Planning Magazine

On the Road to Vaccination, Transportation Is Key

For some groups, lack of transportation — not vaccine availability — is the biggest barrier to getting vaccinated against COVID-19.

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As of February, vaccination rates in some of New York City's wealthier zip codes were up to eight times higher than in parts of predominantly Black neighborhoods. Photo by James Estrin/The New York Times.

While state and local governments have been busy planning for and distributing COVID-19 vaccines, many have left out an important piece: how to provide transportation to people who can't get to those sites.

Millions of older adults and low-income people of color who are at higher risk of contracting the virus don't have cars, don't drive, or don't live near public transit. Some are homebound. Some live in rural areas far from vaccination sites.

Many older adults and poor people also may not have family or friends to drive them, says Denny Chan, a senior staff attorney at Justice in Aging and a member of the California Community Vaccine Advisory Committee, which recommends ways state officials can equitably distribute and allocate vaccines.

The vaccine rollout largely has been left to state and local governments, which are busy trying to keep up with heavy demand and short supply. While transportation hasn't been a priority, some areas, from New York City to Spokane, Washington, have come up with different ways to address the problem.

Aside from getting their own agencies and departments involved, state and local officials also should be partnering with charities and nonprofits that can help with transportation, says Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation.

"Transportation is often neglected, but it's often one of the biggest barriers to health care," Donovan says.

The homebound

One of the biggest challenges for state and local officials is getting vaccines to homebound older adults, says Steven Albert, chair of University of Pittsburgh Graduate School of Public Health's department of behavioral and community health sciences.

An estimated two million people 65 and older are mostly or completely homebound and another five million have health conditions that make it hard to get out, according to the Commonwealth Fund.

"This is an invisible population. They're not like long-term care residents in nursing homes," Albert says. "They are very elderly and frail and they live at home and are an afterthought, in some cases."

Some organizations that offer services to older adults are helping to bring vaccines to those who are homebound or to find transportation to vaccine clinics.

"Transportation is just critical to this," says Sandy Markwood, CEO of the National Association of Area Agencies on Aging.

In central Indiana, for example, an area agency has been reaching out to older adults to help them receive vaccines in their homes or to locate transportation to take them to vaccine sites.

And the Greater Wisconsin Agency on Aging Resources is working with transportation providers and volunteer drivers, some of whom have been vaccinated, to bring older adults to vaccination appointments, according to Markwood.

"I know everyone is struggling to do their best," Markwood says, "but right now, there needs to be a realization that when you're looking to serve older adults and people with disabilities there needs to be a level of support there, and without planning, it won't happen."

In December, Lyft joined a corporate partnership to provide free rides to vaccination sites for low-income and at-risk people. Photo courtesy Lyft

In December, Lyft joined a corporate partnership to provide free rides to vaccination sites for low-income and at-risk people. Photo courtesy Lyft.

Poor and rural communities

Vaccine transportation is also a problem for low-income communities of color, which are disproportionally affected by the virus. Public transit operations also have been reduced in many cities during the pandemic.

The private ride-sharing sector is offering some assistance. Uber announced in December a partnership with the National Urban League and other groups in which it will offer 10 million free or discounted rides to communities of color.

Lyft joined with corporate partners and nonprofit groups in December to launch a program that would provide 60 million rides to and from vaccination sites for members of low-income, uninsured, and at-risk communities.

Officials in some communities are considering using churches, schools, and grocery stores as places where residents can get vaccinated.

In New Orleans, city council member Cyndi Nguyen put together a task force that includes health and social services providers and community and faith-based leaders to map out a plan for her district, which includes the Lower Ninth Ward, a low-income Black neighborhood that was devastated by Hurricane Katrina.

In the Lower Ninth Ward, Nguyen says, there is only one clinic and no pharmacies, so officials need to come up with other solutions.

"You have to get the vaccine to where people are at. We've got to look at bringing in mobile vaccine buses and exploring other options like churches," she said. "We don't want people frustrated and overwhelmed because they don't have ways of getting to the vaccine."

In rural areas, some residents also are facing serious challenges getting to vaccine sites, which are often far away.

Even if state and local governments can make vaccines available at pharmacies, federally qualified health centers, hospitals, and rural health clinics, lots of residents don't live near one.

A December study by the University of Pittsburgh School of Pharmacy and the nonprofit West Health Policy Center found that 35 percent of U.S. counties have two or fewer such facilities per 10,000 residents. For older adults, the researchers found, in 12 percent of counties, at least half of the older population has a more than 10-mile drive to get to one.

Some solutions

While transportation hasn't been a priority, some areas have come up with ways to get people to vaccines — or vaccines to people.

New York City has launched a program for residents age 65 and over who have made a vaccine appointment at a city-operated site but don't have transportation. Staffers direct them to paratransit, ambulette, and taxi ride-hailing services. Some senior center programs also will provide transportation. City officials say they'll be able to offer about 10,000 rides a week.

In Miami Beach, fire rescue workers administered vaccinations last month at affordable senior housing buildings and the homes of homebound older adults. So far, they have vaccinated more than 900 older adults, and they plan to continue if they can get more vaccines, according to city spokesperson Melissa Berthier.

In Franklin County, Ohio, the Office on Aging last month provided free transportation to people 75 and older who had a vaccine appointment.

In Washington State, Spokane Transit is giving older adults door-to-door paratransit rides to their appointments at a mass vaccination site. The cost: $2 one way or $4 round trip for those who don't have a paratransit bus card.

In Austin, Texas, the regional public transit system, Capitol Metro, will send a wheelchair-
accessible paratransit van to pick up and bring home vaccine patients, said Dottie Watkins, the chief operating officer.

"Anyone in the public is able to use it, but our focus is supporting our lower-income and elderly community," she said. "Our goal is to make sure that transportation is not a barrier to people getting their vaccine.

This story was reprinted with permission from Stateline, an initiative of the Pew Charitable Trusts.

Jenni Bergal is a staff writer for Stateline. This story was reprinted with permission from Stateline, an initiative of the Pew Charitable Trusts.