DULUTH — On a sizzling Friday earlier this month in Duluth's Central Hillside neighborhood, Desiré Singer went around back to greet Ever Johnson in her garden.
Together, they talked about different kinds of greens already sprouting, picking weeds and having to do something to pass the time.
On the topic of a COVID-19 vaccination, Johnson, 62, had intended to go to a pharmacy, but was busy hosting her grandchildren, who were away at the nearby youth center. The day before, they’d been fishing together with hardly a bite.
In the presence of Singer, Johnson bit at the chance to get vaccinated.
“When can I get in quicker?” she said.
“I can get you in right now,” Singer replied. “I have clinics here on Fridays.”
And within the hour, Johnson was bandaged over the injection site and headed back to her garden from St. Luke’s hospital.
“I love my job,” Singer said afterward. “I generally work right here, dead smack in the heart of the community."
Singer’s outreach alone, coming as a community consultant for the increasingly influential Healthy Alliances Matter for All, is responsible for the vaccinations of 50 and counting African American residents of Duluth.
It is neither all of the Black residents who've been vaccinated among the nearly 111,000 county residents with at least one dose of vaccine, nor is it anything but a modest number compared to some of St. Louis County’s own vaccination sites, which have seen up to 800 people a day at peak.
But the story behind the effort since February to reach deeper into the Black community reveals a web of cooperation. It involves the spark of an idea from a Duluth city councilor, and strategy from a pharmacy college researcher at the University of Minnesota Duluth.
For the people doing the work, it’s about bridging cracks in systems through which people have historically fallen.
“We wanted to ensure we had access to vaccinations, and that people weren’t being missed when clinics opened,” St. Louis County public health educator Susan Vitulli said.
In this case, access to the vaccine means resistance from a disease that affects Black people at higher rates than other races, including fatalities at 1.4 times the rate of white people, according to The Atlantic’s COVID Racial Data Tracker.
“The immeasurable piece is how many of the 50 people would not have been able to access the vaccine and maybe gotten COVID — and who knows what those implications would be,” said Cassandra Beardsley, executive director for Wilderness Health, a nonprofit agency that serves to better network the region’s 10 independent hospitals.
“It’s deeply meaningful work that’s been done,” Beardsley added, “and it’s probably lifesaving.”
Seeds of action
For City Councilor Janet Kennedy, the idea sprung from work she’d started as a member of the NAACP’s health and equity committee. There, she studied disparities illustrated by factors such as better health outcomes in eastern Duluth versus the Hillside and parts west.
“There wasn’t a mechanism for communities of focus to have a nonprofit that specifically worked for health equity,” Kennedy said.
The creation of Kennedy’s nonprofit, Healthy Alliances Matter for All, couldn’t have been more timely, arriving during the pandemic.
Healthy Alliances gained immediate momentum. The local COVID-19 response was desperate for guidance on how to connect with a Black community already being overlooked, according to national data being collected on the penetration of COVID-19 testing and, later, vaccinations.
“Healthy Alliances Matter for All was sort of a brainchild I had that people really supported,” Kennedy said. “I had a good idea, and people were looking for a place to invest for equity.”
St. Louis County, St. Luke’s and Wilderness Health were among the organizations quick to partner with Healthy Alliances and incorporate its advocacy into planning and events. Healthy Alliances began tabling at COVID-19 testing sites, offering informative pamphlets and free masks.
Meanwhile, at the UMD College of Pharmacy, assistant professor Olihe Okoro was busy conducting grant-funded health disparities research, working to understand the way the coronavirus moved through the Black community.
“I’m not a bench scientist, the community is my lab,” Okoro said. “We didn’t just want data-gathering; we always want to see something come out of whatever we find.”
What Okoro found was not all information reaches people the same way — or even at all. Information about COVID-19 and its subsequent vaccines that seemed inescapable for the past 15 months didn't always filter into pockets of the Black community.
“Access to information is privileged, too,” Okoro said, citing barriers such as newspaper paywalls, television subscriptions and access to the internet or a smartphone.
A solution materialized around street outreach into Duluth's most isolated neighborhoods, where even public health announcements tended not to reach.
"One of the suggestions Janet and her team had was to dedicate a block of time to make appointments, tell people about the openings, and make transportation arrangements if they had to," Beardsley said. "It really became a way to make sure folks who maybe wouldn't have been reached previously, or reached later in the process, had access to somebody who could connect them to vaccinations."
St. Louis County public health nurse Joshua Gorham explained how Singer, working street outreach for Healthy Alliances, can do what the county could not despite its billboards, TV commercials, smartphone alerts and news releases.
“My ability to create relationships in that community is kind of capped,” Gorham said, in part, by the nature of his work being stationed at testing and vaccination clinics a lot of the time. “So, if we can extend our network using other people who live and work in the community, we’ll reach more people and establish more trust.”
Overcoming vaccine hesitancy, or a distrusting side-eye toward the medical establishment, isn’t a one-conversation encounter, said Vitulli, the public health educator.
“It’s a process,” she said. “That’s why it’s helpful to have more than one community partner. It takes three to four times ‘getting touched’ (by advocacy) before people can feel ready to make that leap.”
Value of the work
In order to do the work right, Okoro insisted it be done first-rate.
“Community health workers are doing a lot of work and a lot of times they’re doing it under the auspice of volunteering,” Okoro said. “But you can’t do this as a volunteer. It’s too time-consuming. It’s not sustainable on a volunteer basis. It needs to be able to be paid.”
And so it is, at a rate that surprised Singer when it was bumped up by $3 per hour recently thanks to additional federal pandemic rescue funding.
A one-time United States Marine who puts on her dress blues for appearances with the Duluth Honor Guard, Singer came to the work following her own legal troubles and some of her hardest days of her life brought upon by problems with alcohol. Homeless in 2015, treatment through the Veterans Affairs Medical Center in St. Cloud led her to confront her traumas.
“I believe in my heart that most folks on some type of mind-altering substance is because of something they haven’t dealt with,” Singer said while driving the Duluth streets.
Ever Johnson, seated in the back, spoke up for Singer.
“She is a go-getter, and she’s real good for the community,” Johnson said.
Turning to park, Singer sounded as if she had both arrived at her destination, and found her calling.
“This is my clinic,” she said outside St. Luke’s. “The people out here that I assist? It is me and it was me. I can empathize and sympathize with them. And I love it.”
Since February, she’s been going door-to-door along city streets and into areas strategically mapped out by Okoro and Kennedy, registering folks for the weekly Friday vaccine clinic at the hospital.
"I'll go where some folks are scared to go," Singer said. "But I've got Jesus with me."
Singer's standing appointments at St. Luke's every Friday for the folks she recruits have recently been shifted to midweek as the big-picture COVID response draws back from its peak.
But Singer and Healthy Alliances Matter for All aren't done. Kennedy is already looking for new ways to continue the work as the pandemic response ramps down. She's proud of what's been accomplished.
“Every person we get vaccinated increases our safety in our herd immunity, and decreases the incidence of a variant coming in and catching hold somewhere,” Kennedy said.
Demographically, it's difficult to know how many Black residents have been vaccinated in the city or county. Data on race is self-reported, and not required. Of the 111,000 people in the county with one dose, information for race is missing or unknown for more than 17,000, the county said.
But for those who've been a part of the equity work that unfolds every time Singer greets a Hillside resident on their sidewalk, at their doorstep or in their garden, it's been a success.
“My colleagues and I, we rally around the idea of this ripple effect,” Vitulli said. “Every vaccination given has a ripple effect. It touches many lives in families, communities, schools and workplaces. Every person who decides it’s worth it, and feels comfortable to make that decision, is a big win.”