and get vaccinated on the spot erases dangerous lag time. Dr. Tello’s organization found that many disappeared in the time between an educational conversation and a vaccination appointment weeks later.

Another way to take the vaccines to people for whom the logistics are complicated is to do it at workplaces. Ms. Lee’s organization held a vaccination drive at a construction site in Washington, D.C., and vaccinated 165 people. “They wanted to get vaccinated. There was just no way some of these day laborers were going to take off of work and maybe get sick,” Ms. Lee said. In January, Riverside, Calif., began a program to take vaccines into the fields to reach agricultural workers.

There are plenty of other smart places to distribute vaccines. Take them to food pantries, where low-income and food-insecure people show up by necessity on a regular basis. Do vaccinations at shopping centers where everyone goes to buy food. Vaccine drives could also be held on the first day of school for parents and older children alike; it’s late in the game, since it takes weeks for full immunity, but it’s better than missing them entirely.

Going door to door can also reach people, particularly those who are homebound. The Central Falls Housing Authority in Rhode Island offered shots to its public housing residents at the end of last year, and by January, 80 percent had been vaccinated. In Los Angeles, Ms. Lee’s team contacts the homebound first to talk through any concerns and again a week later to administer a vaccine. Vaccines could even be paired with Meals on Wheels deliveries.

To address transportation issues, the White House collaborated with Uber and Lyft to give free rides up to $25 to and from vaccination sites. But those companies don’t operate in every community, particularly outside cities. The government could also give grants to community organizations that can give people free rides to vaccination sites. “If you have a bus at a church, you can get a grant,” Dr. Boyd suggested.

We have to mandate paid leave so workers can take at least two days to get a shot and recover without jeopardizing their incomes. The Biden administration has offered tax credits to employers with fewer than 500 employees to cover the cost of offering paid leave for getting vaccinated, which he expanded this month. Some states, including New York, have mandated it. But everywhere else, it’s up to an employer to offer it, and if existing paid leave benefits are any guide, it’s the lowest-wage workers who are least likely to get it. The Occupational Safety and Health Administration released an emergency temporary standard in June that requires employers to provide paid time off to get vaccinated and recover, but it applies only to health care workers, despite the fact that a draft version included everyone.

Short of that, community organizations can send people home from getting vaccinated with enough food for their families if they have to miss work for a day or two. When Ms. Lee’s organization did testing in the Navajo Nation, it gave people two weeks of food in case they got a positive result and had to quarantine. It’s now sending people home with food as well as diapers, formula and hygiene kits with things like shampoo and tampons.

Parents also need child care — not just for getting their shots but also if they experience side effects. The government is working with four large child care providers to offer free care, but those centers may not be available to everyone, nor will all parents feel comfortable sending their children to an unfamiliar setting. Instead, we could give them money to pay their trusted source of child care and also offer care at vaccination centers.

State and local officials can kick-start some of this on their own. But the real money, and the power to set the agenda, comes from the White House and Congress. “If the federal government said, ‘We are really concerned, we see that low-income people have not had access to the vaccine, and we’re putting forth a huge effort to bring it to them in their workplaces and homes,’” Dr. Raifman said, “that would be a compelling message that would mobilize people across the country.” Federal funding needs to be filtered down to the local level as quickly as possible. There’s a lot of money for vaccinations, but it has to get to the organizations that are deeply embedded in their communities and ready to pull this off.

Dr. Tello’s organization plans to repeat the block party this summer, this time as a back-to-school event, handing out free backpacks and school supplies as well as flu shots alongside the Covid vaccines. And it will be timed so that those who got their first shot of the Moderna or Pfizer vaccine at July’s party can get their second dose on the spot. “Sometimes,” she said, “you have to make it too convenient so that people can’t say no.”