Vaccines for all: RHHD fosters creative partnerships to reach residents

We’re officially in fall and winter virus season, and for the first time, vaccines and treatments are available for all three major viruses—flu, COVID-19, and RSV. RHHD’s Public Health Nurse Supervisor, Joanna Cirillo, is making sure that as many residents as possible have access.

“Most of my thinking is focused on how we keep up what we’ve built as the [emergency order] COVID-19 support falls away. Our creative energies are going toward how we keep bringing these vaccines to folks.” Joanna says. Her team relies on relationships with community organizations that already work closely with people who may need extra vaccine support. Two particularly meaningful partnerships have taken shape with Health Brigade and Senior Connections.

Health Brigade: Care without stigma 

Health Brigade is the oldest free clinic in Virginia and provides a range of services for low-income and uninsured residents. Their Comprehensive Harm Reduction/Needle Exchange Program is one of only seven Comprehensive Harm Reduction (CHR) programs in the commonwealth (which have been authorized by the General Assembly since 2017).

Needle exchange makes sure that people who inject substances have clean needles to reduce the spread of HIV and hepatitis C. And program co-coordinators Dziko Singleton and Colin King bring these services—along with testing resources and blood draws—to participants. “We go to the same locations every week,” Colin says. “We’re a public health program, but we’re not medical professionals. What we know about the people we serve and love is that a lot of times they’re reticent to go get services in a hospital or a medical clinic for a variety of reasons, because sometimes it’s not safe. So what better way to bring services right to them?” Colin comes to the program from a social work background, and Dziko is a Certified Peer Recovery Specialist (CPRS). Like many Health Brigade team members, she “identif[ies] as having lived expertise as a person in recovery.”

Dziko calls needle exchange and Narcan distribution the “meat and potatoes of the program,” but both she and Colin define harm reduction much more broadly. “Doesn’t a safe place to sleep constitute harm reduction, as opposed to sleeping exposed in a park?” she asks. She describes a program participant walking into the office to chat: “that’s harm reduction, him sitting down with people he trusts enough to come talk to. I think some people look at recovery as only being abstinence based—and I’m in abstinence-based recovery—but it’s not linear. Anytime one of our participants lessens one of their riskier behaviors, when they’re proactive to come get Narcan for themselves and their neighbor, that’s recovery.”

Colin says that vaccination is a key part of making harm reduction comprehensive, and one that requires partnerships. “We can’t provide vaccines but we can talk to people who can and convince them that it’s important that they make it out here, that it’s part of their charge as public health professionals, that they have to come outside of their boxes and see people.”

And while partnerships enable a broader array of services, Colin and Dziko carefully vet organizations and volunteers joining the program. “They need to share our vision,” says Dziko. “We can pick up on stigma, people who say things like ‘these people, poor people.’ If the language is still steeped in stigma, racism, misogyny, we’re not gonna do it. We’re not gonna put our folks under a microscope, because all of us go through enough already.”

“And I think that’s why the partnership with RHHD was important, because we never got any of that pushback from the people we talked to,” Colin says. “It feels like the focus is on public health and making sure people have access to vaccination and [RHHD Outreach Coordinator] Cotina Brake’s resources on Medicaid. And that was a breath of fresh air.”

Cotina is responsible for making the connection between Health Brigade and Joanna’s vaccination team. Cotina met Dziko this summer and brought RHHD resources and COVID supplies to a Health Brigade event soon after. She witnessed Health Brigade’s values immediately: “I saw the amount of people lined up who really look forward to Health Brigade coming into their community. Their impact is showing substance users that they matter. They take their time to say, ‘you may be going through a sickness right now that you have no control over, but you still matter, and we’re gonna show you by bringing these resources to you.’”

RHHD’s partnership with Health Brigade capitalizes on the work both teams are already doing. “Health Brigade participants are already engaging in harm reduction practices,” Joanna explains. “There’s already a mindset of protecting themselves so it makes sense to also talk about vaccines they’re eligible for.” Her team hands out a flyer with information about different vaccines, risk factors, and eligibility so that participants can select which vaccines they need without having to disclose any medical conditions.

Dziko says that because the vaccination team is action-oriented and willing to show up even after hours for evening events, they’re building pathways for other kinds of medical care. “Once you establish that rapport and participants see how non-judgmental these services are, I think people are more apt to seek dental services, have their pap smears, their mammograms, prostate exams. It just opens up the basic human right for medical care. These nurses provide that whether they even realize it or not.”

Cotina credits the success of the vaccination program so far to Dziko and Colin’s consistency. “How many people would gravitate to me just standing there saying ‘hey, we’re giving out vaccines’? Versus someone who shows their face out there every single week—it’s a meet-you-where-you-are action. They were able to build that trust with people to say, ‘you see what COVID has done. And it’s still here. It may not be as talked about, but it still exists. Let’s do what you have to do to protect yourself. And not only saying that, but then being able to immediately provide that service.”

A month’s worth of newsletters wouldn’t be enough space to describe all the work Health Brigade—and the CHR program in particular—accomplishes around Richmond. It wouldn’t even capture Dziko and Colin’s deep passion for this program, which they say is “everything” and “worth it every day.” The coordinators organize needle clean-ups, testing, supply distribution, hormone replacement therapy, and referrals to social services, housing, and additional healthcare through Health Brigade. They run a monthly Community Advisory Board meeting to break bread with participants and discuss the program. And they work with organizations from Bombas—who recently donated more than 4000 pairs of socks—to From the Heart, a local group of women who crochet hats and scarves for participants.

Colin and Dziko encourage anyone interested in CHR services to learn more at their website and come out to an event. You don’t have to be a registered program participant to receive services, snacks, or water, but they encourage people to enroll for the legal protection the program provides. “The Virginia statute says if you are a registered participant on the CHR program, you have some protections,” Dziko explains. Colin adds that registration is confidential and you don’t need an ID to sign up: “the protection can feel small because it’s one little statute in a sea, but this is a right that you have, and these little things become important.”

Health Brigade’s CHR program is a complex operation that works to meet participant needs in as many ways as possible, but at the end of the day, Dziko says the message is simple: “Get vaccinated, get tested, know your status, be kind.”

Want to learn even more about Health Brigade and its work in our communities? On Sunday, Nov. 19, HB’s Darius Pryor will be moderating a talkback at the matinee production of 5th Wall Theatre’s Lonely Planet.

Senior Connections: A wall of protection 

Joanna’s team has also prioritized making vaccines accessible for older adults and folks with disabilities. “The reason most of us get our flu shot is to protect the vulnerable in our communities,” she says.

RHHD has found a partner in Senior Connections—Central Virginia’s Area Agency on Aging. This fall, Senior Connections received a grant from USAging to participate in the Aging and Disability Vaccination Collaborative.

Brittany Rose, who administers the grant for Senior Connections, says that the funding allows for some creative solutions—like gift card incentives—to getting vaccines in the arms of older adults and people with disabilities.

Senior Connections serves seven counties and the city of Richmond, so Brittany’s role involves communicating with different health districts and pharmacies to connect vaccine providers and communities who need vaccines. And that communication is critical in a year when the COVID-19 vaccine has been commercialized for the first time and the COVID-19 public health emergency has ended. “It’s been a challenge just making this transition from the emergency order to the post-emergency order,” she says.

USAging funding has been particularly useful as Brittany, RHHD, and other partners navigate the new financial parameters for both COVID-19 and flu vaccines. What Brittany has appreciated most about her partnership with RHHD is Joanna’s willingness to build a clear and consistent system before taking action: “she took the time to say, OK, I need to figure out how the process is gonna work internally so that when we have a conversation, we can be ready to go. So she came to the table with a very clear idea about process.”

As we approach the holidays, and Senior Connections and RHHD continue to partner on opportunities for older adults to be vaccinated, Brittany encourages people to remember the following:

  • The 2023-2024 COVID-19 vaccine is not a booster: “What I try to share when I talk with folks is that this is an entirely new formulation. So for folks who maybe haven’t gotten any of the vaccine before, you’re considered completely up-to-date once you have this.” Brittany reminds people who had a COVID-19 vaccine last year or early 2023 to go ahead and make an appointment to get the updated vaccine. And children under 5 will still need two doses, along with some immunocompromised folks.
  • Senior Connections is helping caregivers in addition to older adults and people with disabilities: “We have a lot of caregivers and multi-generational families, so while events may be organized with a focus on older adults anyone who comes can get vaccinated. You are that wall of protection—the more people who are living with and working with older adults who get vaccinated, the better protected they are.”
  • Even though COVID-19 vaccines are on the commercial market, you should still be able to access no-cost-to-you vaccines: “For people who are underinsured or uninsured, the Bridge Access Program is going to allow people to receive the COVID-19 vaccine at no cost to themselves. For everyone else, it will be billed through insurance. And for the flu vaccine, the health department is able to offer it to people who are uninsured.”
  • Reach out to Senior Connections to find a vaccination opportunity or if you’re part of a group who wants to host an event: The vaccination hotline for Senior Connections is 804-672-4494.