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Story Publication logo April 26, 2021

The Next Phase Of Chicago’s Vaccine Rollout? Jumping The Hesitancy Hurdle

Image by Manuel Martinez / WBEZ. United States, 2020.

Tracking The Vaccine follows COVID-19 vaccine distribution across a historically segregated city.

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A sign for a Cook County COVID-19 mass vaccination site in suburban Chicago. The sign is bilingual in English and Spanish.
A sign for a Cook County COVID-19 mass vaccination site in suburban Chicago. Image by On The Run Photo/Shutterstock. United States, 2021.

Brittany Norment, a 33-year-old from Chicago’s Englewood neighborhood, wants to wait a little while longer before getting a COVID-19 vaccine.

“I would say I’ve decided I am going to get it. … I’m not opposed to it, [I] just want more time to see how/if it changes,” Norment said.

That’s a big shift from just a few months ago, when Norment heard a myth that the COVID-19 vaccine may cause infertility (it does not), and was concerned about getting the shot because of the medical community’s history of experimenting on Black people. She’s since worked through those concerns, but is still on the fence, not quite ready to roll up her sleeve.

She’s exactly the type of person the state of Illinois, the city of Chicago and, really, the rest of the country are focusing on in this “next phase” of the vaccine rollout.

Four months in, 53% of Chicagoans and 49% of Illinoisans have gotten a first dose. But recent surveys by the Kaiser Family Foundation and other institutions show that 37% of people across the country remain hesitant or opposed to getting the vaccine. And, racial and economic disparities in access are another hurdle.

Public health officials say that even as soon as the next two weeks, supply could outpace the number of people eager and able to get a vaccine. But with the so-called “herd immunity” goal of getting, at the very least, 70% of the population vaccinated, officials are next focusing on how to get those hesitant to get the vaccine on board.

“I think a lot of the people who are … most motivated to get a vaccine have gotten it at this point,” Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said in an interview with WBEZ. “But we’re excited, you know, about what comes next.”

Supply and demand

Parts of Illinois have already hit the hesitancy hurdle. That’s in part because vaccine skepticism is highest among Republicans, so some red counties downstate have been struggling for weeks to fill vaccine appointments.

“We’ve had multiple vaccine clinics throughout the area that have kind of gone unfilled,” said Dr. Joey Jackson, a family physician in Eldorado, Ill., near the border with Kentucky. “Even [at] the local health department’s last vaccine clinic … they had vaccines that they could have given to people that they didn’t.”

But even in Chicago, where vaccine availability has been strained for months, potential signs of a demand slowdown are afoot, Arwady said.

“Look no further than the United Center, where it was very, very, very hard … to get an appointment for weeks,” she said. “We now have appointment availability at the United Center — not a huge amount of it necessarily. But … if you look on Zocdoc (an online health care scheduling service) … there are appointments available at a half a dozen places across the city.”

Arwady also credits new appointment availability with increased vaccine supply. After months of pressure from Chicago, Illinois recently changed its vaccine formula to send more shots to high-demand areas, instead of basing allocations solely on population.

Chicago gets its own vaccine supply from the federal government and does not get additional doses from the state. But the formula tweak means more vaccines can be sent to collar counties around the city. In addition, the state sent Chicago a one-time shipment of 50,000 doses to help make up for vaccines lost due to the pause on the Johnson & Johnson shot.

Regardless, experts say getting the other half of the city vaccinated will require renewed, creative efforts — and fast.

Estimates from the Kaiser Family Foundation show vaccine supply could outweigh the number of people eager and easily-able to get a vaccine in the next two to four weeks. While that varies by state and locality, Arwady made a similar prediction.

One way the city measures supply and demand is by looking at the percentage of their allocation that they’re getting into arms within a week. While that number has hovered around 95%, Arwady predicts the city will see a drop, to perhaps around 70%, in the coming weeks. In suburban Cook County, officials are anticipating an uphill battle as well.

“We .. have gone to 1 in 2 of eligible individuals being able to be vaccinated,” said Israel Rocha Jr., CEO of Cook County Health. “But … we know that this next 50% … becomes harder, because these are the individuals that all of us will have to engage in bridging equity and getting vaccine, because this is going to have to now go into the hearts-and-minds campaign. We’re going to have to change hearts and minds to be vaccinated.”

The other half

In Cook County, “hesitancy” is highest among young people, Black and Latino residents and those who identify politically as Independent or Republican, according to a March survey from Loyola University of 1,195 city and suburban residents. Those statistics mirror national data.

Only 14% of white respondents express hesitancy about getting vaccinated — 27% said they already got a shot. Hesitancy rates are higher, and vaccinations rates are lower, among Black and Latino respondents, the survey shows.

Just 10 to 11% of Black and Latino respondents said they had been vaccinated. That’s as 23% of Latino respondents and 38% of Black respondents say they either probably won’t or definitely will not get vaccinated.

The Loyola survey, which collected ZIP code information, also found hesitancy was more prevalent in high-poverty areas of the county.

But study authors David Doherty and Dana Garbarski point to a crucial blindspot in this study and others: willingness to get the vaccine does not solely depend on whether someone believes it’s safe, that the pandemic is serious or even whether they want a shot.

It’s also about increasing access and ease, not just “changing hearts and minds.”

“The idea of saying that you definitely, or probably will not get the vaccine — some of that could be with respect to hesitancy, but some of what might underlie that is availability,” Garbarski said.

“Do you have time to take off of work to get the vaccine? Do you have transportation? Do you have high-speed internet that you’ve been able to get one of these elusive appointments available online? Like these are all different understandings that might be tied up in that, that at this point our data don’t necessarily discern the differences between all of those motivations.”

In Eldorado, Dr. Jackson reiterates that he thinks a large portion of the unvaccinated population are people who just haven’t been reached yet — a crowd that isn’t necessarily opposed to the vaccine, but is unwilling or unable to spend hours searching for an appointment.

“There’s still a gap in a lot of those people who are a little bit older, or even some people who aren’t nearly as technologically literate or even have access to the internet, who really don’t know that these things are occurring,” he said.

Vaccine rollout 2.0

This challenge is top of mind for Dr. Arwady, whose department has worked to prioritize under-vaccinated and hard-hit communities after the initial vaccine rollout showed major racial disparities in vaccination rates and access — disparities that still exist.

In her interview with WBEZ, Arwady described a new phase of the vaccine rollout where CDPH would set up vaccine pop-ups at libraries, laundromats or barbershops, for instance, with shots and information on-hand.

“We’ve been thinking here a lot about … where do people gather? Where do people wait? Where do people already go to get services outside of health care?” she said.

She also described a partnership with City Colleges to train everyday Chicagoans to be “vaccine ambassadors,” who can answer questions about the vaccine, combat misinformation and direct people to vaccine sites.

The department was light on the details, however, and did not respond to follow-up requests for more information.

But CDPH recently put out a $10 million request for proposals for a new effort that could bring some of Arwady’s vision to life.

That request splits the city into five regions, allowing providers to bid on all five areas or specific ones. Up to $2 million will be awarded to each region.

The city is asking bidders to serve Chicago communities with “strike teams” that would target under-vaccinated populations (similar to the city’s current Protect Chicago Plus locations that are set to expire). The winning bidder would also be required to hold pop-up vaccination sites regularly, with the ability to vaccinate 250 people a day at those events.

The Illinois Department of Public Health did not make someone available for an interview for this story. But according to press releases, it’s also taking steps to combat hesitancy. In April, the state announced a mobile vaccination team would stop in six rural counties with limited vaccine access — though that program may be paused due to suspension of the Johnson & Johnson vaccine.

In March, the state launched a $10 million ad campaign in English and Spanish to combat hesitancy. The ads are targeted to high-vulnerability areas with low vaccination rates.

In a recent appearance on WBEZ’s Reset, Illinois Department of Public Health Director Dr. Ngozi Ezike characterized a second phase of the rollout this way: “All the low lying fruit has been ticked,” she said. “So now we’re gonna have to do the ground game.”


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