Inside a warehouse in northeast Washington, Adedolapo Adegbite packs a portable freezer with coronavirus vaccines and pauses to pull out a blue clipboard. She scans a list of patients, pulls her smartphone out of her scrub pants pocket and dials the first number on the list. After three rings, Peggy Omole picks up.
For nearly three decades, Omole has lived in a fifth-floor studio apartment in the southwest corner of the nation’s capital. While she used to greet guests and watch plays and world-renowned performers at nearby Arena Stage, she hasn’t sat in an audience for a long time. Eight years ago, a doctor diagnosed Omole with chronic obstructive pulmonary disease, “one of those diseases that doesn’t have a cure,” she said. Since then, Omole has been in and out of hospitals to treat her symptoms; her weight has dropped and a persistent cough rattles her frail frame. Her illness and the coronavirus pandemic have confined Omole, 73, to her home.
On the phone, Adegbite tells Omole she is calling from the D.C. Department of Health to confirm her appointment and that she should expect her at the apartment in under an hour. Adegbite preps and packs the 13 COVID-19 vaccine doses she plans to administer that day as she crisscrosses the city. That includes Omole’s.
Until this sunny October day, Omole was among four out of 10 people in the U.S. — nearly 140 million — who are not fully vaccinated against COVID-19. But one shot at a time, Adegbite and three other nurses with the D.C. Department of Health’s at-home program are working to improve the city’s vaccination rate. Originally designed to make COVID-19 vaccines accessible to people who could not leave their homes, the homebound program has expanded to include everyone in D.C., including people with small children and shift workers whose jobs may prevent them from reaching vaccination sites in time.
The pandemic forced people to think about “how we can transform health care to be much more community-based than it is right now,” said Dr. Taison Bell, an intensivist and assistant professor of medicine at University of Virginia Health System. To reach those people typically neglected by health care requires unconventional approaches that may be more costly, labor-intensive or slow, like at-home vaccinations, Bell said.
“It’s not as efficient as a mass vaccination center, but that doesn’t mean it’s any less important,” he said.
And it’s not just happening in D.C. Long after the initial burst of vaccine enthusiasm began to fade, cities and states in the U.S. are working every day to boost the nation’s vaccination numbers. More work needs to be done “community by community, neighborhood by neighborhood, and oftentimes, door to door” to inform and vaccinate more people,” President Joe Biden urged this summer, as the delta variant surged across the country. Since then, a variety of programs have popped up in many parts of the country — from Charlotte to Chicago — to improve local vaccination rates, some of them aimed at providing clear and critical information about vaccines and others, like the one in D.C., aimed at delivering the shot itself.
“Look, equity, equality — it remains at the heart of our responsibility of ensuring that communities that are the hardest hit by the virus have the information and the access to get vaccinated,” Biden said.
In the delta variant’s devastating wake, public health experts warn that cooler temperatures mean more people will spend time together indoors. Those who are unvaccinated are not only at risk of potentially lethal exposure to COVID-19 infection, but they also give the virus more opportunities to mutate into even more transmissible variants. Programs like D.C.’s at-home vaccination program represent a desperate race against time.
‘People are finally realizing’
Back in December, when the Food and Drug Administration began to authorize vaccines to protect people against the virus, Omole heard different — often conflicting — messages about the vaccines and their safety on television and in conversation, she said. For her, there seemed to be uncertainty swirling around the coronavirus vaccines — and it was so difficult for her to even leave her apartment — that she said she “didn’t want to bother with them.”
So she stayed home, in a protective if lonely cocoon, to avoid a COVID-19 infection and further strain her already compromised immune system. Occasionally, she was visited by her younger sister, Toni Foster, and her friend, Thelma Jones, a breast cancer survivor in remission and a patient navigator. Jones urged Omole to get vaccinated and, with Omole’s permission, called the District of Columbia Department of Health to schedule an at-home vaccination appointment.
Earlier this year, the city spread word through television ads, door flyers and on social media. Residents who hear about the program contact a call center, where they answer questions about their health and which vaccine they prefer. People still are surprised to learn that the vaccine is free to receive, Adegbite said — a common piece of misinformation that keeps some from getting vaccinated. People often don’t ask their health care provider for advice, she said, turning instead to friends and social media.
Overall, six out of 10 people in D.C. are fully vaccinated, while seven out of 10 have received at least one shot. Most of them received shots at one of the more than 100 vaccination sites scattered throughout the city. But the program has connected about 1,500 residents with life-saving vaccines, including dozens with booster doses, said Patrick Ashley, senior deputy director for Health Emergency Preparedness and Response Administration at the department. And it has worked so smoothly (so far), that the same model will be applied this winter to get more Washingtonians vaccinated against influenza.
“We’ll do anything it takes to get people vaccinated,” Ashley said.
Peggy Templeman and Lillian Bazemore, her full-time home health aide, each got their COVID-19 boosters during a visit from Adegbite to Templeman’s home in D.C. Brentwood neighborhood. Her doctor recommended she utilize the program because leaving her house was simply too difficult for Templeman, 90, a retired social work clinician who needs Bazemore’s help and an electric stairlift to get downstairs. Getting booster doses at home stripped away the risk while enhancing their protection against the virus.
For generations, factors often beyond a person’s control — race, income, transportation, proximity to care and job protections — dictated their ability to access health care. Together, these systemic barriers pose challenges for people who already “have so many other things going on in their lives and the vaccine is just not top of mind,” said Dr. Leana Wen, former public health commissioner for Baltimore.
But the home visit program has seen a recent surge in requests following federal vaccine mandates and more workplaces requiring employees to get vaccinated to work in-person, said Ashley Hennigan, Adegbite’s manager.
Hennigan organizes and distributes appointment requests to nurses like Adegbite, who each day loads up the cooler full of vaccines into a white D.C. government Honda Civic and drives as many as 80 miles throughout the city. In some houses, multiple people get vaccinated during a single appointment window. Fridays are busy because people tend to be off work or have more flexible hours, Adegbite said.
“People are finally realizing that COVID is really real,” Adegbite said.
‘I think I’ll be getting out more’
Stepping out of a padded elevator, Adegbite turns right and briskly walks a few steps down the gray carpeted hallway of Omole’s building. She wears a backpack filled with alcohol wipes, blank vaccination cards and Omole’s single Johnson & Johnson dose, enclosed in a coffee-colored sterilized baggie.
Adegbite knocks politely and the teal door creaks open. In the dim light, Omole sits on her loveseat with Jones and Foster. A television plays ambient chatter and canned laughter from behind a black lacquer screen with white cranes.
After greeting the three women again and introducing herself in person, Adegbite states to Omole that she requested the J&J vaccine. Jones, the friend, jumps in, saying the J&J vaccine isn’t as effective as the two-dose mRNA vaccines available. But Foster reminds her sister that it’s “better than not having anything.” They ask Adegbite what Omole should do — get a different vaccine?
Such conversations are essential to improving vaccination rates, especially in communities of color, said Dr. James Hildreth, president and chief executive of Meharry Medical College, an historically Black institution in Nashville. Systemic racism placed people in those communities at a disadvantage, making high-quality health care less accessible or affordable. And a history of abuse by the medical system has sown deep distrust among many Black Americans against providers. The pandemic made it harder for society to ignore those effects. When health workers go out and meet patients in the communities they serve, especially if they are from those communities, patients get evidence-based information about vaccines and the virus, Hildreth said. That way, they are then better able to make decisions in their best interests.
Adegbite had had the same conversation about different vaccines many times before with other patients. She briefly maps out the benefits of each one — all of which are offered by the health department — but ultimately, she tells Omole, “It’s your choice.”
Omole stands by her decision. She shifts on the loveseat and pushes up her ochre T-shirt sleeve. “They gonna catch hell trying to find some muscle,” Omole laughs, and everyone joins her.
For Adegbite, 28, this program is a chance to reclaim hope. She became a nurse almost three years ago, and started her career in a hospital in D.C., but then the pandemic upended everything. By early January, she sank into a depression — COVID caused the death of a loved one and one of her patients — and had to take two weeks off. Those moments made Adegbite struggle and wonder, “What else can I do?”
“Lord, what’s gonna happen?” Adegbite recalled. “And he answered. The vaccine came about.” Within weeks, she quit her hospital nursing job and applied to join the city’s at-home vaccination program.
She unwraps an alcohol wipe and draws a sanitized circle on Omole’s slender left shoulder. Adegbite makes the jab and Omole winces and yelps once.
As her 15-minute wait for any adverse reactions begins, Omole starts to talk about her fear of what might have happened if she had instead chosen to stay unvaccinated. She would not want her family to enter her apartment and find her dead. “That’s the worst thing you can do to your family,” she says.
Her decision was deeply personal but at the same time wrapped up in support from the community around her. Now, she thinks about the theater again, and even grows hopeful herself that she might see a show sometime.
“I think I’ll be getting out more,” she says.
Suddenly, she realizes the injection site on her left arm no longer aches. Adegbite fills out the date and dose on Omole’s brand-new vaccination card and hands it to her. It’s time to jump back into the white car and drive to another house, somewhere else in D.C., where another person is ready to get vaccinated.
Editor’s note: Johnson & Johnson is a funder for the PBS NewsHour.