A federal recommendation to halt the use of Johnson & Johnson’s Covid-19 vaccine caused chaos and confusion in Vermont, as the state scrambled to cancel and reschedule hundreds of appointments for those lined up to get the one-dose shot.
The decision — and lingering uncertainty about the vaccine’s potential link to rare blood clot complications — has particularly affected one component of the state’s vaccination plan: clinics targeting those experiencing homelessness.
Of the 12 service organizations in Vermont that had scheduled clinics for the homeless population, four are planning to use vaccines manufactured by Pfizer or Moderna, and the rest are waiting for more information about the fate of the Johnson & Johnson vaccine, according to Deputy Health Commissioner Kelly Dougherty.
Mobile clinics in central Vermont planned to travel from motel to motel, providing easily accessible walk-in shots with the J&J vaccine. But the pause in its use forced the multi-agency initiative to cancel those clinics before they even began.
“Everything had been organized. We had all of our submissions. We had our dates or locations ready to go,” said Theresa Fennell, intake coordinator for Good Samaritan in Barre, which helped run the program. “And then we had to basically dismantle all of that and start from scratch.”
Now, the clinics are planned for two locations in Barre and Berlin using the Moderna vaccine, which has stricter requirements for storage. The J&J vaccine can be kept at room temperature, while Moderna requires colder temperatures.
“We’ve had to restructure these vaccine clinics such that, instead of going from each motel location, we’re going to be operating these central vaccine clinics and then encouraging people to come to the clinic,” Fennell said. “So that adds an extra element of trying to organize transportation for people who don’t necessarily have access to transportation.”
Rick DeAngelis, executive director of Good Samaritan, said that the vast majority of people they work with don’t have cars. The mobile clinics began as testing sites that could be held at motels to test as needed.
DeAngelis said he’s concerned about ensuring that those experiencing homelessness make it to follow-up appointments to receive the second of two doses. “When you’re scheduling the second shot, there’s a percentage of people that just won’t get to it,” he said.
Rita Markley, executive director of Committee on Temporary Shelter in Burlington, said she has similar worries. The social services organization held a vaccine clinic in its main location on Thursday, using Pfizer rather than Johnson & Johnson.
“We are elated to have the Pfizer vaccine” as an option, Markley said. “But the challenge of losing the Johnson & Johnson [vaccine] is that we won’t have the ease of the one-and-done.”
In White River Junction, the Good Neighbor Health Clinic had a clinic planned for the day after distribution of the J&J vaccine was halted, said executive director Dana Michalovic. The organization now has one scheduled for April 27.
The clinic doesn’t have the freezer facilities to keep the two-shot vaccines on site, so instead the Department of Health plans to bring doses to White River and the clinic’s volunteers expect to administer them, Michalovic said.
Whether and when Johnson & Johnson vaccinations will resume is still unknown. The federal vaccine advisory committee in charge of reviewing the issues is scheduled to meet on Friday.
“We’re hopeful that J&J will be back in the running next week but we just have to wait and see,” Dougherty said.
Access and fears
During her time running testing clinics, Fennell said she’s had the chance to meet with “nearly every person” in Washington County receiving motel vouchers. “It has been a great opportunity to talk about Covid, to talk about vaccination in general, and just to sort of build that rapport,” she said.
“A five-minute conversation with somebody can really communicate a lot of information, one-on-one,” Fennell said. “If I asked someone if they’re interested in being vaccinated and they’re sort of hesitant or they’d like more information, I’m right there in that moment to answer questions for them.”
That rapport may prove critically important when Johnson & Johnson appointments resume. Gov. Phil Scott has said at press conferences that he worries Vermonters who are already reluctant to get vaccinated will be more so due to the fear and stigma around the pause in its use.
Fennell said those experiencing homelessness might be more wary of getting vaccinated because they have a difficult history with medical institutions, or may want to avoid needles because they are former drug users.
But the main reasons for reluctance are the same as the general population: “The amount of disinformation that’s sort of floating around the internet can really plant the seed of fear or doubt for people,” she said.
Rebecca Goldfinger-Fein, executive director of the People’s Health and Wellness Clinic in Barre, said much of what seems like vaccine reluctance from the outside is simply lack of access.
When Fennell spoke to “people who are unvaccinated, a lot of them are pretty eager to get vaccinated, and so maybe it really was like the process and registering that was part of the challenge for people,” Goldfinger-Fein said.
DeAngelis gave an example of how different organizations and volunteers have been helping to ease people’s fear of the shot: At one staff meeting on the mobile vaccine clinics, a motel manager asked, “‘Is it OK to hold this person’s hand when they come in to get the vaccine?’”
“You or I may have a family member to talk with, or to make you dinner after, and they don’t have that,” he said. “So it’s great someone like us can do that.”
