A doctor preparing to administer the COVID-19 vaccine. Baylor Scott & White Health

Coronavirus

The Challenge of Vaccinating Medical Deserts in Southern Dallas

"If our goal is to have to have herd immunity, we're going to have to have to make sure that we're not just looking out for ourselves."

Dallas County and Parkland are launching COVID-19 vaccination locations in southern Dallas to address the disparity of vaccination sites in communities that lack clinics and pharmacies. The county’s location at Fair Park began vaccinating residents on Monday.

Still, these so-called “mega sites” might not be the only answer to vaccinating some of the city’s most vulnerable residents. The Catalyst Community Foundation and Catalyst Health Network want to partner with community centers and churches to fill the large vaccination centers’ gaps, bringing smaller locations closer to more residents in a setting they trust. Catalyst is a network of independent primary care physicians who aim to manage patient health through data, care management, and advocacy. 

Much of southern Dallas doesn’t have a Kroger, Walmart, CVS, or other pharmacies. As those sites begin to receive doses for the general public, the already dire health disparities will only increase. To address the issue, Parkland is operating vaccination sites at Ellis Davis Field House near Redbird and Dallas College Eastfield Campus in Mesquite. Dallas County Health and Human Services began operating a mega site at Fair Park on Monday morning, vaccinating members of the public who qualify as 1A or 1B per the state’s definition. (Basically, healthcare workers and members of the public who are 65 or older or have a chronic condition that makes them more vulnerable to contracting the virus. The Dallas Morning News reported this morning that folks who are 75 or older are being prioritized.) 

Still, the vaccine remains limited and providers are using state guidance to determine the residents who are most vulnerable to contracting the virus. 

“Parkland will be notifying its vulnerable patients. There is not an avenue at this time for Parkland patients to proactively schedule an appointment. Parkland is not currently vaccinating the general public and does not plan to do so next week,” read a statement last week from Parkland. 

Between distrust in the medical industry and transportation hurdles, a few concentrated vaccination stations may still not reach many people who need it most. The Texas Tribune found that Dallas County has 140 approved distribution locations. Of those, just 10 are located in majority Black Census tracts while 37 are in majority Hispanic. 

The Catalyst Community Foundation launched during the pandemic to address health disparities in vulnerable communities. The nonprofit partnered with churches and community centers to help provide access to primary care doctors in neighborhoods that don’t have them. Dallas County’s ratio of population to primary care physicians’ ranks 18th among Texas counties. In North Texas, demand is expected to outpace supply by 2030. According to Children’s Health’s Community Health Needs Assessment, “The shortage of primary care physicians is expected to grow by 90 percent, which indicates continued challenges for Dallas County in terms of access to primary care services.”

Catalyst is hoping to address this shortage by leveraging relationships that are ingrained in these communities. Having buy-in from someone familiar to the residents was a must. If a pastor of a church or a recreation center director encourages their parishioners and neighbors to get vaccinated, they are more likely to trust the service, says Dr. Chris Crow, the founder of Catalyst Health. The foundation is now looking at leveraging those relationships to provide vaccinations to the general public where it previously operated COVID-19 testing sites, as supply allows. This summer and fall, Catalyst tested at St. Lukes Community United Methodist Church, Hamilton Park UMC, DC3 in Desoto, Friendship West Baptist Church, Cochran Chapel UMC, and at the Glendale shopping center in conjuncture with nonprofit For Oak Cliff.

Vaccine distribution is off to a slow start in southern Dallas, five weeks since the first doses arrived here. The Bluitt-Flowers Clinic in East Oak Cliff only received 200 doses of the vaccine from the state this week, while Parkland’s Hatcher Station Health Clinic in South Dallas received only 100 doses. Portions of southern and West Dallas have received a few hundred doses here and there—last week’s allotment included 100 to Clinicas Mi Doctor in Oak Cliff, 100 to MD Family Clinic in southeast Dallas, another 100 to Heavenly Hands clinic in southern Dallas, for instance—but the majority is landing with the county health authority, the Parkland system, and UT Southwestern Medical Center.

Gov. Greg Abbott has said the state’s priority is supplying providers that have the resources to vaccinate thousands of residents each week, which means most will be found in the Medical District and at the centralized mega centers.

Crow says the organization is preparing for the coming weeks, when smaller providers are more likely to receive more doses. He hasn’t identified exact locations, but they will be mostly south of I-30 in medical deserts and vulnerable neighborhoods. It will likely be a mix of two to three churches and two to three community centers, for a total of five sites. When the organization was testing in these neighborhoods, the testing site would rotate through five locations every week.

The vaccine distribution will most likely function the same way, rotating to reach the greatest number of residents. There won’t need to be many infrastructure changes to shift from testing to vaccines, as the Moderna version doesn’t require ultra-cold storage like the Pfizer version does. The same mix of Catalyst caregivers and neighborhood volunteers that ran the testing centers can also vaccinate these communities.

In many ways, giving the vaccine is a simpler operation, because staff won’t have to deal with any specimens to maintain their purity while the samples are tested. Catalyst ran PCR tests, which meant getting results in and communicating those to the patients, which won’t need to happen now. Crow says they will start as soon as they have enough vaccine to distribute, which he says has been a moving target.

“It is all a function of getting enough of the vaccine,” Crow says. “It could be next week, or could be when Biden takes charge. As soon as we get them, we will get started.”

Some of the skepticism stems from systemic racism in the United States, including the Tuskegee Syphilis Study. For 40 years, the federal government allowed syphilis to ravage the bodies of poor, Black sharecroppers in rural Alabama. Doctors with the Centers for Disease Control and Prevention withheld treatment so they could study the disease’s effects on the body. Public health officials say they are running up against that distrust in deploying the vaccine. A Pew Research Center survey from December found that only 42 percent of Black adults said they would definitely or probably get the COVID-19 vaccine, compared with 61 percent of Whites. 

“There’s a massive desert down there that doesn’t have a pharmacy, doesn’t have a Walmart, and has massive transportation issues, as well as economic hurdles,” Crow says. “We have learned about the depth of the health disparities in certain areas, and it doesn’t matter that there’s going to be a vaccination site at the Cotton Bowl. For many unhealthy, poor, Black neighborhoods, they’re just not going to get there. And if they could, they wouldn’t trust it.”

If these areas have low vaccination rates, the entire population will be vulnerable. There will always be groups that are unable to get the vaccine because of age or medical condition. Providers will have to be creative about connecting with distrustful or hard-to-reach communities. Leaning on established community relationships may be one answer. 

“Trust is another big piece that the barrier, and that that is why our strategy includes working with trusted partners in those communities,” Crow says. “Because those communities have churches and community centers that support them, they have trust in those places. If our goal is to have herd immunity, we’re going to have to have to make sure that we’re not just looking out for ourselves. We have to make sure that everyone is getting it, and everyone includes all those people as well.”

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