Community health centers: One year of vaccinating the nation’s most vulnerable
The coronavirus pandemic has resulted in public health and economic crises on a scale most Americans have never experienced in their lifetimes, while laying bare critical vulnerabilities in the nation’s public health system. As we continue to examine how we can improve the ongoing coronavirus response and better prepare ourselves for any future public health crisis, it is essential that we understand the failures that occurred and recognize our triumphs. One of our triumphs is the administration of more than 19 million vaccinations of the most vulnerable Americans by community health centers, also known as federally qualified health centers — an effort which is marking its one-year anniversary this month.
As coronavirus vaccines were rolled out in late 2020 and early 2021, many had difficulty accessing them due to various social and structural barriers, such as inability to get time off work, lack of experience navigating the health care system, or concerns about payment, transportation issues, lack of language proficiency, and fear of immigration enforcement.
Community health centers — often the only avenue to obtain quality, affordable primary care for uninsured or publicly insured patients largely excluded from accessing it elsewhere — were enlisted to help overcome these barriers. An influx of federal dollars allowed health centers to hire additional staff and expand their outreach campaigns, not just to their own patients, but also the broader community — sometimes going door to door. These centers are trusted and often longstanding entities in the communities they serve. They are uniquely well suited to this task.
The patients treated at these centers are among those hit hardest by COVID — frontline, agricultural, and migrant workers; public housing residents; the elderly living on fixed incomes; people experiencing homelessness; low-income families; and immigrants with limited English skills. Over 90 percent of health center patients are low-income and nearly 60 percent are people of color.
Health centers’ effort to provide language-appropriate services through staff who’s cultural and racial identities mirror the patients they serve is integral to their success, says Gloria Warner, Chief Operations Officer for Beaufort-Jasper-Hampton Comprehensive Health Services (BJHCHS). These services help to establish health centers as “trusted messengers.” “We look like them, and we’re part of who they are,” says Warner.
BJHCHS, a network of health centers spread across the largely rural southern tip of South Carolina, dispatched a mobile unit to vaccinate resort workers at Hilton Head, a group of mostly Hispanic and Jamaican immigrants who struggled to take time off work and may have lacked awareness of how to go about getting vaccinated. Health centers have been a key force in narrowing the vaccination gap between white Americans and those of color, with 68 percent of vaccines administered to people of color compared to 40 percent administered to racial and ethnic minorities in the general population.
One year after these efforts began, we are seeing evidence of their impact. A joint analysis from the Morehouse School of Medicine and the National Association of Community Health Centers shows that areas with health centers have had fewer coronavirus infections and deaths, compared to areas without them — an average of 200 fewer cases and nine fewer deaths per 100,000 people.
These triumphs notwithstanding, challenges remain. The workforce shortages that have plagued the health care industry during the pandemic have not spared health centers. As of January 2022, 44 percent report they do not have adequate staff to administer vaccines. Chronic illnesses, such as long-haul COVID, mental illness, and substance use disorders are on the rise, and health centers are projected to add 8.5 million new patients over the next four years.
Fortunately, the Biden administration has made historic investments to support major health care construction and renovation projects at health centers across the country, thanks to funding Congress provided under the American Rescue Plan. These investments will help advance health equity and health outcomes in medically underserved communities, including through projects that support COVID-19 testing, treatment, and vaccination.
As we continue our efforts to make America’s greatness accessible and affordable for all Americans, we must provide health centers with the level of consistent funding to build the primary care workforce and infrastructure to meet the demand for affordable, accessible health services now and beyond the pandemic.
James E. Clyburn is House majority whip and chairman of the Select Subcommittee on the Coronavirus Crisis.