When Lakeisha Brown knocks on doors to talk about the coronavirus vaccines, she anticipates tough conversations. Oftentimes, folks are confused or scared of the jab. They have plenty of questions but few opportunities to get answers.
“I try not to be pushy,” Brown said. “I’m not here to make your mind up for you. I’m here to help you along the way.”
Most people are grateful that she cares enough to reach out, and they welcome the pamphlets she provides dispelling myths and rumors about the vaccines. She’s often walking the blocks of impoverished neighborhoods that have been overlooked or abandoned by the health care system.
They were fishermen, artists, basketball coaches, bus drivers.
Once, while canvassing in Colfax in Grant Parish, a homeowner sicced his dogs on her. She escaped unscathed but wasn’t fazed by the encounter. She said she's used to the polarizing reactions vaccines now elicit. It’s the reason why her job is important.
Since April, Louisiana has trained nearly 300 canvassers to go door to door in hard-to-reach communities to get public health information about the coronavirus vaccines directly in the hands of residents. The targeted outreach is paired with pop-up vaccination sites and is one component of the state’s sprawling campaign to boost inoculation rates.
Canvassing garnered renewed attention last week after President Joe Biden highlighted the work as an essential tool in the nation’s vaccination drive. His comments came as Louisiana braced itself for a startling — and avoidable — surge in coronavirus cases, fueled by lackluster vaccination rates and made worse by an aggressive new strain of the virus known as the delta variant.
“We need to go to community by community, neighborhood by neighborhood and, oftentimes, door to door — literally knocking on doors — to get help to the remaining people protected from the virus,” Biden said Tuesday.
Louisiana began its experiment in vaccine canvassing months ago as the centerpiece of its “Bring Back Louisiana” campaign. The operation modeled itself after the get-out-to-vote campaigns that materialize ahead of elections, with the goal of mobilizing residents to attend pop-up vaccination sites at nearby churches and community centers.
The program kicked off with a pilot in each of the state’s nine public health regions and focused on ZIP codes with lagging vaccination rates that ranked poorly on a social vulnerability index, a tool used by U.S. Centers for Disease Control and Prevention to predict health outcomes. In a state like Louisiana, where well-being is often divided along racial lines, that primarily consisted of Black communities.
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To recruit canvassers, the Health Department has relied on partners with relationships within the targeted communities. That has included groups like Together Louisiana, a faith-based organization with statewide contacts, and the Power Coalition for Equity and Justice, which boasts of its ability to turn out more than a quarter-million Black voters. The “vaccine champions,” as officials call them, are paid $15 an hour for their labor.
“Most of the people I come in contact with I’m familiar with in some way,” said Brown, whose canvassing has centered around Alexandria. “I live in the community. I am the community. They trust talking to me.”
Before they’re deployed, canvassers undergo a rigorous module that prepares them with facts about the vaccine and tips on how to have constructive conversations that avoid defensive reactions. The training is administered under a contract with the Louisiana Public Health Institute, which developed the course alongside research from LSU and Tulane University on COVID-19 health disparities and community engagement.
The campaign’s overarching goal is to get shots in arms, but the canvassers' main priority is getting facts into the hands of the public. They’re taught to respect any questions that may arise and to engage in nonjudgmental conversations about the vaccine. Pressuring someone into getting the jab is explicitly off limits.
“Work for the yes but respect the no and have faith that the no will turn into a yes,” said Benjamin Nugent-Peterson, an organizer with Together Louisiana, reciting a mantra offered by one of his canvassers.
Oftentimes, getting to that "yes" requires canvassers to make multiple passes through a community. “This one woman told me, ‘I keep seeing you, and every time I see you, I learn something different,' ” Brown said. “She was like, ‘You actually care, so I’m going to go for it.' ”
The strategy is resource-intensive, but state officials argue it’s important that their public health strategy have an on-the-ground presence that meets Louisianans where they are, even if does make minimal gains in vaccinations.
“No one is under the pretense that canvassing is some silver bullet,” said Aly Neel, a Health Department spokesperson. “But community engagement, in and of itself, is important.”
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Louisiana’s vaccination rate continues to lag the nation, with just 39% of its population — or 1.8 million people — having received at least one dose, ranking ahead of only Mississippi. Meanwhile, around 55% of the United States population has received at least one dose.
As the pilot programs wound down, the state began tweaking its outreach formula. It began distributing information about nearby vaccination sites into its canvassing material, even if the pop-up event wasn’t specifically sponsored by the Health Department. And while door-to-door outreach made sense for dense, urban areas, it didn’t quite translate for sprawling, rural communities.
“We learned that we couldn’t force this model on every place,” Neel said. “We couldn’t have a rigid, cookie-cutter approach. We had to be nimble.”
In Bush, out in rural St. Tammany Parish, a crew of volunteer firefighters opted to set up an information table outside the local Piggly Wiggly instead canvassing door to door. Scott Brewer, the area’s fire chief, said his staff also weaved conversations about vaccine resources into their everyday work.
“You get a little fender bender, and while we wait for the police to show up, instead of sitting there staring at each other, we said, ‘Hey. We’re doing a vaccination drive. Got any questions? Here’s the info,' ” Brewer said.
Recently, the Health Department has begun to experiment with mobile vaccination sites, pairing canvassers with vans manned by Louisiana Army National Guard troops ready to offer doses on demand. That idea emerged after attendance at pop-up vaccination sites, which occurred after canvassing had taken place, was lower than expected.
“We found that a lot of people who would say they would get a vaccine simply wouldn’t show up,” said Dr. David Holcombe, the state’s regional medical director based in Alexandria. “That’s not to condemn them. People have complicated lives.”
The feedback canvassers gathered from residents on the ground also helped the Health Department craft alternate strategies to break down barriers to getting vaccinated. It launched a vaccine hotline, for example, with extended hours so residents who lacked internet access or were too busy during the workday could easily schedule an appointment or ask questions of a medical professional. The hotline has since fielded more than 5,000 calls and scheduled 2,300 appointments.
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The canvassing effort is continuously evolving as new information emerges about the coronavirus, the vaccines and shifting public attitudes. It remains the “heartbeat” of the state’s outreach efforts, officials said, even as the state promotes other strategies, like $2.3 million vaccine lottery.
“Even if we don’t see outstanding results on the front end, we’re building a better way to do this,” Nugent-Peterson said. “There’s no lack of challenges, but there’s still a lot to be encouraged by.”