Oregon's Looming Challenge: Vaccinating Essential Workers

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Oregon’s so-called essential workers stock grocery store shelves, staff cash registers, clean airports and muscle freight from loading docks in the midst of the pandemic.

Using masks and social distancing, they clock in, lacking the luxury of working from home like white-collar workers.

They also lack the luxury of free time to wait hours to get a needle jab to inoculate against COVID-19. Some also lack Internet access or a smartphone, which means the state cannot rely on an all-encompassing email blast or a cell phone app to learn about vaccine clinics.

Lawmakers on the Oregon House Subcommittee on COVID-19 heard about these challenges on Wednesday in a presentation about the state’s roll out of the vaccine. The presentation offered a stark reminder that Oregon’s work to immunize the population remains in the early stages, even as the state started this week to vaccinate K-12 educators, school staff and early childhood instructions, a group of about 150,000.

“We need to make sure that (essential workers) don't have to wait in line for hours,” Melissa Unger, executive director of the Service Employees International Union Local 503, told lawmakers. “Folks that have to work, can’t afford to miss work.”

The groups the state initially targeted for vaccination -- hospital and other health care workers, nursing home residents and staff, and now, K-12 staff -- are relatively easy to identify and contact.

But when it comes to essential workers, no one is even sure how to define them or how many there are, let alone how best to reach them and get them vaccinated. 

In an era of priority lists and limited vaccine supplies, Oregon’s hardy blue-collar workforce must wait -- and it’s unclear how long. Unless they have been laid off or sick, for nearly a year they have worked during a raging pandemic to feed their families and pay their bills. Yet, many Oregonians are in the state-mandated vaccination line ahead of them, including some 750,000 senior citizens.

The SEIU Local 503 represents about 72,000 home health workers, caregivers, airport employees and others in Oregon. 

Unger said one approach to reaching workers is to have vaccination events at work sites where possible, so employees know they have a spot. The SEIU worked with Oregon Health & Sciences University earlier this month to offer home health care workers drive-through vaccine clinics.

In that effort, an email went out to workers, Unger said, noting that they went to workers with access to email and technology.

People who cannot speak English or who lack Internet access need information earlier, Unger said. It’s critical to work with community groups that these residents know and trust: officials should do more than rely on a first-come, first-served basis to administer the vaccine, Unger said.

There’s also the issue of “vaccine hesitancy,” Unger said, adding this is different from anti-vaxxers who tout conspiracy theories and refuse to be vaccinated. 

Instead, these are people who may not trust the vaccine because it’s new. It “makes sense” that Black and brown people who have been harmed by the health care system and its historical racism would distrust a vaccination, Unger said, stressing the need to reach minority communities directly.

People of color have been disproportionately hard-hit with COVID-19 during the pandemic, prompting policymakers and public health officials to examine disparities and historic racism in the health care system.

Vaccination Priorities Evolve

Oregon’s vaccination priority lists continue to evolve.

The state’s vaccine advisory committee is working to prioritize the remainder of the 1b group, which includes K-12 employees, and will meet on Thursday to make recommendations. The sequencing is not yet hammered out, but the group’s priorities include people of color, refugees, people age 16 to 64 with chronic conditions, inmates, essential workers and multi-generational households.

Patrick Allen, director of the Oregon Health Authority, said the state will follow the committee's recommendations if they pass a legal and operational analysis. 

The state has received nearly 601,000 doses of vaccine so far, and administered 340,369 doses. Health care providers hold doses in reserve because the vaccine requires two doses spaced apart for each person.

Allen said health care providers are administering an average of about 13,000 doses a day, with peak days hitting about 16,000 doses. All locations that are administering the vaccine tell state officials they could give more doses if they received them, Allen said. 

“My message consistently is, you are all going to be disappointed with the amount of vaccine you are getting because you're all going to be capable of administering more shots,” Allen said.

Manufacturers ship the vaccine directly to hospitals and other providers like pharmacies and long-term care facilities. The Oregon Health Authority determines how much each provider gets. The federal government determines how much vaccine each state gets, based on demographic data.

Oregon wants to eradicate racial disparities in the vaccine push, yet it is unable to determine the race of tens of thousands of Oregonians who have been vaccinated, Allen said.

As of Wednesday, 46,223 Oregonians who had been vaccinated with one or two doses did not have a race listed in the demographic data. That’s about 16% of nearly 286,000 people who've started the vaccination process. It’s unclear why there is no racial data on these people. The deficiency is a “huge blind spot,” and stems from the system the federal Centers for Disease Control and Prevention uses to track vaccinations, Allen said

Vaccination "Traffic Jam" Predicted

Providers are still vaccinating the state’s 1a group, which includes health care providers, staff and residents in long-term care facilities and adults who live at home but have a caregiver. The group includes an estimated 300,000 to 400,000 people. 

Allen acknowledged that rollout was bumpy. Initially, only hospital workers could get a shot, which meant that hospital employees with little or no contact with patients, like billing and office staff, received shots before medical workers who treat patients at standalone clinics. The state eventually made vaccinations available to everyone in the 1a group at once. 

Allen said the initial plan was “probably more complicated than it needed to be.”

The state is still working to vaccinate this population, even as it began allowing K-12 teachers and school staff to get vaccinated this week. That’s happening before the vaccine is being made available to seniors age 65 and older.

That decision came under fire from health care providers and senior advocates who fear the delay endangers the elderly. About 90% of the Oregonians who have died of COVID-19 are age 60 and older. 

Gov. Kate Brown said the move is needed to get children into in-person instruction to help struggling families and youngsters.  

The state plans to roll out the vaccine to seniors age 80 and over the week of Feb. 7 and each subsequent week make it available to younger seniors. By the last week of February, seniors age 65 and older will be eligible to get a shot, but whether Oregon will have the needed supply of vaccines remains uncertain.

Allen estimated it will take 12 to 16 weeks to get through the senior population.

“This is going to create a traffic jam, if you will,” Allen said.

You can reach Ben Botkin at [email protected] or on Twitter @BenBotkin1.


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