Two new papers from Mass General Brigham demonstrate the effectiveness of bringing COVID-19 health care services to where people need them the most. At the beginning of May 2021, a team from Mass General Brigham began providing COVID vaccinations to underserved populations living in the greater Boston area by sending mobile health units to 12 predominantly low-income and racial/ethnic minority communities in Massachusetts. Using community health vans, teams offered easily accessible vaccination on a walk-in basis without regard to insurance, immigration status, or ability to pay. In a paper published today in The American Journal of Public Health, Mass General Brigham authors describe the success and challenges of the new program, which had higher vaccination rates among adolescents, non-white populations, and people of Hispanic ethnicity compared to vaccination rates in the state and in the local communities.
"To date, our program has provided almost 20,000 COVID-19 vaccination doses," said corresponding author Priya Sarin Gupta, MD, MPH, medical director of the Mass General Brigham and Kraft Center Community Care Van Initiatives. "Our goal was to take COVID-19 health and vaccination services to the community and meet people where they are. The data from the first few months of Mass General Brigham's Community Care Vans, sometimes called our 'clinics on wheels,' show us that if you build it — and you build it well — they will come."
In their AJPH paper, Sarin Gupta and colleagues outline what it took to build their program well and implement it effectively. Key elements to the program included:
- Engaging and partnering with community nonprofit organizations, local departments of health, and school board representatives;
- Staffing vans with trained, multilingual staff members and engaging a large volunteer network;
- Identifying the right places and times to reach communities that have been hardest hit by COVID-19.
The program also used a "double equity" model, engaging with a local transportation company that was at risk of downsizing because of economic losses during the pandemic.
In a companion paper recently published in Preventive Medicine, investigators analyzed results from the first three months of the program. From May 20 to Aug. 18, 2021, the community health vans held 130 sessions and administered 2,622 COVID-19 vaccine doses. During the study, just 20 percent of people who received a vaccine from one of the mobile clinics self-identified as white. More than 56 percent listed their ethnicity as Hispanic (compared to the state's vaccination rate of about 18 percent). Additionally, participants were more likely to be adolescents — the average age of people vaccinated at the mobile clinics was 31 years old. These early findings allowed the program to iterate and expand to more communities to maximize the program's reach to communities serving people of color and those with high rates of health-related social needs.
The authors note that mobile health units could be used to help address other community health needs beyond – and sometimes entangled with — COVID-19. The vans are now expanding their offerings to include a menu of services to offer care for preventable and chronic conditions, including offering high-blood pressure screening.
"Already, we are seeing participants come to us who are interested in getting vaccinated, and also get screened for high-blood pressure while they are there — and vice versa," said Sarin Gupta. "Some participants ask us, 'What are you going to provide next?' It gives me hope. If we can provide care with cultural humility and ensure that everyone has access, we can begin to overcome barriers such as mistrust."
Funding: This work was supported by the National Institutes of Health (NIH; RADx-Up grant NIH P50 CA244433-02S1), the Massachusetts General Hospital (MGH) Kraft Center for Community Health, and Mass General Brigham.
Paper cited: Sarin Gupta, P et al. "Mobile health services for COVID-19: counseling, testing, and vaccination for medically underserved populations." Am J Public Health DOI: 10.2105/AJPH.2022.307021
