By Mahlon Meyer
Northwest Asian Weekly
At first, everything seemed to go wrong as Fu Chen Ming-yue, 91, waited for her shot. The Seattle Fire Department, which would administer the vaccine, was over one hour late (they were delayed at another site). She couldn’t readily understand the instructions. And, in the end, the entire process took a half hour, at least.
The problem was that all the accommodations needed to finally get the needle into her white, snowy arm, as she pulled up her sleeve, were a trade-off for the speed that the governor is demanding as he tries to have as many people vaccinated in the shortest amount of time.
Acknowledging this, the fire department coordinator on site, Acting Captain Brian Wallace, said, “If we were just plowing through the population, the eldest to the youngest, that would speed things up, but our goal is to target people that slip through the cracks.”
Indeed, it took a small army to get Fu vaccinated. Workers from the nonprofit Chinese Information and Services Center (CISC) went door to door yelling in Cantonese for residents to “da zhen” (get vaccinated). As more workers interpreted for her as she moved through the registration line, fire department staff took down a bevy of information, and more interpretation was needed to explain potential side effects.
“Some seniors feel anxious about getting the vaccine,” said Michael Itti, executive director of CISC. “The Seattle Fire Department staff showed great care and warmth with the seniors and even said hello in Cantonese or Mandarin at the registration table.”
But in the cramped lobby of the Imperial House, a low-income building where residents live in tiny apartments packed closely together, Fu could barely navigate her walker between all the chairs set up by technicians, medical personnel, and observers.
City leaders are aware of the dilemma. Even as they continue to push for more equitable distribution of the vaccine, which requires numerous supports and more time, they face pressure to distribute their doses as quickly as possible. Last month, Gov. Jay Inslee announced that those providers that did not use up all their vaccines within seven days could lose additional allotments, and paired up with Starbucks and Amazon to begin mass deployment.
“It’s a tension that folks have been discussing at various levels of government, between speed and scale up relative to equity,” said Seattle Deputy Mayor Mike Fong. “If you want to achieve and accomplish an equitable frame, it will require some of these supports, it will take some coordination with providers that have relationships with those communities, it will take interpretation and translation services, it will take us going to community rather than community coming to us.”
In some cases, the city has had to go to bat for local agencies that serve the most vulnerable populations.
While the Virginia Mason Medical Center, teaming up with Amazon, administered 2,000 shots last month, the only clinic in the Chinatown-International District (ID) capable of giving vaccines did not get a single dose allotted to it by the state for the past two weeks.
After countless calls to various government contacts, Teresita Batayola, president and CEO of International Community Health Services (ICHS), finally contacted the mayor’s office, which pressured the public health department for Seattle and King County. ICHS then obtained 500 doses.
“That call was the key fulcrum,” said Batayola.
But in deploying them, she and her partners in the CID sometimes faced even worse bottlenecks than the fire department did.
Aware that elderly, vulnerable people were spread out around the area, community leaders even as early as March made the decision they would have to organize them for testing or treatment in existing groups, by building or employer, said Maiko Winkler-Chin, executive director of Seattle Chinatown International District Preservation and Development Authority (SCIDpda), which receives funding from the city and manages low-income public housing in the neighborhood.
But reaching out to privately-owned buildings, particularly when they only had a few days to use their vaccine allotment (SCIDpda partnered with ICHS), was practically impossible, although Winkler-Chin achieved some success.
Oftentimes, despite working through multiple agencies and people, it took days just to contact the management of a building. Some, for instance, were owned by family associations or Tongs, with complicated ownership structures and opaque managerial systems involving family members and many others.
For one building, she was first told there were 15 people ready to be vaccinated. Later, however, someone else simply said there was “some interest.” ICHS, which was distributing the vaccines, had only days to use them up or lose their chance for more in the future. So Winkler-Chin, not wanting to jeopardize ICHS’ supply, asked for only 50 doses. In retrospect, she would have asked for more, she said.
With the help of ICHS, she and her staff quickly held shot clinics in the basement of one of their low-income buildings, the Bush Hotel, for residents and others. They also worked with the fire department at other locations.
But for those who don’t live in the ID or are not on the ICHS list of patients, there’s no immediate hope of even getting in the line for a shot. Many of the smaller, family-owned clinics in the ID have patients they’ve been seeing for decades who are scattered all over the area, from Rainier Valley to Renton.
Dr. Sing Lam has over 9,000 patients spread out around the region who come to him due to the trust they’ve built up with him over long relationships, he said. But Lam, who does not even receive doses of the flu shot until two months after the big pharmacies do, is unable to vaccinate his patients.
The sole pharmacy in the ID where shots could be distributed cannot handle the Pfizer vaccine, which requires ultra cold temperatures. Nor is there any plan to apportion it the Moderna vaccine, Lam said. As a result, only a handful of his patients have been vaccinated.
Like other marginalized populations, many of them are wary of the vaccine and rely on doctors they know, like Lam, to assuage their fears.
Still, it may take larger community organizations to step in.
“A doctor’s wife just emailed me while I’m on the phone, and she said most of her clients don’t live in the neighborhood, but I’m going to have to tell her that we’re really focusing on Chinatown and I will have to get back to her, that I’ll contact ICHS and the Asian Counseling and Referral Service for the organizations that they work with,” said Winkler-Chin.
Complicating the process, refugees and some immigrants often need a familiar face to overcome hesitation about getting a vaccine.
“I’m afraid to get a shot, but the virus is horrible. I’m even more afraid to get it, so I have no choice, I have to come,” said Huang Hui-lan, 73, standing outside the Imperial House waiting for the vaccine. Huang came to the U.S. from southern China in 1986 and worked as a seamstress until recently. CISC called her and in Cantonese urged her to get a shot.
And for those fleeing war and other catastrophes, the fear can be greater.
“Most of the refugees are kind of wary, they don’t know the system and have so many barriers, most need a friendly face to ask, ‘What’s going to happen to me, what are you going to do to me?’” said Dr. Uyenvy Pham, a family medicine and obstetrics doctor at ICHS.
Like 80% of her clients, Pham speaks Vietnamese, and she shares a background that allows her to reach refugees who’ve come through even the most horrific experiences. As a child, Pham fled Vietnam in a small boat that was regularly swamped with hammerhead sharks and attacked by pirates.
Another challenge is defining where the most vulnerable population resides.
“The CID has the highest concentration of seniors, the highest rate of poverty, and the highest concentration of those who do not speak English as a first language,” said Winkler-Chin.
Moreover, the limitations of low-income housing in the area could also contribute to outbreaks.
“Many seniors live in congregate housing where they share kitchen space and laundry facilities.
These risk factors, plus the use of online eligibility and appointment systems that require English and technology skills, mean seniors in the ID face many challenges and need assistance to improve their wellbeing,” said Itti.
King County, as a whole, however, gained 200,000 people, growing by 11% according to the 2010 census. Half of those were foreign-born. And yet online registration for a vaccine in South King County, which is the most diverse, is in English only.
Although the state changed its allocation formula last week, with the stated goal of giving weight to community health centers that serve low-income populations, the effects seem lagging.
This week, again, ICHS got zero shots (although it did get 100 booster shots for its Shoreline clinic).
“The State Department of Health has to start giving us guaranteed numbers so we can work on our elderly frail population,” said Batayola.
Earlier last month, the governor also broadened the criteria for vaccinations to include people over 65 years old along with those over 50 in multigenerational households, “but they left out equity in the distribution,” she said. “Unless they tie action to policy, it’s so easy to miss equity.”
Dr. Pham will be honored at a virtual event on Feb. 9 from 4-5 p.m., http://bit.ly/3qwXfqy.
Mahlon can be reached at firstname.lastname@example.org.