As vaccine demand plummets, Ramsey County COVID specialist takes message on the road

Jul. 5—Mark Jackson was born into relief work, quite literally. The son of a Peace Corps director, Jackson was born in Kenya and raised at a young age in Liberia until civil war forced his family to return to Minnesota.

Jackson, who holds a degree in biology from Macalester College and a graduate degree in Global Health from McMaster University in Ontario, worked for the National Institutes of Health as a researcher before becoming a relief worker for the World Health Organization and various non-governmental organizations. It's a calling that has taken him to earthquake, typhoon and virus-outbreak disaster sites, mostly in Haiti and the South Pacific.

Throughout his career, he's combed through mass graves in the Philippines with search and rescue dogs, delivered vials of polio and measles vaccines by horseback in East Timor and negotiated with local governments that aren't always appreciative of the help.

On March 27, 2020, toward the outset of the pandemic, Jackson began a new job with Ramsey County Public Health as a COVID-19 Program Specialist at Mary Hall in downtown St. Paul, where the county housed symptomatic homeless residents.

Since December, he's overseen the county's community vaccination clinics, which are mostly geared toward populations that might otherwise be hard to reach.

All Minnesotans 12 years and older are now eligible for the vaccine, but demand has slumped in recent weeks, and clinics that once generated wait-lists and uninvited "vaccine hunters" now draw as few as three or four visitors. While 74 percent of Ramsey County residents age 18 and over have had at least one dose of a COVID vaccine, the U.S. as a whole is expected to fall just shy of President Joe Biden's goal of vaccinating 70 percent of the nation's adults by July 4. Check ramseycounty.us/covidvaccine for links to vaccination sites.

The following interview with Jackson has been edited for length and clarity.

Tell me about the highs and lows of this work.

What makes it worth it, it ain't the money, it's the satisfaction of being able to make a difference. At first, a pandemic is this big outside cloud. In the early days, we didn't know if we're supposed to wear a mask or if we're hand-washing enough. One of the ways you take back power is to be on the ground. I consider myself privileged. We had a really, really strong team, and it makes it a joy to do the work. We are getting this vaccine out, and testing, and hopefully saving the lives of our homeless folks.

The low point is rampant exhaustion. It's six- and seven-day workweeks. I haven't taken a full week off since March 27, 2020. But I wouldn't be able to sit on the couch. It doesn't feel right. If you can help, you have an obligation to.

Talk to me about the early days of the pandemic when you were working with the homeless at Mary Hall. Until the pandemic hit, the county hadn't been a provider of residential homeless services.

I actually lived in Mary Hall for the first two months. It was 24/7. Literally the day I arrived was the day we got our first client. Over the months, we got more staff, got people from Social Services to come in and manage it rather than Public Health. At the same time we were running hotel programs. Our whole goal was to decrease the sheer population density, and use federal relief CARES dollars to (help people) isolate better. That's still ongoing. Starting in June 2020 we saw the need for mass testing, so my role shifted.

So you focused on testing until a vaccination was available in January?

We did large drive-through testing sites with 500 to 1,000 people a day, and smaller ones at African-American churches, at homeless shelters, at the consulate of Mexico, at community sites. All that was done with M Health and Black Nurses Rock and the state emergency operations center. The state had the contracts with Mayo Labs to run all these nasal swabs we were collecting, as well as PrimaryBio, a software start-up out of California created to manage these massive testing operations and notification systems. They had a guy on the ground here in Minnesota who would literally change the software for us on the fly while we were standing in the parking lot. Without all that, we would have had far less of an impact than we did.

There was a big shift toward state-run saliva testing at Roy Wilkins Auditorium, which freed us up as a local public health agency to do the more nimble work at these community sites. We went to the closing session at Roy Wilkins, and I believe they did over 147,000 tests just at that site. Without them, if the state had not taken such a pro-active approach and set these massive sites up for testing and then vaccine, we would have had a much higher, much steeper hill to climb in Ramsey County.

And then you shifted toward vaccination?

We started vaccinating in earnest in the first week of January. Our testing team was also our vaccine team. Nasal swabs now become needles. As soon as the vaccine was available, we just switched tracks. We were able to roll it out quickly because we knew the folks, we had the locations lined up, we had the relationships. Those included Hmong American Partnership and Karen Organization of Minnesota.

It was pretty hard to get a vaccine just a few months ago.

In January, we were subject to some scarcity. Vaccine was prioritized by age and by profession. You're basically trying to build the plane while flying it. The amount of strain that this pandemic put on homeless shelters was crazy. We wanted to make sure we offered vaccines there immediately, as soon as we had it available in January and February. Luckily the vaccine shortage didn't last for too long. We're getting more and more from the federal government at the state level, and it's being rolled out county by county to the folks most able to use it.

It really became, how many clinics can you put up in a week? We had an incredible team who were manning the phones and maintaining these massive lists of eligible people. It's been a long 16 months. We did less than 1,000 doses of any vaccine in the prior year, and in the first six or seven months of 2021, we've given about 55,000 doses. There's countless people involved in this.

You said supply and demand shifted at some point — people used to show up uninvited, and now you can't give this away fast enough. Did you have to turn people away with a stick?

It didn't get to the point of stick, but there were some tense moments there. There's a lot of social media groups, one was called 'Vaccine Hunters,' and once a link got posted there, it was like a game of hide and seek. For the first three months, it was pretty difficult to manage people showing up. There were some pretty animated people. We did have a Ramsey County Sheriff's deputy on site. For Public Health people working on a Saturday, turning people away, that was a tough thing to do. I would say that phase was extremely stressful for myself and my team. If you go to our website right now, you can get into any clinic. You can even walk up, no appointment necessary. We are actually doing more vax clinics than in the past, 52 in June alone. This is to try to catch the maximum number of hesitant folks or people with a barrier of some sort. We are even doing home visits now for homebound people.

The county has spent a lot of time promoting equity in vaccine access. Why is that so important?

A virus doesn't care if you're rich, poor or about your race. But at the lower end of the socioeconomic spectrum, or if you don't speak English, or have transportation difficulties, or can't take time off work, it makes it that much more difficult. Folks who are less well off are disproportionately impacted. If you're a janitor, you can't miss work. If you literally can't get time off on medical leave, or take unpaid time, you're going to have to go to work and expose everybody else. So it's a domino effect. Some people don't have Internet access so they're not even going to be able to navigate the website to make an appointment. We tried to make sure our testing and vaccination sites were on public transit sites. There's a lot of community groups that were helping to get the word out and help promote these locations, and most importantly, that they were not going to get hit with a large medical bill.

Why are the people who are holding out actually holding out?

I had one gentleman who was convinced that 10,000 people had died from the vaccine itself. How do you counter that? If they already don't believe the government, how do you quote government data? I like to think of each person who gets vaccinated as an ambassador. That can change people's attitudes. Having someone who you trust in your life who has been vaccinated can make all the difference, as opposed to me sitting there with the written results of all these clinical trials. That's where Black Nurses Rock comes in, and the Oromo Community Center. We set up there every couple weeks. They know there's a translator there, and someone who is Oromo himself helping them. You can't just roll in and say 'oh yeah, you guys have to get this.' It doesn't work that way. There has to be trust.

How much have things slowed down?

Instead of 1,200 people on a day in March, on the Saturday of Juneteenth we set up at four locations, with over 16 hours of total clinic time, and we vaccinated less than 100 people. That contrast is pretty apparent there. At some point, online marketing only goes so far. It becomes groundwork.

Is a lot of vaccine getting dumped?

I don't manage the supply, but as far as I know, we have not had to throw out a significant amount. But that time is coming soon, especially for the Johnson and Johnson vaccine. The repercussions of when they put on that 11-day pause was quite bad. That pause turned a lot of people off. The rumor mill goes crazy. You can't blame the average citizen for asking questions.

At some point we should probably be shipping unused vaccine out to the rest of the world, no?

Rich countries have an obligation — not only a moral and ethical one — but it's also just a matter of self-preservation. These variants are going to keep popping up. Western, rich countries need to protect themselves by vaccinating the rest of the world. Obviously, any country is going to take care of its own citizens first, but nothing is going to get back to normal until we send this coronavirus to the place where we sent smallpox and have almost sent polio.

These vaccines took almost a year to roll out, but that was faster than many experts expected. That's a success story, no?

More than 99 percent of people who have died since the start of COVID were unvaccinated. I would not be surprised if these vaccines become the standard for all vaccines.