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Public health authorities have responded by shifting efforts away from mass vaccination sites and focusing on communities with the lowest vaccination rates. This hyperlocal approach, using census-style canvassing operations, education campaigns and mobile vaccination events, hinges on making the shots easy to reach — and helping the hesitant change their minds. In some places, officials seem willing to try just about anything: free beer in New Jersey, crawfish giveaways in New Orleans, complimentary baseball tickets in New York, $100 savings bonds in West Virginia, $50 gift cards in Detroit — and a $1 million lottery in Ohio.

The most successful efforts will result from talking to people who have not been vaccinated and using those conversations to develop “bespoke solutions” designed for particular neighborhoods, said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania.

Even if the initial conversations unvaccinated people have with outreach workers don’t change their mind on the spot, it could cause them to think more about their decision — a potential first step. And the conversations will teach community health centers how best to reach vulnerable groups, including public housing residents, farmworkers and the homeless, to help with access issues like language barriers.

“Tailored community outreach is what we need to be doing now,” Schmidt said.

In many of the country’s most vulnerable areas, that work is only now getting underway.

‘Protect yourself by any means’
Last Saturday morning, newly enlisted volunteers gathered around a table at a Salvadoran restaurant in Newark, New Jersey, to introduce themselves and prepare for their first day canvassing in the Lower Broadway neighborhood. This section of the city’s North Ward has a large population of immigrants from across Latin America and is an area state officials identified as having a low vaccination rate. (Officials wouldn’t provide that rate, but state data shows that only a third of Newark residents have received at least one shot.)

Heading the volunteers was Nayeli Salazar de Noguera, program outreach manager for the Covid Community Corps, a state Department of Health project to send out teams to strike up conversations with people who have not been vaccinated. She handed out suggested talking points, along with informational flyers and cards with details on free rides to vaccination sites. She told the volunteers to listen to people’s concerns, let them know about a nearby vaccination site at the New Jersey Institute of Technology, and emphasize that the shots are free and do not require insurance or proof of citizenship.

“Today is the first day we are going into this community to learn what the barriers are,” she told the volunteers, most of whom lived in Newark. “There still is a lot of education to be done.”

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They broke into pairs and began walking through a retail corridor.

One of the first people they stopped was Derrick Jones, who was walking to work at a shop on Broadway. Jones, 60, who is Black, said through a mask that he didn’t trust the government’s rapid deployment of the vaccines and wouldn’t get a shot unless he felt comfortable that it was safe.

“It’s a possibility, but I don’t see my mind changing,” he said.

The volunteers, Kim King, 52, a community health worker at a local nonprofit, and Philip Reinhardt, 22, a student at NJIT, listened closely and then chatted with Jones for a few minutes. It turned out that King and Jones had friends in common.

“Well, if you change your mind, hit me up,” King said.

The lack of trust in the vaccine development process is a common concern among those who have not got vaccinated, particularly among Black people, according to a Pew Research Center study. Salazar de Noguera tells outreach workers to emphasize that the vaccines have been shown to reduce hospitalizations and deaths, and to appeal to their sense of duty in not inadvertently infecting people they love or work with.

King and Reinhardt next stopped to chat with John Melendez, 51, who was walking with a cane, a mask under his nose. Melendez told them he was homeless and had been turned away from a nearby vaccination site because he didn’t have identification.

“You don’t need an ID to get a vaccination,” King said.

“Oh, no?” Melendez asked. “What I gotta do?”

King offered to arrange an appointment at the NJIT site, but Melendez said he’d get his daughter’s help setting it up. He took the flyers and said he would call for a free ride.

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“Protect yourself by any means,” King said.

“That’s what I’m going to do,” Melendez responded.

At a tire shop, King and Reinhardt chatted with two customers, women in their early 20s who said they had no plans to get vaccinated. Mercedes Colon said she’d been sickened by other vaccinations and feared the side effects. Gema Quintero said she was “still looking into it.”

Reinhardt told the women that Covid-19 had recently hit his household, infecting everyone in his family except his father, who’d got his first dose of the vaccine.

King handed the women flyers and encouraged them to learn more.

“It’s not just about protecting yourself, but it’s about protecting your loved ones,” she said.

Afterward, Colon said in an interview that she had relatives with underlying health conditions that put them at higher risk of getting sick. She said she would now reassess getting vaccinated. “I’m not completely closed off to it,” she said.

Quintero said she also would mull it over. “I wasn’t going to do it. But now I’m not sure,” she said.

Nurse Maritza Beniquez, right, became the first person in New Jersey to get the shot when she received the Pfizer-BioNTech vaccine at University Hospital, in Newark on Dec. 15.
Nurse Maritza Beniquez, right, became the first person in New Jersey to get the shot when she received the Pfizer-BioNTech vaccine at University Hospital, in Newark on Dec. 15.Kirsten Luce / Pool via AP
The ‘expensive last mile’
In Yazoo County, Mississippi, where only 23 percent of the population has received one dose, outreach has relied on places of worship like the Tulane Baptist Church, which hosted a vaccination clinic in its parking lot May 5.

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Among the 45 people who showed up was Jeffrey Montson, who said he’d received repeated calls from two aunts who were members of the church.

He said he appeased them by saying he would get vaccinated eventually. But Montson, 51, wasn’t sure the vaccines were safe. He told himself: “No, I’m not getting it.”

But the aunts kept calling him, and he finally relented, walking 10 minutes to the church, where he got his first dose.

If he hadn’t shown up, “I would never hear the end of it,” Montson said.

Thaddeus Williams, right, pastor of Tulane Baptist Church, talks outside of a vaccination event in the congregation’s parking lot in Yazoo, Miss.
Thaddeus Williams, right, pastor of Tulane Baptist Church, talks outside of a vaccination event in the congregation’s parking lot in Yazoo, Miss. Williams spent part of the morning trying to grab the attention of passersby.Bracey Harris / NBC News
In South Los Angeles, where just 38 percent of residents had got a shot as of last week despite infections outpacing the rest of Los Angeles County since the beginning of the pandemic, a volunteer group called Get Out the Shot worked with the Kedren Community Health Center to organize a vaccination clinic May 9 at the Pueblo del Rio apartment complex. The group spent the two days beforehand going door to door to spread the word.

One of the volunteers, Brian Ramos, 18, said most people who had not been vaccinated either didn’t know where the nearest vaccination site was or had no way to get there. Others were undocumented migrants who feared interactions with authorities.

“I’ve told people, ‘I know how to make appointments,’” he said. “They told me the only problem for them was transportation.”

More than 60 people got their first doses at Pueblo del Rio, according to Dr. Jerry P. Abraham, who leads Kedren’s vaccination efforts. The center has also held pop-up clinics at factories, a Black fraternity and a church.

“This is that very expensive last mile,” Abraham said. “You literally have to go hunt down those arms.”

Facing skepticism
In Detroit, the mayor’s office is using a $1 million grant from the Federal Emergency Management Agency to send canvassers to 230,000 homes by summer’s end.

Image: Door-knock initiative to tackle COVID-19 vaccine hesitancy, in Detroit
Victoria Kovari directs canvassers including Jacqueline Robinson, center, during a door-knock campaign to provide information about vaccinations in Detroit on May 4.Emily Elconin / Reuters
“We’re not just dropping literature,” said Victoria Kovari, who ran the city’s 2020 census campaign before leading the vaccination outreach operation. “We’re actually trying to have conversations with people.”

Those conversations don’t always go well. During canvassing May 4, several residents refused to open their doors. One woman, who was sitting in her car as a canvasser approached, drove off, saying, “I don’t want to be a Tuskegee experiment.” She was referring to a decadeslong study by the federal government that withheld treatment to Black men with syphilis.

Jacqueline Robinson, a leader of The Peoples Action, a nonprofit group that helps low-income Detroiters and is working with the city on the vaccine canvassing effort, said she understood the distrust among many Black people. She talked about race with residents as she made her way down the street.

“We just wanted you to know that there are people who look like you that are getting vaccinated,” Robinson, a 31-year-old Black woman, told Mecca Shabazz, 26, at her doorstep. “It’s a safe thing.”