Flint, MI— “Have you been vaccinated?” Sheila Rickman yelled out the window of a van.
The woman, who moments ago was smoking a cigarette on her porch in a northwest Flint neighborhood, shook her head.
“I have nurses with me that can do it right now,” Rickman shouted, gesturing at her team in the backseats.
Most days, Rickman serves as a care manager for opioid use at the Genesee Community Health Center. But on Thursdays and Saturdays, she takes to the streets in her van, equipped with all three COVID-19 vaccines, free lunches, educational materials, and a team of health advocates and nurses. They drive through Flint’s poorest neighborhoods in an attempt to reach the unvaccinated. It’s a slow, often fruitless process, but the team is making some progress, one vaccine at a time.
The woman waved them on, a cigarette squeezed between two fingers. Rickman thanked her and resumed driving slowly down the street.
The neighborhoods seem endless at times. Some streets stretch for miles into the city with nothing nearby but more neighborhoods, more homes, more rusted, bowed fences, and collapsed roofs.
It was quiet for a Saturday afternoon in July as people took shelter indoors from the Michigan humidity. But those who did venture outside couldn’t escape Rickman’s croaky hollering: “Have you gotten the COVID-19 vaccine?”
The van rolled past a home with several cars parked on the lawn, one with a shattered back windshield. Shards of glass still cover the backseat. A group was gathered around, smoking and chatting.
Sitting on the passenger side of the van, Ivory Miller, a community health worker, took the lead and asked if anyone there would like to be vaccinated.
“We got one!” he exclaimed, clapping. The team cheered, and then, like a NASCAR pit crew, they assembled. The van doors flew open and the six of them took their positions. Within seconds, they had set up a chair, readied the paperwork, and snapped on their latex gloves.
As the Delta variant runs rampant and cases increase once again, vaccine demand has plummeted in Flint and Genesee County.
But in places like Flint, where over half the population is Black and 38% of residents live in poverty, the reasons why someone may or may not choose to get vaccinated are nuanced. At first, experts attributed the low vaccine rates to a lack of access. But more recently, that seems to have changed. Many residents are hesitant due to misinformation and a lack of good information.
Currently, 53.9% of Genesee County residents have received their first dose, about 8% less than Michigan overall. In Flint, rates are even lower.
Bridge Michigan compiled vaccination data for every census tract in the State of Michigan in May 2021. For most census tracts in Flint, vaccination rates were less than 35% and increased by an average of 1% per week. These residents are the late majority and laggards—the vaccine-hesitant. They are also Genesee County’s most at-risk and hard-to-reach populations.
“We’ve really vaccinated the individuals that were, for lack of a better word, the ones that were always going to get vaccinated or only took a little bit more information or a little bit more time to make their decision,” Kayleigh Blaney said, deputy health officer for the Genesee County Health Department.
As a second wave of COVID looms and the Delta variant spreads, health organizations in the county have teamed up to move the needle, so to speak.
Moments after Rickman’s crew exited the van, a man in his late twenties, who wouldn’t share his name, ran inside the house.
His sister, Alexandria Sexton, apologized and said he’s against the vaccine.
“He thinks that our bodies are like God,” a woman said, who also declined to be named, but said she was his girlfriend.
Mary Kobet, a nurse, asked who was getting the shot. Alexandria pointed to the house and said her mother, Christina Sexton, would be coming outside shortly.
Meanwhile, a toddler, dirt smudged on his cheeks, bolted out the front door, screaming and wrapped himself around Alexandria’s leg.
“Can we give y’all some lunch?” Miller asked her. “It’s gourmet, man. It’s chicken salad on a croissant.” Alexandria said she’d take five, enough for everyone at the house.
The meals are prepared by Chef Gary West of the Genesee County Community Action Resource Department. He follows behind the mobile team in a refrigerated van.
Miller asked if anyone else wanted to get vaccinated. Alexandria and her friend Danielle Oaks, who was sitting on the trunk of the car with the shattered windshield, said, “No.”
“My reason is probably stupid,” Alexandria said. “To be honest, I feel like I’m going to get sick from the vaccine, even though I know that you can’t. It’s more afraid of getting sick because my immune system’s not the best either.”
The girl who wouldn’t share her name pulled up a video on her iPhone.
“If you really want to know, here’s the reason why,” she said, referring to why her boyfriend didn’t want to be vaccinated.
On the phone was a colorful animation of microchips entering a person’s bloodstream via a syringe. Subtitles in an East Asian language rolled across the bottom of the screen. The toddler’s screams drowned out the audio, but it was easy enough to understand.
“That’s why we are going out twice a week at the same locations,” Kobet said, “There’s a lot of hesitancy. A lot of misinformation out there. … So, we give them an opportunity to get educated on Thursday, and then maybe we come back on Saturday.”
Sexton, finally settled in a chair on the edge of the driveway, began filling out the paperwork. This would be her second dose, something she had been putting off for months because she was nervous about side effects.
Another family member emerged from the house, Emma Sexton, and told the health workers she also wanted the shot. They pulled out another chair from the back of the van. Shaking and taking deep, long breaths, she sat: Emma hated needles.
“I’m very proud of you for saying, ‘Yes, I will do it,’ because that takes guts. I’m very proud of you,” Rickman told her. Emma nodded, almost in tears.
“So, this is what’s going to happen,” Rickman said, taking a wide stance and raising her arms above her head. “When they go to stick you, I’m going to be right in your face, and I will do a little fat happy dance or whatever to get you so that you don’t even pay no attention. Sound like a plan?”
Rickman danced. Emma giggled, and Kobet administered the shot.
When it was over, everyone, including the family, cheered.
“You guys are so great,” Emma said, adding that it wasn’t as bad as she thought it would be. “You guys are so supportive, and I appreciate that.”
Finding the Hard-to-Reach Hesitant
Rick Sadler, a geographer and assistant professor at the College of Human Medicine at Michigan State University, has been researching, mapping, and collecting data on COVID disparities in Flint since the onset of the pandemic.
He works with a team in partnership with the Flint Center for Health Equity Solutions, an organization that uses data to inform solutions to COVID racial inequities.
“The suggestions, recommendations for Flint are different than statewide because statewide it’s pretty clear wealthy suburbs are getting vaccinated. People in wealthy suburbs are getting vaccinated, and people in rural areas and cities are not,” Sadler said. “The association to race is there insofar as race and socioeconomic status are correlated.”
Early on in the pandemic, solving racial and socioeconomic inequities meant preventing Black people from disproportionally contracting and dying of COVID.
Genesee County officials worked with the State of Michigan to establish barrier-free clinics to increase access to testing. They were strategically placed around Flint in high-risk areas. The Flint Mass Transportation Authority began offering free rides to clinics, as many Flint residents cannot afford cars or bus fare.
By January 2021, Flint’s COVID disparities were significantly reduced. As vaccines rolled out, local health officials already had a plan to address these same disparities once vaccines were available to the general public.
In Flint, vaccines are offered at major pharmacies, doctor’s offices, and barrier-free clinics through the health department at least three times each week.
In May 2021, the health department launched a mega vaccine site at Diplomat Pharmacy, which closed three months later as demand decreased.
“I think it’s significantly less of an access issue than it was earlier,” Blaney said. “But to say that there’s absolutely no access issues, we always know that there’s going to be access issues, because those are going to be the folks that we don’t know about, or we can’t find, or we can’t get to.”
The mobile team is finding them, little by little.
Back in the van, Miller navigated the team using his “peep-ometer,” a kind of intuition that leads him to those willing to be vaccinated.
“A peep-ometer is just something that,” he paused and thought for a moment. “This is my community, and I know where people live and migrate and where some of the areas are more or less desolate. You know, there’s not a lot of people. So, I follow my peep-ometer and we bump into people, and this type of thing happens,” he said referring to the Sexton family.
To date, the team has engaged with over 300 residents and provided almost 70 vaccines, Nichole Smith-Anderson, special projects director for the Greater Flint Health Coalition, said.
“Genesee Community Health Center has distributed over 2,000 vaccines to date. This is important because if people don’t get a vaccine while we are out, they can and do follow up with the health center directly as that is what we invite them to do,” Smith-Anderson said.
However, sometimes, no amount of information will change people’s minds.
The van rolled up on a young couple in their early twenties who were relaxing in their car. Rickman’s voice boomed through the streets once again.
“Have you been vaccinated?” she asked.
The young man, Raheel Hutchinson, smiled and shook his head.
“Do you want it?” Rickman asked. Hutchinson sighed and looked as if he would consider it.
“Are you scared? Okay, I get that. A lot of people are scared. Do you want me to pull over so we can talk to you? Because, honey, the thing that’s worrying me, and that’s why I’m out here on Saturday, is because of the Delta variant. The Delta variant is worse than any other variant, period, and it’s killing people really quick right now,” Rickman said.
Hutchinson remained silent and the team got out of the van. Kobet approached the passenger side of Hutchinson’s car to speak with the young woman, Esperanza Gasper.
“I’m skeptical about it because I’ve seen other people who have side effects and I don’t know how my body’s going to react to it,” Gasper told Kobet. “I’m debating whether I should do it, but I think I need a little bit more time.”
Kobet reassured her that they would monitor her for 15 minutes after the shot and that if anything happened, they had medical supplies on hand and could easily get her to the hospital. She wouldn’t budge.
Rickman offered to hold Hutchinson’s hand. He laughed.
“I’m allergic to needles,” Hutchinson said.
“He got plenty of tats,” Miller whispered.
Rickman pleaded with Hutchinson for the next five minutes, but to no avail. She handed him some informational pamphlets. West passed them two chicken croissant sandwiches, and they continued down the street.
Those in their 20s and 30s, like Hutchinson, Gasper, and several members of the Sexton family, have some of the lowest vaccine rates in the county.
According to Michigan’s COVID-19 vaccine dashboard, 30.1% of 20–29-year-olds and 36.5% of 30–39-year-olds are fully vaccinated. This is nearly 10% less than the state overall for the same age groups.
“Those who are physically well, who are not really that educated about the vaccine itself, and who have not experienced the virus firsthand or have a loved one to be affected, they don’t see the value in getting the vaccine,” said Sherelle Bell-Brown, emergency preparedness health educator for the GCHD, who has been working barrier-free vaccine clinics in Flint.
Bell-Brown said the clinics have seen a drastic drop in patients over the summer.
“In February, we were seeing about 1, 000 a day at our clinics,” she said. She estimates that now, they’re doing 20 vaccines a day.
“I think the best way to reach those people is just to be transparent. Talk about your own experience, let them know, ‘Hey, I’m in the same age group, I look like you. I’ve gotten the vaccine and I’m well,'” Bell-Brown said.
All About Timing
Later, the van pulled into an abandoned lot where a man in his early twenties, Jaelon Daniel, sat in his car. His passenger-side tire lay on the ground.
He’d been waiting for his sister to bring him a spare, when he heard Rickman yelling.
“I thought ‘Why is this lady yelling at me?’ I tried to be nice,” he said. When he learned they were giving out vaccines, he figured, why not?
“Just ’cause I haven’t had it,” he said.
The mobile team went to work. The crew assembled once more, and Daniel exited his car, rolled up his sleeve, and took a seat.
“I’m not in the best mood,” he said.
A homeless man approached and asked for a sandwich, but he didn’t want the vaccine. West handed him a lunch.
Daniel took a sandwich too and ate while the team monitored him.
“It’s odd, I can’t lie,” Daniel said about the situation.
Odd, but worth it to the mobile team.
“Yeah, I’m tired, but I like doing this because this, to me, isn’t work,” Rickman said.
They may only vaccinate two or three people each week, but for Rickman and her team, every shot is a step forward.
“Even one is good,” Kobet said. “Because that’s one more vaccinated.”