“We try to plan a route with the fewest potholes”: a Q&A with the head of a mobile vaccination team
If some people can’t make it to a vaccination site, no problem, says Ruben Rodriguez. He’ll go to them
Ontario’s vaccination rollout has been, at best, bumpy. In March, the province’s Covid-19 Science Advisory Table released a document pushing for the deployment of mobile, in-home vaccination units to inoculate Ontario’s 75,000 homebound seniors—many of whom are unable to travel to vaccination sites due to barriers, physical or otherwise.
But the issue of access doesn’t just affect the elderly, says Ruben Rodriguez, who—as the lead coordinator of Humber River Hospital’s Covid response team—has witnessed first-hand what’s standing in the way of giving Torontonians their shots. Through late March and early April, Rodriguez and a team of six nurses have hosted mobile vaccination clinics across North York and Weston. Here, he shares what it takes to bring medicine from the hospital to the home.
How did you end up running the mobile vaccination team?
At Humber River, I’m the director of Reactivation Care Centres, Long Term Care and Congregate Care Support. My regular job is to support our nine long-term care and nine retirement homes. When the vaccine rollout happened, because I already had those connections with the homes, I was assigned the responsibility of also supporting their vaccines. We did 35 homes in total.
What has the mobile rollout looked like so far?
The mobile-enhanced support team is about providing the vaccine to as many seniors as possible. In collaboration with the administration at the homes, we did their first vaccines in January, with a second dose in February. The intake rate among the population of long-term care residents associated with Humber River is 92 per cent, which is excellent, but we are currently doing another round to capture more staff members. Health care workers have to come to the clinic to receive the vaccine, and sometimes people don’t want to leave work to do it.
When we finish the nursing homes, we’ll ask if we can also support naturally occurring retirement centres, which is what we call residential settings with a large contingent of seniors that aren’t officially long-term care facilities. Many of these seniors don’t have the computer literacy to book appointments online, and some of them also have mobility issues, so arenas or hospitals are not necessarily the best environment for them. I’m advocating that we need to do more mobile work, because I’ve seen the success of it.
How does one go about vaccinating an entire building, start to finish?
First, we try to make partnerships in the community, with people who are already naturally engaged with that building—leadership in the long-term care community, obviously, but also service providers in our area, like Lumacare, Unison, Black Creek Community Health Centre and LOFT.
Those providers go door-to-door canvassing to see who is interested in receiving the vaccine, and they connect back with me to say, “Hey, we’ve secured 200 individuals.” We already have a formula for how many people we can do per hour: for 200 people, it takes three hours. Then I put in a request at the pharmacy for that number of vaccines, which is recorded as Covid data for the province.
And on the day of?
We go to the pharmacy and do what’s called a “transfer of custody” of the vaccine. Our team receives a cooler, which looks like the ones you take on a picnic, but ours have a temperature-monitoring system built in. The temperature has to remain between two and eight degrees Celsius, and we try to map a route to the vaccination site that we know won’t have much traffic or construction, to avoid bumping. My partner sits with the cooler on their lap.
When we arrive, we secure a room to do the preparation and thawing. Once we have 40 per cent of the syringes prepared, two pairs of nurses start going floor-by-floor and door-to-door in pairs. The other three people finish prepping the remaining syringes. When they finish, they join the rest of the team, so we can have up to five floors going at the same time. Some residents are able to walk down the hallway to come to us, but some of them have to stay in bed, which means their own staff do some of the vaccine observation. But they’re all trained.
How many other Toronto hospitals have a mobile vaccination team right now?
UHN, Scarborough and North York General. We meet regularly to strategize so we have a consistent approach across the city and so we can maximize our learning and be as effective as possible. Our mobile teams are constantly looking at what is happening around the world—the peer-reviewed research and the guidelines from the province—to be sure that we are following best practices that have been identified by the scientific community. There’s new data released every week. If it was successful somewhere else, we try to replicate it here.
A sizable number of vaccination spots are going unfilled. What barriers to access are still going unaddressed, and how can the mobile teams get around them?
We have a large community of people who don’t have the ability to access resources and book appointments online. So if we continue to only maximize the use of larger spaces—which require high literacy, ability to access the internet and whatnot—we will only be targeting those people.
We need to go directly into the communities with low-income families and new immigrants who might not speak English, and leverage relationships with their community leaders. A lot of them are in northwest Toronto—and the highest Covid positivity rates are in those neighbourhoods. I have a meeting today with UHN to see if our mobile teams can do an entire high-positivity postal code in one day to see what the intake is. That’s what we’re planning right now.
What’s missing from the most widely circulated Covid data?
Most of the data shows the percentage of people in Ontario who have been vaccinated. But what I’m curious to see is what percentage of people in the highest-incidence areas have been vaccinated. Also, if you look at the pharmacy campaigns, most are in areas where the incidence rate is not as high. In northwest Toronto, very few pharmacies are even providing the vaccine. That tells you we need better distribution.
What characteristics do you look for in staff when you’re assembling your mobile teams?
We already had people from different backgrounds who spoke a variety of languages, and we’re about to bring in more members. We’re currently looking for Spanish-speaking people, because we noticed a lot of the people in the community are Spanish-speaking. Now we actually specify that we’re looking for people who speak multiple languages.
What has the on-site response been like among the vaccine recipients? Do they like that you came to them?
The common theme is a sense of relief and thankfulness that they were able to do this in their own home. There was one lady in Black Creek who was interviewed by a reporter, and she said, “I feel so grateful that someone came to my door, and I don’t have to go through the struggle. I feel thankful and protected.” Her grandson was there, too, and he got really emotional. I think the significance of his grandmother being able to get the vaccine really hit him. I have my regular job, but whenever I can make time in my schedule, I roll up my sleeves, because I feel like this is a priority we should be focusing on.