What experts say Detroit needs to do to improve lagging COVID-19 vaccination rates

Detroit — A majority of southeast Michigan counties are vaccinating residents at twice the rate Detroit is and that gap is threatening to prolong the pandemic in Michigan's largest city and forcing health officials to find alternatives to mass-vaccination sites like the TCF Center and Ford Field.

About 1 in 5, or 21%, of Detroiters have received at least one shot, according to the city's vaccine dashboard, compared to 33% of residents in Macomb County, 40% in suburban Wayne County and 41% in Oakland and Washtenaw counties. Statewide, 37% of all residents have at least one dose.

COVID-19 vaccination clinic traffic is guided along West Jefferson Avenue towards the TCF Center in Detroit on March 24, 2021. The TCF Center parking garage is being used as a drive-thru COVID-19 mass vaccination clinic.

At the current rate, the city won't be able to reopen by the summer "and there's no reason it shouldn't be able to," Mayor Mike Duggan said this week, although he added "if our vaccine rate is running far less than the surrounding communities, we're not going to make it."

Duggan said suburbs vaccinating residents at a higher rate has been a problem since vaccines became available in late December.

"The wealthier the community, the higher the vaccination rate. That's just the case," Duggan said Monday. 

Nearby Washtenaw County has one of the highest vaccination rates in the state at 43.3% and a low infection rate of 4%, and it's not by coincidence, Duggan said.

"We need to do what our wealthier communities are, which is taking advantage of the vaccine," he said.

The city has five options to get the vaccine: By drive-thru or walk-up at the TCF Center, at Community Saturday events at local churches, at a Johnson & Johnson vaccine site at the Northwest Community Center, and at Ford Field, a regional mass-vaccination center set up by the Federal Emergency Management Authority.

However, fewer than 1 in 10 of the more than 82,000 doses administered at Ford Field through Monday night went to people who identified as Black, said Mike Nowlin, spokesman for the Protect Michigan Commission. 

Based on the state's vaccine data, Oakland County has double the population of Detroit, about 1.2 million, and has vaccinated twice as many residents with nearly the same number of doses.

Denise Fair, Detroit's health director, acknowledged the "slow start" but said early doses "weren't going to Detroiters, they were going more to hospitals."

Doses have also gone in recent weeks to non-residents. In an effort to reopen, Detroit expanded vaccine eligibility to anyone working in the city. City spokesman John Roach did not have exact numbers but said about 60% of doses have been given to Detroit residents and 40% to non-residents.

Fair argues Detroit faces a high degree of difficulty in vaccinating its population.

While people in other communities might seek out the vaccine, Detroiters often have to be sought out because not everyone has the ability to get to an appointment, take the time away from work or find a babysitter, observers say.

To speed up vaccination rates, Detroit has expanded eligibility faster than any city in the state since vaccines began rolling out in December. The city created a COVID-19 hotline at (313) 230-0505 to schedule vaccination appointments, offered $2 roundtrip rides to the TCF Center and expanded eligibility to "good neighbors," anyone who drove a Detroit senior citizen to get vaccinated regardless of the hometown of the driver.

The city also expanded "Senior Saturdays" that are now "Community Saturdays" into churches in the city, created family days for city workers to get vaccinated with their family members, and on Monday, opened a walk-in vaccine clinic on the roof of the TCF Center.

Vicky Kovari, an executive assistant to Duggan who headed the city's 2020 census outreach campaign, said the lowest response rates are concentrated in Detroit's most impoverished areas with high renter turnover, multi-family apartment buildings and a lack of internet access.

Detroit plans to open eight vaccination sites next week in neighborhoods, begin a $400,000 advertising campaign on TV, radio, billboards and social media to promote vaccination and begin a $1.2 million citywide effort to send paid workers door-to-door to convince Detroiters to be vaccinated.

The gap between Detroit and its neighboring communities is caused by a combination of vaccine hesitancy, societal barriers and not enough of the vaccines being available in neighborhoods, said Dr. Debra Furr-Holden, associate dean for public health integration at Michigan State University and director of the Flint Center for Health Equity Solutions.

Furr-Holden said Michigan's leaders need to make changes over the next three weeks that will shape the months ahead.

"We have a very biased in-person perspective of Michigan on how we, as a state, are contributing to the further spread of this virus and expanding this pandemic," she said. "This vaccine will turn the tide on this pandemic. We need to as well by removing barriers and having more community-based sites to reach people where they are."

Vaccinating 'where they are'

Dongelo Moore, 39, president of Detroit nonprofit Better Men Outreach, said his group was hired by the city to knock on doors, and so far has visited 35,000 residents in 20 days, passing out informational fliers and engaging Detroiters in conversations about the vaccine.

For five-hour shifts, six days a week, the 25-person group, in bright blue T-shirts, fans out to reach people. They don't offer vaccines but rather information on them. They explain the shots are free. 

Some people have already taken the shot, Moore said. 

Others mention the Tuskegee syphilis study. In 1932, 600 African American men in Alabama, 399 with syphilis and 201 who did not have the disease, participated in a study and were told by researchers that they were receiving free health care for "bad blood" from the federal government, according to the Centers for Disease Control and Prevention. In truth, they did not receive the proper treatment needed to cure their illness, and the study that was supposed to last six months went on for 40 years. 

More:As COVID-19 vaccinations ramp up, skepticism prevalent among Michigan's Black residents

"We hear that a lot," Moore said. "Especially from the elderly. They bring up the airmen."

Demetris Smith, 29, one of the Better Men Outreach contractors, estimates he's reached about 300 homes a day. Contractors earn $20 an hour. 

"I'm helping to educate my city about the vaccine, and learning more about it myself," Smith said. 

The city's door-to-door initiative, meanwhile, is expected to get underway by the end of April and employ 50 to 55 people who will spend six to seven weeks conducting an initial round of outreach in all of the city’s seven City Council districts. In Detroit's lowest-income areas, the teams will make a second or third pass, concluding by mid-September.

Wayne County residents have the highest vaccine hesitancy in Metro Detroit, according to U.S. Department of Health and Human Services estimates from March. In Wayne County, 29% of residents said they had a "strong hesitancy" or were "hesitant" to receive a vaccine, compared with 26% in Macomb County, 21% in Oakland County and 20% in Washtenaw County. 

Negus Vu, 39, community organizer and president of the People's Action, a Detroit nonprofit, said most elderly people he's met want the vaccine. "It's that whole survival thing," Vu said about the high-risk status for many older people. "But people 40 and under, they're not going for it."

Young people tend to think they don't need it because of their youth and health, or express concerns about long-term effects, he said.

"Young people think we got it a little too fast," Vu said. "We're also in the age of YouTube, and there's a lot of conspiracy theories."

Fair said while she was downtown during the Detroit Tigers' home opener on April 1 monitoring capacity in restaurants and bars, she spoke to a 24-year-old Black woman who told Fair she wouldn't get a vaccine.

"Getting vaccinated means you're at less risk of getting the virus or dying from it or spreading it to someone else," Fair said she told the woman.

More:As COVID-19 vaccinations ramp up, skepticism prevalent among Michigan's Black residents

Not 'herd immunity'

Furr-Holden said in Flint there was a waiting list with the Genesee County Health Department that capped at 80,000 people and about 75% of the people on the list weren't able to be booked because of phone issues. People were either not answering their phones, not returning the call to book an appointment or calling back and not being able to wait on hold.

"We have gaps in ensuring that the people who want the vaccine actually are able to get the shot in the arm. We know there are so many people who are still facing barriers," she said.

"There's a real concern in the community because of the increase in spread so mass vaccination sites are very unappealing to a lot of people because it goes against the messaging that's been around this last year."

"Even when we focus on our churches, what kind of message does it send if Michigan is this hot red state and look how many churches held in-person Easter service."

Dr. Stephen Thomas, a professor of health policy and management at the University of Maryland School of Public Health and director of the Maryland Center for Health Equity, agrees that mass vaccination sites aren't the way to reach the nation's most vulnerable.

A mass vaccination clinic was recently opened at Six Flags amusement park in the heart of Prince George County, which is 65% Black and 20% Hispanic, "but who shows up at Six Flags? White folks,” he said.

“It’s a scramble but it’s also a big problem because the very people that need it the most are also maybe not as computer savvy, can't sit around after midnight refreshing webpages or can't stand in a line at an amusement park or stadium," Thomas said.

"Hesitancy should not be used as an excuse or a smokescreen for an allocation system that is still broken. And I think putting a life-saving vaccine on the internet, and not ensuring that everyone has access to it is a problem."

In Flint, they've shifted focus to increasing community-driven sites with no appointments required, Furr-Holden said.

In Genesee County, 33.6% of residents have at least one dose of vaccine, close to the state average of 37%. 

Additional vaccine sites will help, but they won't solve hesitancy issues, Thomas said, adding the characterization of the one-shot vaccine has made some reluctant.

In Maryland, Thomas works with a program called Changing Hearts and Minds About Institutional Racism focusing on bringing resource centers and vaccines to barbershops and beauty salons across the country. 

"I'm just being honest with you, I just came out of the barbershops today, they said ‘Hey, if we can't trust them with baby powder, how can we trust them with a vaccine?' All of this is happening at the same time," Thomas said.

As for what will work in Detroit, Thomas said, it has to start with reframing the messaging.

"They inadvertently dehumanize people, some of it is just jargon of the field, but now it resonates in a different way because of all the polarization in the country," he said. "It has to be more of a conversation that’s a two-way street. Not 'herd immunity,' we're not animals. 'Community immunity.'"