Why Oahu Neighborhoods Have Such Sharp Differences In Vaccination Rates

Six months after the first doses landed in Hawaii, more than 70% of people in one East Honolulu ZIP code have been inoculated against COVID-19.

But drive an hour north up to Haleiwa, and that percentage drops in half, according to the most recent data from the state Department of Health.

Despite a statewide vaccination rate of 57%, broad swaths of Oahu still have fewer than 35% of their residents vaccinated against COVID-19. In Wahiawa and large parts of the North Shore and West Oahu, vaccination rates lag noticeably behind.

Haleiwa is one of the areas of Oahu where fewer than 35% of residents are vaccinated against COVID-19.

The problem is multifaceted. Hawaii only rolled out the vaccine to the general public aged 16 and up about two months ago, requiring people who weren’t in priority categories to wait. The age of eligibility was lowered to 12 last month.

But a Civil Beat poll of more than 1,500 registered voters conducted in April found 12% of respondents didn’t plan to get the COVID-19 vaccine at all. A state Department of Health poll of nearly 500 Hawaii residents in April and May found 9% opposed the vaccine.

That still leaves thousands of people who may be open to receiving the shot, yet haven’t done so. State and private health officials say it’s a problem of access to COVID-19 vaccines as well as education about their effects.

That same state poll found the vast majority of Hawaii residents who haven’t gotten a shot yet said they were worried about safety and didn’t trust the vaccine. About 21% cited concerns about convenience.

“You can almost consider them to be a provider desert.” — Chantelle Matagi of the DOH

Julius Pham, who leads COVID-19 vaccination efforts at The Queen’s Medical Center, takes those convenience concerns seriously and is trying to address the geographic differences as the state races to get as many shots in arms as possible to allow a safe reopening after more than a year of lockdowns and restrictions.

Pham thinks by now, Oahu residents who were eagerly waiting for vaccines likely have snagged appointments. The challenge is reaching people who aren’t opposed to the vaccine but might not take it unless it is easy to get.

Vaccines have become more readily available in recent months, with some pharmacies offering walk-in hours, schools giving shots and mobile units conducting outreach. But people who live in remote, rural areas remain at a disadvantage, especially if they are already on the fence about whether to get a vaccine.

“It’s much easier for folks who live in town to get it,” Pham said. “(The vaccine is) easily available six days a week, seven days a week, here in town, whereas out there they might only have a clinic once a week so it would have to correspond to the day that they’re not working or they have the time off.”

“We hear it from people all the time: ‘If you hadn’t come out, I wouldn’t have gotten vaccinated,'” he added.

As of June 23, here’s what COVID-19 vaccination rates look like by ZIP code on Oahu. Screen shot/DOH data interactive

The DOH is responding to the need for more accessibility by partnering with community organizations in the neighborhoods with relatively low vaccination rates, said Chantelle Matagi, who co-leads the Pacific Islander contact tracing team.

She said geographic divides in vaccination rates reflect preexisting disparities in health care availability. Hospitals like Wahiawa General and Kahuku Medical serve many patients in neighborhoods stretching from Wahiawa to Hauula but have limited staff to produce mass vaccination events, she said.

“Unlike Kalihi that has Kokua Kalihi Valley, Kalihi Palama, Queens, those areas do not. You can almost consider them to be a provider desert,” she said. “(The pandemic has) really highlighted the inequalities and inequities within the medical system and that’s part of what we’re trying to address.”

The Health Department is also compiling data breaking down the percentage of people who have been vaccinated by ZIP code in part to help planners strategize on where to conduct pop-up vaccine clinics or other events.

Time And Time Off

One barrier to getting the vaccine is the availability of time: the time it takes to get to the vaccination site, the time needed to take off work for the appointment, the time it takes to recover from any side effects.

Haleiwa resident Rod Moniz got his vaccine through an event at Leeward Community College for public employees like himself. But when he tried to persuade a couple of North Shore friends to get vaccinated, they cited transportation woes.

“They were like, ‘It’s so far, it’s too long,’” he said. “They don’t want to fight the traffic.”

The time it takes to drive or take TheBus to an appointment and back is no joke on the North Shore, where tourists are back in full force and two-lane roads are notorious for lengthy traffic jams.

The North Shore’s congested streets may discourage people who are already on the fence about getting vaccinated. Anthony Quintano/ Civil Beat

It’s also a question of aligning time off from work with the vaccination day. That’s particularly hard for people who work jobs with limited or no paid time off.

Hawaii’s unemployment rate in May was still above 8%, about four times higher than pre-pandemic levels, but some jobs are returning as pandemic restrictions loosen and the visitor industry surges into summer.

Mervin Kuahiwinui, 47, lives in Mililani but works in Haleiwa at a clothing store and just got his second Moderna dose two weeks ago. He got the vaccine partially because his daughter is getting married next month and she really wanted him to be fully vaccinated before the wedding. But it wasn’t easy.

Every three or so days for about a month he’d refresh the vaccine appointment page at Longs Drugs. He could only see five days of appointments at one time and none aligned with his work schedule. He got discouraged and once, stopped checking for a week.

Then one day he spotted a Facebook ad for a vaccination appointment. He clicked it and was able to snag one at 6 p.m., perfectly timed with the end of his shift.

Matagi from the Department of Health said some Hawaii companies have requested vaccination administration sites, but when she and other health officials show up, only 10 or so people are there. Once she asked what happened and learned workers didn’t get time off to attend. “There seems to be a disconnect,” she said. 

Health officials from the public and private sectors conduct vaccine education outreach events in Kapolei. Cory Lum/Civil Beat

There’s also concern about the aftermath. An April poll by the Kaiser Family Foundation found that nationally, nearly half of U.S. adults who weren’t yet vaccinated worried about missing work because of possible side effects, which include temporary fever or exhaustion.

Gloria Fernandez, who leads the health department’s public health nurses division, said that was the fear of a single mother at an outreach event she conducted.

“Who is going to help me take care of my children?” the woman asked Fernandez, who at first wasn’t sure what to say.

Fernandez eventually helped the woman work through her options and figure out how to get a vaccine.

Gov. David Ige warned Friday that a slowdown in vaccination rates could hamper efforts to reach 70% of the state’s population, which is the benchmark he has set for lifting COVID-19 restrictions in the state.

“That’s a big concern,” he said Friday on the Honolulu Star-Advertiser’s “Spotlight” program. “I know people want to know when we project to hit 70%. It’s really hard to make that prediction because the pace of vaccinations has really fallen off.”

Fear And Facts

Information may be another barrier — both the lack of it and misinformation that proliferates, often on social media.

Fernandez’s team is responding by doing outreach events in places like Kaiaka Bay Beach Park in Haleiwa, going door-to-door in Waialua with the Waialua Community Association and accompanying food drives in Hauula.

Some progress has been made. More than 70% of Hauula residents are now vaccinated, and Laie’s vaccination rate is above 35%. But rates still lag in Haleiwa, Kahuku and Waialua.

Darrah Kauhane, who leads the nonprofit Project Vision, has been offering vaccinations weekly to Hawaii’s homeless community as well as the formerly incarcerated through partnerships with shelters and other organizations.

More than half usually accept the vaccine when offered, especially those who have experienced coronavirus outbreaks in shelters and jails, she said. Those who don’t usually say they’re not ready because they think the vaccine is too new and they’re wary of potential long-term effects.

“What we try to do is build trust with the client,” she said, adding that her team has persuaded people who initially said no to get a shot.

Emma Zoller thinks she might eventually get vaccinated but doesn’t want to yet because she is worried about potential side effects. Anita Hofschneider/Civil Beat/2021

Emma Zoller, 26, is among the North Shore residents who have had the opportunity to get the vaccine but so far declined. That’s because she heard from friends and on Instagram that the vaccine could interfere with her period.

“I want kids and that’s the most important part of the female body,” said Zoller, who is originally from Maui.

Some women have said the COVID-19 vaccine temporarily interfered with their period, but there’s no evidence that it leads to infertility.

Zoller hasn’t been worried about getting the virus itself because she’s young and lives in a house with other people in their 20s who she believes are at low risk.

“I know I’ll probably eventually end up getting (the vaccine),” she said, noting that it may be required for work, visiting loved ones or even attending concerts. “Until it’s absolutely necessary, I’m not going to.”

By Anita Hofschneider, Honolulu Civil Beat

https://www.civilbeat.org/2021/06/why-oahu-neighborhoods-have-such-sharp-differences-in-vaccination-rates/