When the coronavirus ripped through Lewiston last summer, Abdulkerim Said and other health workers went door to door to recruit members of the city’s immigrant community to get tested for the virus. Within a few hours, they had more than 100.
Now Said and other community health workers are hoping to help the city’s immigrants access coronavirus vaccines and potentially bring an end to the pandemic in one of Maine’s hardest-hit cities. But the vaccine poses new challenges. Even if Said gathered hundreds of residents in a day, “we are not sure all the clinics in the Lewiston area have enough vaccines,” he said.
Shortages of vaccines have been a central theme since Maine extended vaccine eligibility to older residents last month. But the early rollout has also highlighted racial inequities, with Black Mainers accounting for only 1.1 percent of vaccinated patients who report racial data despite comprising about 1.6 percent of the state’s population.
That is despite significant disparities in virus cases, with Black Mainers remaining about 3.5 times likelier than white Mainers to have gotten the virus, according to state data. Immigrants make up about half of Black Mainers, with community leaders pointing to workplace exposure and crowded housing arrangements as drivers of transmission.
Much of the early vaccine gap likely stems from the state’s eligibility requirements. Mainers 70 and older are the current priority and immigrants skew younger. But as they do outreach in their communities, advocates also say complex registration requirements and barriers to information and transportation limit access for older immigrants in Maine.
Said, executive director of the Lewiston-based New Mainers Public Health Initiative, said he agreed with the state’s decision to prioritize older Mainers, who are most likely to die from the virus. But he wondered if communities of color could also receive some priority.
“Maybe a little bit of vaccine could have been reserved for people of color, because we were disproportionately highly impacted by COVID-19,” he said.
Maine’s initial rollout targeted staff and residents of congregate care facilities, health care workers, first responders and other critical COVID-19 response workers. The state then extended eligibility to people age 70 and up in mid-January. The state’s latter phases target Mainers between the ages of 65 and 69, those with certain pre-existing conditions and some frontline workers before but do not mention race.
After immigrant leaders expressed concern last summer that their voices were left out of planning to combat the spread of the virus in their communities, the state set up a vaccine equity task force that meets weekly and includes leaders of several community groups.
“We are working aggressively with these communities because we want them to help develop those plans then to empower their communities to figure out what is the best way, when it is each individual’s time to get vaccinated, that there are no systematic barriers to them doing so,” Department of Health and Human Services Commissioner Jeanne Lambrew said last week.
Maine DHHS is also taking applications from organizations aiming to improve vaccine equity, provided that groups can show the ability to administer at least 1,000 weekly vaccines. Maine Center for Disease Control and Prevention Director Nirav Shah said proposals were approved in Penobscot and Aroostook counties and the agency was optimistic about one in Washington County, which has the biggest Hispanic and Native American populations per capita in Maine.
In Androscoggin and Cumberland counties, where Maine’s population of African immigrants is most concentrated, community groups are working to educate immigrants about the vaccine and connect those who are eligible with providers.
Navigating the different vaccine registration systems — a challenge for many older Mainers — is especially difficult for immigrants for whom English is not their first language, said Mufalo Chitam, executive director of the Maine Immigrants’ Rights Coalition.
While Black Mainers occupy a significant portion of the nursing home workforce in Maine, she noted, few older immigrants are residents of long-term care facilities. Instead, many live with family and rely on relatives for transportation to a vaccine site, making organization harder.
“We have to handpick the elderly from our neighborhoods in order to take them into the vaccination sites,” Chitam said. “If they were categorized as a congregate [setting], they would work directly with CVS as a unit.”
Many immigrants come from countries that have seen mass vaccination campaigns for other infectious diseases, Chitam noted, which helps reduce vaccine hesitancy. But Said acknowledged that some misinformation still goes around on platforms such as WhatsApp.
The Maine Immigrants’ Rights Coalition translated informational sheets into eight languages, including Somali. Hospitals including St. Mary’s Regional Medical Center in Lewiston have shared fliers about the vaccines in more than two dozen other languages. Community health workers who got vaccinated have also made multilingual videos talking about their experiences.
Androscoggin County, which includes Lewiston, ranks eleventh out of the 16 counties in terms of the share of its population vaccinated. Said, who is eligible as a health care worker, received his first dose of the Pfizer vaccine at Scarborough Downs last week but acknowledged that such travel was not an option for everyone.
The Birch Street Health Center in Lewiston, a federally qualified health center that serves some of the city’s immigrant population, began offering vaccinations earlier this month. But the clinic has only received 100 weekly vaccines at most, and did not get any this week as statewide supply remains limited. Lewiston’s two hospitals, Central Maine Medical Center and St. Mary’s, were allocated a total of 1,500 vaccines, according to the state’s order.
State officials say supply remains the biggest barrier to the rollout, as the demand for vaccines among seniors — and the capacity of health care providers to administer vaccinations — continues to exceed Maine’s weekly allotment from the federal government. Said agreed.
“People are eager to vaccinate themselves, especially now in our community,” he said. “We are educating people for the next month or so, so people will be willing to be vaccinated. But do we have the vaccine?”