Along a busy corridor in New Brunswick, New Jersey, dozens of workers gather inside temp agencies, where they wait for an informal network of vans to shuttle them to warehouses.

Many who are milling around here on French Street became eligible for COVID-19 vaccines more than a month ago, but few have secured appointments. One woman couldn’t afford to miss a shift. Another worried the side effects would make her too sick to work the next day, and 68-year-old Ramon Rosario said frankly, he didn’t know where to go. He qualified back in January as a senior citizen, but without a computer or steady internet access, he hasn’t been able to book an appointment.

“They’re making it difficult for me,” he told WNYC/Gothamist in Spanish. He said when a friend tried to help him, the available locations were too far to visit without a car. “I’m 68 years old. I can’t walk very far.”

With most appointments only available online, a digital frenzy has crowded out efforts to ensure doses are reaching the most vulnerable communities. That’s prompted a handful of local governments and clinics to begin reserving spots for residents and at-risk populations.

Some organizers said state officials have been slow to understand the barriers preventing people from getting vaccinated. They say they need more night and weekend appointments, more sites that reserve spaces for community members rather than open to anyone who can access the online registration systems, webpages translated into languages other than English and transportation to those vaccine hubs. They’re also calling for better coordination with community leaders.

“You’re missing the community part. That's why your programs don't work properly because you don't know the other side,” said Teresa Vivar, director and founder of Lazos America Unida, a group that supports Mexican-Americans. “We have the knowledge of the streets. We have the knowledge of our own lives and experiences.”

Governor Phil Murphy vowed to prioritize equity during the early days of New Jersey’s vaccine rollout. State health officials launched a call center in February where staff offer translation services and help people make appointments through the official website. But those efforts are falling short. State data show Black residents make up 13% of the state population but have received 6% of doses, while Latinos account for 21% of New Jersey but just 11% of doses. White residents comprise 54% of New Jersey and have received 55% of its shots.

They're counting on the counties to do the hard-to-reach communities.
Jim Tedesco, Bergen County Executive

“It’s not where it needs to be, there’s just no two ways about it,” Murphy said on WNYC’s Ask the Governor on April 28th. He said the state had made progress and would announce additional steps on Monday to vaccinate hard-to-reach areas in greater numbers. New Jersey does not provide demographic breakdowns by county or zip code for its vaccine data.

While Murphy has touted partnerships with churches to target people of color, ongoing research by the Kaiser Family Foundation shows Blacks and Latinos are more likely to turn to trusted health providers, friends and family to get information about the COVID-19 vaccines rather than religious leaders.

On Thursday, New Jersey’s health department announced all six megasites would open for walk-ins and no longer require appointments. The state health department will also deploy three mobile vaccine units in neighborhoods with low vaccination rates later this month. But community organizers say these efforts don’t go far enough, and county leaders confirmed the state had asked them to take charge.

“They're counting on the counties to do the hard-to-reach communities. That’s been their position,” Bergen County Executive Jim Tedesco said. “It’s the right thing. The state doesn't have the contacts... the state doesn't understand the dynamics in all 21 counties.”

In Paterson, the city’s vaccination site is primarily walk-in to ensure all residents can benefit. Bergen County formed an equity task force that targeted doses to the Lenape tribe and the homeless. The Visiting Nurses Association of Central Jersey allied with local groups to set up pop-up clinics inside food pantries, churches and nonprofits to deliver state-provided doses.

Governor Murphy said demand for the COVID-19 vaccine is slowing in New Jersey, similar to what’s happening in New York City and nationwide. But Tom Thees, executive director of the central Jersey VNA branch, said he expects demand for the pop-up clinics will continue.

“There's plenty of immigrant populations, plenty of farmworkers in these counties, there's plenty of part-time workers,” he said. “You've got an important segment of our community that needs to have easy access to a vaccine in order to embrace it.”

Trusted gatekeepers

In New Brunswick, a coalition of nonprofits, church leaders and a local clinic are furiously trying to vaccinate the community—especially immigrant workers—and setting up an operation to make sure everyone who wants a shot can get one.

Foot soldiers like Reynalda Cruz, who organizes with the nonprofit New Labor, pass out flyers for an upcoming pop-up clinic and write down the names and numbers of those interested. Workers pepper her with questions: How many doses and appointments will it take? What happened to the Johnson and Johnson vaccine? Will side effects make them too sick to work?

Many say it’s the first time someone has talked to them about the vaccine and their eligibility.

“No one has come here until now,” said Jose Enrique, a day laborer, who has yet to be vaccinated. “The problem is, we work every day.”

Cruz says she wants employers, who hire temps, to honor state law and pay sick days when workers get the vaccine or suffer any side effects. But Cruz says many aren’t following those rules or letting their employees know about it, and it’s hard for day laborers who multiple contractors can hire in the same week.

Another worker, Eliazar Jose, said a pharmacy refused to inoculate him because he was undocumented and lacked insurance. People are eligible for the COVID-19 vaccine regardless of immigration status or insurance. The Department of Homeland Security stated that it wouldn’t conduct raids at vaccination centers and encouraged undocumented immigrants to get the shot.

Once Cruz compiles a list of people, they are contacted by another organizer who helps them register on the state website. The process can be cumbersome because the page requires an email address and is only available in English.

A spokeswoman for the health department said translations were coming “soon.”

New Labor organizer Reynalda Cruz visits a temporary staffing agency in New Brunswick.

Vivar said her staff helps people register by sending them links through Facebook so they can use their smartphones—often their sole source of internet access. Once registered, another volunteer sets each person up either with an upcoming pop-up clinic or an appointment set aside for local groups by the Eric B. Chandler Health Center, part of Rutgers Robert Wood Johnson Medical School. Since March, this federally-funded clinic has used about half its doses on its patients and reserved the other half for local organizations.

“They seem to have a never-ending list of people they can send to us, and they're the constituents who want to see,” said Dr. Steve Levin, the medical director of Eric B. Chandler Health Center. Dr. Levin said they began setting aside vaccine slots because when the clinic relied on the state’s appointment site, people would arrive from all over New Jersey.

“We would get people driving here from an hour-and-a-half away, two hours away. They were not our constituency. And so we stopped doing that,” he said.

The clinic now partners with about 12 organizations as well as the local board of education to reserve slots for teachers. Thanks to the collaborations, inoculation rates for the Latino community increased from 19% to 32% over the last four weeks, he said. For the Black community, vaccination rates remained around 20%. New Brunswick is about half Latino and 15 percent Black.

Tamara Leech, a public health professor at Montclair State University, said in the absence of structural changes by the state to eliminate the digital divide and health disparities, relying on community groups to find solutions makes sense.

“This is probably one of the best approaches that we can do to recognize that the community members and the community organizations are actually the experts … are the ones who can move the needle for us,” she said.

But to ensure this penetration happens statewide, officials need to incorporate those models into their system, or a least incentivize it with sustained funding for the gatekeepers in the community, Leech said.

Health department spokeswoman Dawn Thomas said the agency directed $2.3 million in federal aid through grants to 31 community groups to improve vaccine access this year. Another $80 million from the Centers for Disease Control and Prevention will fund similar efforts though it’s not clear whether nonprofits will receive this money.