ST. LOUIS — On a recent, chilly morning in the DeBaliviere Place neighborhood, a group of residents filed out of the Kingsbury Terrace apartments and climbed into a bus bound for a COVID-19 vaccine clinic.

As the bus wound through the city, and the residents — mostly seniors — rode to their appointments, several said they might not have made it without the ride.

"This is a blessing," said Alberta Smith, 67. She preregistered for a vaccination through two local hospital systems more than a month earlier. But this was her first opportunity to get one.

Area health agencies and community groups are mounting an unprecedented effort to vaccinate seniors and residents who are homebound, disabled or don't have internet or transportation.

The Urban League of Metropolitan St. Louis is holding one-day vaccination events at senior apartments with the state and the Missouri National Guard. Health departments and hospitals have set up telephone hotlines. Local health centers have sent staff to seniors' homes to get residents signed up, and organized buses to bring them to vaccine clinics. Churches and health clinics have held virtual town halls, to make sure parishioners and patients have the information they need about the vaccines.

"COVID-19 is really unprecedented in terms of, how deadly it is, that it's a communicable disease that's spread from person to person," said Rhonda BeLue, a public health professor at St. Louis University and chair of the city's Joint Boards of Health and Hospitals. "So there are a lot of unique things about COVID that really are going to require a serious all-hands-on-deck, urgent response to save the lives of the people in the St. Louis region.

"It's really a different beast, and it's going to require us to be creative and to really come together as a community to make sure that nobody's left behind."

Last Sunday, the St. Louis Housing Authority vaccinated 300 at its headquarters. Staff had called nearly every public housing resident older than 65 in the days leading up, making more than 2,000 calls, said housing authority Executive Director Alana Green. About 50 residents needed a ride to get there, she said. Buses from two local health care providers, Southside Wellness Center and the Five Star Center, picked up most, but a few lived too far away. The Housing Authority paid for them to come by taxi.

"Unless someone gives them transportation," said Southside Executive Director Ollie Mae Stewart, "they're not going to be able to come out and get the shot."

The providers, health departments and community groups behind the region's COVID-19 vaccination efforts know the stakes: the vaccines offer protection to the area's most vulnerable. 

Seniors are far more likely to have severe or fatal cases of the novel coronavirus. In Missouri, residents 65 and older make up 17% of the population, and about 18% of COVID-19 cases. But they account for 85% of the deaths attributed to the virus.

Vaccinating seniors

Though the scale and urgency is unprecedented, health experts say there are lessons to learn from past successes, from mobile vans to community health fairs.

In the past, public health agencies have reached people by going door to door, running mobile units like mammography vans, and by partnering with local organizations. At health fairs, they've offered basic care, like blood pressure checks, diabetes screenings and HIV tests.

Experts say that it will take efforts from health care entities and community organizations alike to reach the region's most vulnerable.

Almost a third of the seniors who requested COVID-19 vaccines through the federally qualified health center CareSTL Health did not have a telephone, said CEO Angela Clabon. On Feb. 15, when a winter storm hit the region, CareSTL staff sent out rescheduling emails and texts to alert everyone they could.

More than 100 people were scheduled to receive vaccinations that day — many for a second dose — and Clabon thinks about 40 people did not receive the messages. Staffers worked later in the week to call and reschedule the rest of them individually.

"That really was a stress moment for us, because we did not want for them to miss their second dose," Clabon said.

LaJunta Howell, 84, waited there for her vaccination last Saturday. She said seniors' abilities to get vaccinated depends on their support system. Her granddaughter, Faleceia Talley, brought her to the clinic that day.

"As you get older you need someone to look out for you," Howell said.

Throughout the pandemic, Urban League staff have gone door to door handing out masks and offering residents resources to help with basic needs like employment and utility assistance. On one morning earlier this month, two of the organization's urban engagement specialists, Jeremy Ferrell and Marlon Cook, went through the Kingsway East neighborhood handing out masks and flyers in the streets and convenience stores. Then they drove to a nearby, one-day vaccination event at CMC Retirement Village, on North Kingshighway Boulevard near Natural Bridge Avenue, to help residents sign in and get shots.

At the event, Missouri National Guard medics administered vaccines in the building's community room, where residents said, before the pandemic, they would play bingo and card games and watch television together. The hallway was turned into a waiting area on one end, with chairs lined up for those signing in, and, on the other end, an observation area, where residents were monitored in case of adverse reaction.

One resident, Joyce Coffey, 82, said she was overjoyed to receive her first dose of COVID-19 vaccine.

"I can't wait for the second one," Coffey said.

Like many seniors in the St. Louis area, Coffey said she needed someone to bring the vaccine to her. Coffey needs help moving around, getting in and out of cars and buildings. She said it would have been hard for her to go to get vaccinated elsewhere.

When she'd waited the full 15 minutes, Coffey was helped into the elevator by Ferrell and Missouri National Guard Sgt. Joshua Roth.

"I think this is great, that they're doing this," Coffey said as she rode the elevator up to her floor.

Ferrell accompanied her, helped her out of the elevator, and back to her apartment.

"I really, really appreciate you," Coffey told Ferrell when she was safely inside.

Do you have a vaccination plan?

Dr. Fredrick Echols, St. Louis' health director, said that eventually vaccination events could be held in churches and community centers, and other places that are easy for area residents to access. The health department will evaluate different sites in the city, to ensure they have enough parking, and are spacious enough to hold a socially distanced event. And FEMA is planning to provide a mobile unit to the city, to help vaccinate residents who are homebound.

"We have to stop putting the onus on the people in the community, and we have to do that heavy lifting for them," Echols said.

BeLue, the SLU professor and city health chair, likened the vaccine rollout efforts to voter registration. While in the past people have asked, "Do you have a voting plan?" the new question for St. Louis-area residents is, "Do you have a vaccination plan?"

Scientists believe COVID-19 may become endemic, and people may need booster shots in the future.

If the virus continues to circulate, COVID-19 vaccines may become part of everyday health care, like flu shots.

"This is going to be a long-term effort," BeLue said, "that's going to become part of our daily lives."