It is a Thursday afternoon in mid-July, and preparations for the Tenderloin Resource Hub’s weekly COVID-19 vaccine site are well underway. Everything happens outside of GLIDE at 330 Ellis Street.
The day starts with a thorough pavement washdown. Canopy tents expand. Tables and chairs are set up. Two-way radios, iPads, mobile hotspots, and laptops are readied for use. Medical supplies are laid out, vaccines pre-drawn, cartons of safety vests, and stationery are unpacked, and shift volunteers are trained depending on their roles.
The COVID vaccine collaborative at GLIDE’s Tenderloin Hub is a true citywide partnership. The collective includes clinical staff from San Francisco’s Department of Public Health (SFDPH), University of California, San Francisco Medical Center (UCSF), and the San Francisco Community Health Center (SFCHC), which serves as the clinical supervisor. Along with non-clinical staff from SFCHC, GLIDE, and community partner Code Tenderloin, teams gather every Thursday to coordinate the many moving parts for the weekly pop-up vaccination site. Their latest strategic effort is the deployment of “Roving Vax” teams.
Months earlier, it was recognized that vaccine equity initiatives were needed in low-income and communities of color in San Francisco. The Tenderloin trailed the city’s vaccination rate by seven percent. To address the disparity, GLIDE joined an innovative collaboration between UCSF’s Benioff Homelessness and Housing Initiative (BHHI), Life Sciences Cares-Bay Area, SFCHC, and SFDPH.
“GLIDE is tremendously proud of our partnership. Together we are reducing barriers to vaccine access and serving some of the most marginalized people”
— GLIDE President & CEO Karen Hanrahan
“There are significant challenges in providing access to COVID vaccinations to the housed and unhoused residents of the Tenderloin,” said GLIDE President and CEO Karen Hanrahan at the launch of the TL vaccination site. “GLIDE is tremendously proud of our partnership. Together, we are reducing barriers to vaccine access and serving some of the most marginalized people. Bringing a weekly neighborhood vaccination clinic to the Tenderloin is an absolute accomplishment.”
Since a successful “proof of concept” pilot in late March, the Tenderloin Hub vaccine site has made a significant impact. As of August 19, the pop-up clinic administered 2,509 vaccine doses. Fifty percent of those jabs were Johnson & Johnson/Janssen single dose COVID-19 vaccines, with first and seconds doses of Moderna vaccines making up 45% and Pfizer injections coming in at 5%. At its operational height, the GLIDE vaccination site stretched halfway down Ellis Street with dedicated areas for line management, registration, and tents for vaccine preparation, administration, and patient observation.
“At the start of the vaccination site, we saw large numbers of Tenderloin residents and workers eager and ready to receive the vaccine,” said Senior Director of Programs Lillian Mark. “Those who may have been unsure or slightly hesitant were also successfully brought to the finish line through sustained outreach in the community.” Several weeks later, though, the TL Hub began to see vaccine demand diminish. Mark observed that the decline was most likely due to vaccine-hesitant residents who were unlikely to travel to Ellis Street. Around the same time, an effort to prevent open vaccine vials from going to waste yielded an unexpected discovery. “The clinical team at SFCHC decided to venture out on their own. So, after the site closed, they went out onto busy TL street corners and visited family restaurants, with the mission of getting those vaccines into arms. And they were incredibly successful,” said Mark.
The impromptu street outreach led to the establishment of Roving Vax teams. Modeled after the successful mobile outreach efforts of SFCHC’s Street Medicine initiative, two sets of roving teams are outfitted with two-way radios, and backpacks, and rolling carts carrying vaccines, iPads, hotspots, and incentives like $25 gift cards to facilitate on-the-spot vaccinations throughout the Tenderloin.
“What’s also unique about the Roving Vax teams is they’re comprised of medical professionals and outreach staff from GLIDE’s community partners in the TL, “said Mark. The team’s make-up is critical to the success of the effort. “When they encounter someone who has mistrust towards healthcare, the teams can rely on the TL outreach staff to reassure them,” she adds. “If they want to know more and want to speak with a nurse or a doctor, a healthcare professional is readily available in the moment. This range gives any person a range of opportunity to ask about any of the misgivings or doubts they may have about the vaccine.”
The established success of GLIDE’s Harm Reduction Services is an additional asset to the street vaccination effort. In addition to providing Opt-In harm reduction mobile services to unhoused and housed residents, a GLIDE mobile services van is part of a plan to deploy Roving Vax team members to neighborhood locations far from the TL Hub, allowing a team in the area to resupply quickly instead of losing time returning to the Hub.
In an interview with her organization’s communications office, SFCHC Nurse Practitioner Shannon Heuklom, who helped design the roving vax team model, noted the goal was to lower vaccine barriers as far as possible. “We did a substantial amount of vaccines by these roving teams. And I think we vaccinated the hardest to vaccinate folks,” said Heuklom. “People who aren’t going to go elsewhere. People who have a little bit of mistrust built in. I think we showed if we come to people where they’re at and give good education, and connect, so many good things come out of that.”
In the last three weeks of July, the majority of the vaccines provided through GLIDE’s Tenderloin Hub — more than 80 percent — were a result of the efforts of the Roving Vax teams. In addition to street vaccination teams serving the unhoused in the TL, they’ve also vaccinated housed residents, workers, and small business owners who don’t have the flexibility to come to the TL Hub. Along with the expansion of roving teams, GLIDE has also shifted the hours of the vaccination site to 3 to 7 p.m. to accommodate residents who can’t visit the Hub during standard business hours, helping to meet the needs of more people in the community. GLIDE currently offers the only weekday-evening-hours COVID-19 vaccination site in the TL.
“Our shared commitment to achieving vaccine access and equity for the Tenderloin has been at the heart of all that we have done,” said Mark. “Since the start of April, this group has met, planned, executed, evaluated, and pivoted every week to continuously ensure Tenderloin residents and workers are aware of their vaccine options, lower threshold for services, augment outreach and education, and redesign service delivery methods to meet the diverse needs of the community.”
When the vaccination site began in the spring, the neighborhood lagged behind the city’s overall vaccination rate of individuals receiving at least one COVID vaccine dose by 7 percent. Current numbers tell a different story. According to the city’s COVID-19 Vaccinations By Neighborhood Map, as of August 28, the Tenderloin has an average vaccination rate of 80 percent, while the city average is 78 percent.
With the rise of the COVID-19 Delta variant, the Hub’s Roving Vax teams plan to continue their efforts throughout the summer to support the city’s goal to vaccinate all San Franciscans.