Evidence Shows Clinics on Wheels Increased Access to COVID-19 Services for Underserved Populations

Two new papers from Massachusetts General Brigham demonstrate the effectiveness of bringing COVID-19 health services to where people need them most. In early May 2021, the Massachusetts General Brigham team began providing COVID vaccinations to underserved populations in greater Boston by deploying mobile health centers to 12 predominantly low-income and racial/ethnic minority communities in Massachusetts. Using community medical vans, the teams offered readily available vaccinations without regard to insurance, immigration status or ability to pay.

In an article published today in American Journal of Public HealthMass General Brigham authors describe the success and challenges of a new program that had higher vaccination rates among adolescents, nonwhites, and Hispanics compared to statewide and local communities.

“To date, our program has provided nearly 20,000 doses of COVID-19 vaccination,” said corresponding author Priya Sarin Gupta, MD, MPH, medical director of community outreach initiatives at the Massachusetts Brigham and Kraft Center. “Our goal was to bring health and vaccination services against COVID-19 to the community and meet people where they are. Data from the first few months of Mass General Brigham’s Community Care Vans, sometimes called our ‘clinics on wheels,’ show that if you build it — and you build it well — they will come.”

In them AJPH Sarin Gupta and his colleagues describe what it took to build their program well and implement it effectively. Key elements of the program included:

• Engaging and partnering with community nonprofits, local health departments, and school board representatives;
• Staffing vans with trained multilingual staff and engaging a wide network of volunteers;
• Identifying the right places and times to reach communities most affected by COVID-19.

The program also used a “dual equity” model by partnering with a local transportation company that was threatened with downsizing due to economic losses during the pandemic.

In a companion paper recently published in Preventive medicine, researchers analyzed the results of the first three months of the program. From May 20 to August 18, 2021, medical vans conducted 130 sessions and administered 2,622 doses of the vaccine against COVID-19.

During the study, only 20 percent of people who received a vaccine from one of the mobile clinics called Bel. More than 56 percent reported their ethnicity as Hispanic (compared to a statewide vaccination rate of about 18 percent). In addition, the participants were mostly teenagers — the average age of those vaccinated in mobile clinics was 31 years. These early findings allowed the program to be replicated and expanded to more communities to maximize the program’s reach in communities serving people of color and those with high levels of social health-related need.

The authors note that mobile health centers can be used to address other public health needs other than, and sometimes related to, COVID-19. The vans are now expanding their offerings to include a menu of services to offer care for the alert and chronic diseasesincluding offering high blood pressure screening.

“We’re already seeing participants come to us who are interested in getting vaccinated and also getting screened for high blood pressure while they’re there, and vice versa,” Sarin Gupta said. “Some members ask us, ‘What are you going to give next?’ It gives me hope. If we can provide care with cultural humility and ensure that everyone has access, we can begin to overcome barriers like mistrust.”