COVID-19 VACCINE COLLABORATION
This month, we continue to highlight how health centers are expanding their capacity and workforce to support sustained efforts to vaccinate as many patients and members of their communities as possible. In this issue we highlight the work of health centers that are:
• Vaccinating the homeless who are traditionally a hard-to-reach population 
• Leveraging partnerships with health systems and trusted community organizations 
• Integrating dental teams into their vaccine efforts
Colorado Coalition for the Homeless’ Multi-Prong Strategy
Is Vaccinating Hundreds in Denver’s Homeless Community
Meeting clients where they are at is an essential strategy used by the Colorado Coalition for the Homeless (the Coalition) to administer the COVID-19 vaccines to its clients. Based in Denver, Colorado, the Coalition takes a comprehensive approach to the causes and consequences of homelessness. This is done by supporting adults and children experiencing or at-risk for homelessness with integrated healthcare, housing, and wrap-around services. 

“We decided to deploy a multi-prong strategy where we can reach folks in various access points - rather than hosting mass vaccination events,” says Joanna Leonard, PharmD, MPH, Director of Pharmacy Services at the Coalition. “It is often difficult to get clients to come to one place.” 

Many of the Coalition’s patient populations face chronic homelessness and suffer from mental health issues, emotional and physical trauma, and serious chronic medical conditions. They distrust the systems of care that support them. Thus, administering the COVID-19 vaccine to this community can require very high touch outreach and meeting them where they are most comfortable.
The Coalition’s multi-point strategy consists of:
• twice-weekly COVID-19 vaccination clinics at their Stout Street Health Center where they administer up to 100 doses per day
• vaccination administration during regularly scheduled patient visits 
• a mobile vaccination team who goes out to vaccinate clients at residential sites or locations where the Coalition provides temporary housing and support services
• running medical clinics in the lobbies of six Denver hotels serving as a protected active sites. These sites offer a safe housing alternative to the city's homeless community in an effort to reduce COVID-19 transmissions.
This multi-prong and high touch vaccination strategy is proving to be very effective and getting hundreds of people who are homeless, or at-risk for homelessness, vaccinated. To date, the Coalition has administered over 700 doses of COVID vaccines to patients. This includes vaccinating 138 patients in protected action sites (30% had received 2 doses and 70% received only 1 dose).
Health System Partnerships

“Don’t be afraid to reach out to your community for help. It is not about who can give the most vaccines. It is not a race. We are all in this together,” advises Ronda Arline, Director of Nursing at Albany Area Primary Health Care (AAPHC), which serves a rural, primarily African American community in South Georgia.

The health center initially administered the vaccine in their clinics but quickly realized that they did not have space to manage their routine clinic care and administer the COVID-19 vaccine. Phoebe Putney Health System, the area’s leading hospital and health care system and long-time AAPHC partner, jumped in to help by donating a large space in a location that was easily accessible to the patient community. The space has become AAPHC’s central mass vaccination site where they are now regularly vaccinating hundreds of community members.

When additional vaccine doses are needed, AAPHC reaches out to Phoebe and local and surrounding county health departments for help with donated vaccines. Everyone responds and shares vaccine when they can. “We are not afraid to get out there and make it known we are willing to do this and ask for help,” added Arline. Their outreach efforts have resulted in vaccinating 8600 people with many more to be vaccinated in the weeks and months ahead.
Trusted Community Partners That Help Build
Vaccine Confidence and Engage Communities

Working with community organizations that are trusted leaders is also invaluable partnership strategy that health centers are employing to support their mass COVID-19 vaccination efforts. They can help to reach deep into communities, particularly marginalized ones, to help build vaccine confidence because they understand the community concerns and hesitations and can talk and relate to them. This is the approach that Appalachian Mountain Community Health Center (AMCHC) is taking to connect with underserved African Americans in Asheville, North Carolina. AMCHC is closely collaborating with Chosen, a local grassroots organization founded by an influential group of Black community leaders living in Asheville. Chosen is committed to proactively solving problems and closing gaps for those in marginalized communities, including the need to get people in this African American community vaccinated against COVID-19.

“We went boots to ground,” explains Reuben Pettiford, AMCHC’s CEO and an active member of Chosen. “We talked, we called… it wasn’t that people weren’t skeptical because some were, it was that they needed somebody they trusted just to talk to them. Once we talked to them, they were more than willing to sign up.”

In addition, Chosen members also volunteer at the vaccination clinics. Not only do they help with a clinic’s operations, but they also serve as a familiar and trusted source of support to community members.

Their efforts have been met with great success. For a vaccination clinic held in February, Chosen helped to quickly sign-up 300 African Americans with many more placed on a waiting list. This partnership model has worked so well that AMCHC is mirroring it within the local Latinx community to educate, build trust, and ultimately get these community members vaccinated.
Expanding Health Centers’ COVID-19 Vaccine Workforce: Spotlight on Dental Teams
With health centers across the country taking an “all-hands-on-deck” approach to administering the COVID-19 vaccine to as many of their patients and communities as possible, dentists and dental teams are being utilized to make these labor-intensive efforts possible. Now, a new federal declaration published March 11 permits licensed dentists and dental students throughout the country to vaccinate the public against COVID-19, regardless of state laws that prevent dentists from doing so.
 
“I love that we have found yet another way we can integrate service lines in FQHC settings, “says Lisa Bozzetti, DDS, Dental Director, Virginia Garcia Memorial Health Center, Hillsboro, Oregon. “At the start of the pandemic, dental was pulled from elective treatment and helped with COVID-19 testing and our pharmacy, so this feels like a natural extension of that.” 
 
Dr. Bozzetti shares that their dental teams have been supporting COVID-19 vaccine administration alongside the medical teams since mid-February. Oregon passed a law in 2019 allowing dentists to administer all vaccines, so Virginia Garcia Memorial Health Center’s dental team actually began their COVID-19 vaccination training in January through a curriculum offered by Oregon Health Sciences University (OHSU).
Dentists administer vaccines, load vaccine syringes, enter patient data into electronic medical records while others on the dental team help with check-in of patients, cleaning rooms, among other vaccine clinic operations. Now, the dental team is regularly reassigned to vaccine clinics allowing the health center to expand capacity to host large vaccination clinics across the organization.  

COVID-19 Vaccine Training for Dental Teams

“Dentists and hygienists are used to giving injections in the mouth while aiming for specific nerves so to give a vaccine is not a large lift,” says Dr. Ethan Kerns, DDS, Chief Dental Officer, Salud Family Health Centers, Fort Lupton, Colorado. “Some training needs to be done, but we are well poised to take on that level of work.”

The Centers for Disease Control and Prevention (CDC) offers several free self-paced modules in one CDC-hosted training course to train dentists and other health care providers how to administer the COVID-19 vaccine and learn about the three vaccines currently available.
 
With each state having its own requirements for COVID-19 vaccination trainings, the American Dental Association has compiled this resource with links to COVID-19 vaccine education trainings from federal and state governments and non-governmental organizations.
COMMUNITY HEALTH CENTERS IN ACTION
What are the important facts to know about the new Johnson & Johnson (J&J) COVID-19 vaccine?
1) The Johnson & Johnson (J&J) COVID-19 vaccine is another important tool in our toolbox to equitably vaccine as many people as possible, as quickly as possible. 
2) All the COVID-19 vaccines, including the new J&J vaccine, have been shown to be highly effective in preventing serious impacts from the virus including hospitalization and deaths. There is not one vaccine that is better than another. 
3) The J&J COVID-19 vaccine was studied in multiple countries including South Africa and Brazil, both places where variants of the virus have emerged.
4) The clinical trials have shown it to be highly effective at keeping people from getting hospitalized and dying. It is 85% effective against severe forms of the disease, which rivals both the Moderna and Pfizer vaccines.
5) The J&J COVID-19 vaccine requires only one shot.
6) The J&J COVID-19 vaccine can be stored in a regular refrigerator for several months.
What should health center providers and leaders say to patients and staff who may request one of the three available vaccines or think one vaccine
is better than another? 

The federal government invested in the development of multiple COVID-19 vaccines with the goal that one or more would be found safe and effective. Widespread use of these vaccines would bring the pandemic to an end. 

All three COVID-19 vaccines now available in the United States have been proven effective in preventing serious illness, hospitalizations, and death from COVID-19. Use of these vaccines is critical in bringing an end to this unprecedented pandemic. The CDC) recommends that the best vaccine for you is the one that is available to you at the time of your vaccination appointment.
MONTHLY RESOURCES
NEW from NACHC! COVID-19 Vaccine Distribution Clinic Operations Toolkit
 
serves as a guide for health center senior leadership and healthcare providers preparing for and honing their COVID-19 vaccine administration processes. This toolkit shares sample tools, advice, workflows, and best practices from health centers across the country. These materials reflect health centers' efforts to develop the most appropriate and tailored operations for their organization, staff, patients, and community.
Tips for Talking about the three COVID-19 Vaccines and Answering Patients Most Commonly Asked Questions 

Are your patients asking questions about the three COVID-19 vaccines that are now available? CDC’s COVID-19 Vaccine Recipient Education web page offers tips and vaccine fact sheets in English and Spanish. The materials include proven communication strategies and tips for effectively setting expectations and answering questions from COVID-19 vaccine recipients.
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This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,000,000, with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.