It’s hard not to feel discouraged about where things stand now with COVID-19. After months and months of cases going down, we are seeing a spike in infection rates going up because of the Delta variant. It’s highly transmissible and causing a new wave among the unvaccinated. Experts predict that cases will increase further before they start to decline, though we’re not likely to see a comparable rise in hospitalizations or deaths in most areas in the country because 164 million Americans are fully vaccinated. Even so, there is a long way to go before we get out of the pandemic and the Delta variant upsurge means a different ground game is in order.
We sat down with Basim Khan, MD, Executive Director of Neighborhood Health, to get a sense of how he’s shifting his focus to ensure more underserved people are protected. (View transcript below). Neighborhood Health was one of the initial 250 health centers chosen for the Community Health Center COVID-19 Vaccine Program back in December. Early on the health center, which serves a predominately low-income and uninsured patient population in Northern Virginia, set up seven vaccination sites in areas accessible to underserved communities and worked with 100 partner organizations — African American churches, organizations serving Latino and Asian communities, food assistance agencies and social service groups — to ensure anyone who needed a vaccine could get one. Now the center’s strategy is shifting to meeting the patients where they are, having a series of conversations to address concerns about the vaccine and counter misinformation. It’s not easy work, but it’s making a difference. To date, Neighborhood Health has administered 60,000 doses of COVID-19 and 85 percent have been to people of color and 79 percent to uninsured patients.
Our conversation Dr. Khan is part of a podcast series, Health Centers on the Front Lines, that NACHC is launching to chronicle the role of health centers in meeting this public health moment with courage, dedication and no small amount of humanity. Watch the video of our conversation below or you can listen anywhere you get your podcasts. Visit our podcast page for links to common podcast services.
Transcript: Leveraging Partnerships to Fight COVID: Neighborhood Health
Amy Simmons: When the White House coronavirus task force rolled out their strategy for ensuring equity in Covid vaccinations, Neighborhood Health in Northern Virginia is exactly what they had in mind. The health center cares for 40000 patients, most of them low income, uninsured and people of color. This is a population who suffered higher rates of infection and death from Covid. Neighborhood Health was one of the first of the 250 health centers chosen for the Community Health Center Covid-19 vaccine program. They set up seven vaccination sites located in churches, community centers and retail areas and are working in partnership with local churches, agencies and safety net organizations to get shots in the arms. At peak, Neighborhood Health was vaccinating up to 5000 people a week, and that got President Biden’s attention. Last April, he paid the health center a visit.
President Biden: Is this where you register?
President Biden: And can they just show up to register or they need an appointment to come?
Lady: Yeah, you need to have an appointment. So we usually ask them for their license or insurance card and ask them what time to come in and ask them, ‘How are you?’ And be polite and everything. Tell them it’ll take a minute and ask them to sit down.
President Biden: And roughly how many people daily come through?
Amy Simmons: And we’re fortunate to have with us today one of the people who is on hand to answer the president’s questions during his visit. We have Dr. Basim Khan, executive director of Neighborhood Health, and I’m your host, Amy Simmons Farber. I wanted to start with where we are now. The U.S. is in a pivotal moment with a Delta variant causing another pandemic of the unvaccinated. How is this changing your ground game at Neighborhood Health?
Basim Khan: I think it’s great, and it’s great to be here and thank you for having me. And what I would say about the Delta variant is that it reinforces the importance of trying to get as many people as possible vaccinated so that they’re protected because the vast majority of people who are being impacted by this variant are people who have not yet received the vaccine. And our goal is to reduce any barriers that might exist for vaccination to really get out there into the community and engage people where they are able to make it as easy as possible to get the vaccine, to share information with them and just to be there in places where people might not otherwise have gone to a center or some other place to get vaccinated. So our focus is really community based and we have a lot of pop up events and mobile events that we’re doing in various different parts of community, and our focus is just to try to get out there and get as many people vaccinated as possible.
Amy Simmons: Doctor Khan, tell us a little bit about your patient population and if they are subject to what we’re hearing about misinformation on social media where they’re getting their information sources. Is this a concern for you as a community health center physician?
Basim Khan: Our patient population is primarily a low income, uninsured, immigrants, people of color, and like anyone else, they are susceptible to misinformation; and there is a lot of misinformation that’s floating around in social media, and that is a concern for us, and there’s a baseline level of mistrust and anxiety as well. However, there are ways to overcome this misinformation, and that comes through a lot of one on one engagement and as physicians, as clinicians, as people in the healthcare setting, we’re used to this one on one engagement with our patients, and that’s really important for patients to be able to hear from his or her clinician about the importance of getting vaccinated. So the ability to answer questions one on one is really critical and it does have an impact, and I don’t think anyone should underestimate the impact that has.
In addition, we’re working out in the community together to try to reach people who are not our patients yet from underserved populations and so we are relying on trusted messengers, whether it’s our own physicians trying to get out there in the community and our clinicians to be able to put out a message. But in addition, faith leaders and other people in the community trust, we’re enlisting them to be able to get the information out there and really engage the people one on one to try to get more comfortable in getting vaccinated.
Amy Simmons: Well, I’m glad you brought that up, because this has been about your hallmark approach has been leveraging partnerships with faith leaders, with churches, with social organizations and Latino and Asian community organizations.
Can you tell us about this? Is this a successful model that you think other health centers should follow in building trust?
Basim Khan: We think it is, and at the onset of our vaccine effort, we understood and acknowledged that our focus would be equity in vaccination to try to reach the populations who have been most impacted by Covid. And, of course, our patient population is that and that was the lowest hanging fruit, if you will, to try to reach out to our patients and their relatives. But we need to figure out a way to reach underserved populations who are not already being served by our health centers, and we felt that the best way to do that was to really engage with our community partners, with different organizations, communities that work with similar patient populations. So it was the faith community; a lot of churches, especially black churches or churches that serve some of the immigrants communities that we want to get vaccinated.
In addition, it creates nonprofits, nonprofits and a whole host of areas, whether it’s food assistance, social services, housing, in addition to these local agencies that provide services to the populations we’re trying to reach. So we connected with them and we said, ‘Listen,’ this was back when it was difficult to vaccinate and get vaccinated. We said, ‘Listen, if you’re able to refer patients to us, or you refer your clients to us, your patients to us, we’ll make sure there’s no line. We’ll make sure we get them and we will make sure it’s convenient for them.’ And working with over a hundred different groups, we were able to get a lot of black folks community vaccinated and our home models built on that and our whole focus has been working with community partners because they’re able to reach people who are not out of the woods and ensure that they get vaccinated.
Amy Simmons: And is this approach working now as we’re sort of scaling back the mobilization effort, and now you’re focusing on more of an individualized approach to building the vaccine confidence. Is the same partnership working with you on that change of strategy?
Basim Khan: It is, and I’m glad you brought that up, because, as you know, back in April, the strategy changed. A lot of the larger vaccine sites closed because of lower demand and perhaps the more difficult round of reaching people in smaller numbers out in the community again and more earnest. It’s the same model to some degree because we realized that we can’t do it alone. We can’t just go and set up shop in some community without communicating with the community or with entities in the community that have trust, that have a presence there and are able to convince people. So we’ve been partnering with local housing and really connecting with them and trying to find ways to reach their residents. We’ve been partnering with churches, we’ve been partnering with other social services agencies and what’s been helpful has been hearing our work with what they’re doing. So they might be at food distribution and we offer vaccinations there, it might be some celebration or some of their event and we offered vaccinations there.
It’s really pairing our efforts for what they’re already doing to give the vaccine. And of course, the other part of this that you can overlook is really going door to door, we have been doing that, we have community health workers who go out to try to get people to get vaccinated. So in this effort, it’s sort of been quality above approach, and we try every avenue we can to try to reach the most people, and if certain things, work better that others then certainly we try to work with it.
Amy Simmons: Going back to your use of community health workers and the knocking on doors. Do you feel like you’re in a kind of a race against time as a Delta variant is creating spikes in different states?
Basim Khan: We do feel that we’re in a race against time and we feel a sense of urgency because when you get vaccinated, you’re not protected right away. You need to get the first dose and with the MMR vaccine. There’s a second dose and then it’s two weeks after the second dose. So it takes some time for someone to get protected. So it’s really important that people get vaccinated as quickly as possible. And yes, we do feel that we’re in a race against time, especially with the emergence of this Delta variant and an increase in cases of the virus focused in certain areas around the country where the vaccination levels are lower. We are seeing some increased pretty much everywhere. So we are trying to get people vaccinated as quickly as possible.
Amy Simmons: So you’re seeing an increase in cases at your health center as well among the unvaccinated or?
Basim Khan: We are. It’s very small in our center, but in Northern Virginia, more generally, we are seeing an increase in cases and I think it doubled in the last few weeks from a relatively low number. So it’s not as much as compared to other parts of the country, but we’re definitely seeing an increase and we’re preparing for a further increase in trying to get as many people vaccinated as possible.
Amy Simmons: Now that the FDA has approved a Pfizer vaccine for 12 and older and the J&J and Moderna vaccines for 18 and over, I think that’s correct, right? That’s what’s been approved. We now have the opportunity to vaccinate younger people, and you’re just now starting out with this effort. Do you use a different approach to reach the younger patients who are vulnerable?
Basim Khan: It is, it takes more of an effort in some ways because there perhaps isn’t as much of a motivation, because obviously Covid, the impacts are greater in the elderly and not as much younger population. So it takes a little bit more convincing. The other issue is obviously around parental consent and ensuring that the parent accompanies the child and we’re able to give consent in some other way so that it’s a little bit more work as well. So it is more work. But, that’s how the vaccine effort is in general, the days where you had a big vaccine center and people were just lining up to get vaccinated, those days are behind this. Now, you really have to get out there and engage people one on one, put in the extra effort to be sure that people get vaccinated. So it’s more work but it’s more pleasure happily doing. And, it’s really important.
Amy Simmons: Your health center was one of the initial 250 health center sites to receive a direct allocation. So you are sort of early in the process with this going through the last few months in terms of launching this effort, can you share some of the lessons learned, some of the mistakes you made early on that you corrected, that you would advise other health centers to follow?
Basim Khan: Absolutely. I think for us, probably the biggest point is the willingness and the ability to adjust whatever strategy you’re using to the realities on the ground. You might try one thing and it doesn’t work. So then you shift into something else. We have to do that a lot of times. And through this effort, as just the situation has changed, as demand has decreased in certain populations, we had to shift from larger sites to more efforts in the doctors’ offices, in our actual health centers because we had offsite clinics. And then in addition to that, more community based efforts. And a lot of times the community based efforts, there’s a lot of variety in terms of how successful you are.
We might have some events where we vaccinated 150 people, the next day, we might have an event where we vaccinate five people. We just have to learn whatever lessons we can learn from that. But also realize that even if you vaccinate five people, there’s some inherent value in that because those were five people who are not vaccinated before you reach out to them. But nevertheless, it’s definitely a learning process. And we just have to have the nimbleness and that ability to change as things going on. The other point I would emphasize is never forgetting what the purpose of this is. And obviously it’s to try to get as many people vaccinated as possible. But in our case, it’s really to ensure that the focus remains on the populations who have been most impacted by the pandemic and who are least likely to get vaccinated, perhaps a more traditional setting. So it’s that laser like focus on equity and on reaching underserved populations that is really underlying our entire effort and being able to just consistently remember that it’s really important as the process continues and as so many other things change in the process. That’s one thing that hasn’t changed.
Amy Simmons: So that’s absolutely valuable information there. And I also remember in our previous conversation, you were telling me about the value of integrating primary care into building trust and that you had had a series of conversations with the patient who was reluctant to get the vaccine. Do you remember that story that you told us and in the last conversation?
Basim Khan: And it’s a telling story. Fortunately, many of my patients have received the vaccine. And it just goes to show the importance of the relationship between a primary care clinician and the patient.
If you look at surveys, Americans across the spectrum are saying that the people that they’re most likely to trust are their primary care physician or their primary care clinician. So one shouldn’t underestimate the importance of those interactions, as you know and there’s perhaps a lot of the evidence showing primary care however, there’s a lot going on. And sometimes prioritizing things and fitting everything in can be difficult, but what I’d say is that among these priorities, Covid vaccination really is so critical. So health centers and primary care practices really need to put in the effort to develop the workflows to ensure that every single person walking through their door, whether it’s a patient or someone accompanying the patient is offered a vaccine.
We have to find a way to do this. And this is what we do in primary care. We have patients that they’re overdue for colon cancer screening or some other preventive care intervention. And vaccination is no different at this point in time. Even more important, and we should never underestimate the fact that these interventions are one on one conversations we have because you never know where people may stand. And I had a patient who tends to resist a lot of preventive care interventions. She tends to resist getting a mammogram and other cancer screenings, flu shots. So when the Covid vaccine came up, I told her about the vaccine. I listened to her and her concerns. And very quickly, she said that she was just not going to do it. She didn’t trust it and she needed more time to even consider it. But nevertheless, we had a respectful conversation.
I told her how much I cared for her and her wellbeing, as I always have. And I told her why I thought she should get vaccinated. And I left the door open for future conversations in case she had any questions. I didn’t assume that the job would be done with just one conversation because she said no. And frankly, I wasn’t feeling that optimistic based on how quickly this week I noticed that two weeks later she signed up to get vaccinated, which I thought was incredible because I’ve yet to get her to do so many other things. And the lesson for me is don’t make assumptions. You don’t know where your patients are when it comes to vaccination. I mean, it’s always worth having that respectful conversation that might go a long way. And ultimately, in many of their cases and some of their cases, it might save lives.
Amy Simmons: And we always talk about the role of health centers as trust ambassadors. And to me what you are saying is that building trust requires a series of conversations. And that’s what health centers offer as a provider of care.
Basim Khan: It does. It’s a long term relationship. And that long term relationship is the basis. And that trust that comes from that familiarity is the basis of so much positive and primary care, including vaccines that are no different. I’ve had ongoing conversations with patients about different topics that have lasted weeks or months or even years. And it’s through that engagement where you get to understand where they’re coming from. And then it gets you the highest likelihood of being able to make an impact and do things in a certain direction.
Amy Simmons: You have been at this fighting Covid for over 18 months now. What was one of the hardest challenges for you as a health center physician?
Basim Khan: So many challenges in our patient population get so impacted by this pandemic was difficult. They were getting infected in higher numbers because of their risk factors. Many were in the hospital. We’ve lost patients, I have lost patients of mine as well. And that’s difficult and incredibly stressful. But in addition to that, ombudspersons staff has been immense of the stress of ensuring that you’re safe, that your staff are able to keep their families safe from the stress of the pandemic in their daily lives outside of the health care setting. And all of that has been challenging, but also the stress of really having to step up and really having to not only manage to stay safe, but to provide primary care, but can also really respond to the pandemic with testing and treatment and vaccination. And I would say, even though it’s been really stressful, I couldn’t be more proud of our staff and just the incredible heroic efforts that they’ve done in the way that they’ve stepped up.
They’ve really taken ownership of this problem, the pride that they’ve had and being of service to our community and the patients we serve in this very difficult time. I couldn’t be more proud of what they’ve done and I couldn’t be more inspired. And that’s helped all of us going forward.
Amy Simmons: One final question. What concerns you the most about the Delta variant right now?
Basim Khan: What concerns me is how much more transmissible it is, whereby people might have been protected in certain circumstances, but the Delta variant, their likelihood of infection, obviously, if it not vaccinated more so, is something that concerns me. What also concerns me is people are tired of this pandemic, they want it to be over. They are tired of the restrictions. People don’t want masks, but the pandemic isn’t over. And in some ways, with the Delta variant in certain respects, it’s worse and that fatigue, that’s what worries me. It also worries me that things are going to get worse potentially as we go into the fall. And we really need to make sure that we get people vaccinated as much as possible so that we are best prepared to face it.
Amy Simmons: Have I left anything out in terms of questions? Is there anything that you would like to add or tell us today?
Basim Khan: The one thing is our team is getting 60,000 vaccines. We just crossed that milestone. Of course, the overwhelming majority are in underserved communities. And it’s an achievement that we’re really proud of that we’ve been able to contribute to this effort in that way in health centers across the country are really contributing to the effort in the communities that have been most impacted front and center. So proud and grateful to be part of that.
Amy Simmons: That’s really amazing. 60,000 shots and thanks to your work with the partnerships and the alliances that you’ve built in the community to build trust, and hopefully that will continue in the race against the Delta variant. Dr. Khan, I want to thank you for joining us today and for your work on the front lines of Covid. Thank you very much.