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A Denver Health mobile vaccine clinic is seen on Wednesday, August 11, 2021. (Olivia Sun, The Colorado Sun)

In Colorado’s push to vaccinate as many people as possible against the coronavirus, these are the hardest days.

The delta variant of the virus is leading to a renewed surge in infections and hospitalizations. Health officials fear what will happen if the surge carries into the fall, when kids are back in school and respiratory illnesses like COVID-19 typically thrive.

But there are no more easy gains to be made in the vaccination campaign. About 65% of people in Colorado eligible to receive the vaccine — those ages 12 and above — are now fully immunized. That figure has increased by only 5 percentage points since July 1, when about 60% of the state’s eligible population was fully immunized.

The vaccination campaign has become a one-by-one affair: One conversation and one shot at a time. And, despite that challenge, it is moving forward. The number of vaccine doses administered in Colorado has increased slightly in recent weeks, to more than 59,000 doses per week.

To better understand where the vaccination campaign is having success, The Colorado Sun sent reporters to two very different places in the state — a Walmart parking lot in conservative northwest Colorado and an affordable housing community in the center of Denver. There, we saw two different methods of persuasion, each producing results.

A vaccine and new school clothes, or auto parts

CRAIG — Michelle Barnes had concerns about the coronavirus vaccine, but the fact that the uber-contagious delta variant was spreading across Colorado at the same time her teenage girls are gearing up for fall sports helped make up her mind. A $100 gift card to Walmart helped, too.

So on a baking-hot day at the end of July, the Steamboat Springs mom drove her 15- and 13-year-old daughters to a vaccine van parked outside the Walmart in Craig, about an hour up the highway. Each girl got a shot in the arm plus $100 to burn in Walmart. 

Gov. Jared Polis’ gift card program that began in late July is averaging about 650 cards per day and reached 12,952 cards by the middle of this week. On July 29 alone, the state gave out 1,182 Walmart gift cards at nine sites, including a mobile home park in Lafayette, a YMCA in Longmont and a food bank in Grand Junction. The cards are going fast, but “Comeback Cash” clinics are scheduled through Friday.

A line of people wait for COVID-19 vaccinations at a pop-up clinic outside Walmart in Craig, in northwest Colorado, July 27, 2021. Everyone who got a vaccine got a $100 Walmart gift card as part of a state incentive program. (Jennifer Brown, The Colorado Sun)

While a vaccination van parked in Craig typically gets about 10 customers in a day, the one giving away Walmart gift cards attracted about 45, according to state health department officials. The red van that parked for three days in front of the Craig Walmart was on a five-day tour, staffed by Denver-area health workers, through some of Colorado’s least-vaccinated counties. 

In Moffat County, where just under 44% of eligible people have received at least one dose of the coronavirus vaccine, the line for shots outside Walmart was 10-people deep when the vaccines began that afternoon.

Barnes’ 15-year-old daughter, Charley, planned to spend her gift card on school clothes. Her younger sister, 13-year-old Dixie, was looking for jewelry-making supplies. Both girls are on a mountain biking team, Dixie plays soccer and runs cross country and Charley plays lacrosse. 

Director of Aurora Interfaith Services Christina Stimson prepares boxes of produce for a food drive on Tuesday, August 10, 2021, at a Denver Health mobile vaccine clinic. Organizations around the metro host food drives and events to incentivize residents to get vaccines. (Olivia Sun, The Colorado Sun)

Their mom was worried about whether the vaccine was safe, especially after reading internet reports — widely debunked –that the vaccine could affect the girls’ fertility later in life. Then came the delta variant. Also, a friend of Barnes had two family members die from COVID-19. She worried about her daughters getting sick or quarantined from school and sports. And she heard about the $100 gift cards on the radio. 

“I want them to have as normal a school year as we can,” Barnes said.

Sidney Lawrence also had doubts about the vaccine, and even the origins of the coronavirus, but he was still in line at the Craig Walmart with his 12-year-old daughter so she could get a shot and a gift card. The seventh grader was looking forward to spending the whole amount on new clothes. 

Lawrence, his wife and daughter drove the 48 miles from Meeker to the vaccine bus. Although the $100 gift card was a definite draw, he was suspicious about why the government is paying people to get the vaccine. He said he believed the coronavirus was a biological weapon developed by China, and that the U.S. government is now trying to protect its citizens.

“The U.S. government just does not give away (medicine),” he said. “When they start giving away insulin and EpiPens, I’ll buy it.” 

Lawrence and his wife got vaccinated about a month before their daughter, after paying close attention to the health effects both of relatives who caught the coronavirus and those who got the vaccine.

“We were sicker than a dog for two days, me and my wife both,” he said. “My eyeballs hurt. Two days, I could taste sound.”

Gordon Burch, a 60-year-old mechanic in Craig, came to Walmart to get a vaccine so he could spend $100 on oil and car parts. He wasn’t moved to seek out a vaccine appointment during the past several months but decided to wander over to Walmart after hearing about the gift cards on the radio. It took about 20 minutes — five to wait in line and 15 to wait in the observation area — and he was done, thanks to the one-shot Johnson & Johnson.

Burch’s motivation was simple. “It’s a 100-dollar gift certificate.” 

Nine traveling vaccine vans, sweepstakes and scholarships

The Walmart gift card giveaways began in July to add oomph to the governor’s mobile vaccine campaign, which includes nine vans that travel across the state. Polis’ office started talking to bus companies back in March, and partnered with Yankee Line to launch the program’s initial four vaccination buses in April, bound for Weld County.

Then, looking for a way to sweeten the offer, the governor’s office decided to spend federal coronavirus relief funds on $100 Walmart gift cards for anyone who would get vaccinated at selected pop-up clinics. 

The gift cards have increased participation at mobile clinics by about threefold, state health officials said. 

The initial plan was to spend $1 million on gift cards, with Walmart donating 10% of the cost and the rest coming from interest the state earned on federal coronavirus aid. That paid for 11,000 gift cards, but the program has surpassed that by about 2,000, so far. No end date has been announced, and state health officials said it could continue for two to three more weeks.

Volunteers prepare boxes of produce for a food drive on Tuesday, August 10, 2021, at a Denver Health mobile vaccine clinic. Organizations around the metro host food drives and events to incentivize residents to get vaccines. (Olivia Sun, The Colorado Sun)

The mobile vaccination program was “an initiative that came down from the governor to meet people where they are,” said Brandy Emily, head of the state health department’s health equity branch. And the gift cards were the added incentive to get people to go get a vaccine on their lunch break, or make an extra stop after work, she said. “People work long hours. They have busy lives. We are just trying to make the vaccine as accessible as possible.”

“Some of them just need that extra push,” Emily said.  

Traveling health care workers gave COVID-19 vaccines outside Walmart in Craig on July 27, 2021. People who got a vaccine also received a $100 Walmart gift card as part of a state incentive program. (Jennifer Brown, The Colorado Sun)

Not every pop-up vaccination clinic around the state gives out the gift cards, however. The 102 gift card locations in 21 counties were chosen in part based on vaccination rates in the surrounding area. People can use their gift card 24 hours after receiving the shot, and they can qualify whether it’s their first or second dose of the COVID-19 vaccine. Participants are required to fill out paperwork with their name and birthdate so that health workers can check to see whether they are already vaccinated.

The gift card giveaway comes after Colorado spent a total of $6.25 million on five $1 million weekly drawings in June and early July for people who had gotten the vaccine, as well as 25 college scholarships of $50,000 each for vaccinated Colorado teenagers. Residents who received at least one dose were automatically entered into the drawings. A Colorado mother of four was the fifth and final sweepstakes winner in early July. 

“It is not a convincing thing for me”

DENVER — Adrien Matadi stepped out from his place in the shade on a 97-degree day and called toward a man who had just received his first dose of vaccine.

“Which one did you get?” he asked, smiling.

Matadi works as a care navigator with Denver Health’s Refugee, Immigrant and Migrant Navigation Program — also known as the RIM program. On a typical day, pre-pandemic, he might arrange medical appointments for members of Denver’s refugee and immigrant communities. Or he might help families find housing. Or he might provide crucial cultural insight for doctors hoping to better understand their patients. A refugee himself, from the Democratic Republic of the Congo, he speaks six languages and has lived in four countries.

But these days, much of his time is consumed with improving COVID vaccination rates among refugees and immigrants in Colorado.

Denver Health Care Navigators Adrien Matadi, Kuang Oo, and Rasulo Rasulo pose for a portrait on Wednesday, August 11, 2021, at a mobile vaccine clinic in Denver. Care navigation is often seen as an important role between patients and clinicians to assist individuals with healthcare choices through consultation and social work. (Olivia Sun, The Colorado Sun)

On Tuesday, Matadi and the RIM program’s two other navigators attended a food distribution event at a community organization on East Colfax Avenue in Denver, where they handed out information on the vaccines and answered questions. On Wednesday, they were back at work again, sitting patiently at a mobile vaccine clinic in Denver’s Park Hill neighborhood, ready to provide whatever help was needed.

This is the compassionate tedium of the current vaccination effort — a campaign of diligence and availability. There are times when Matadi will spend an hour on the phone with a single family.

“There’s always these hard rocks,” he said of people with strong reluctance to receive the vaccine. “And whenever they are like that, I say, ‘OK, no problem. I respect your time. When you want to learn more, call me.’”

A week or two later, they often do.

Since the start of the pandemic, navigators with the RIM program have reached out to more than 10,000 members of Colorado’s refugee and immigrant communities. At the beginning, it was mostly to warn about the dangers of the virus and to encourage community leaders to cancel cherished events or take other precautions.

“We are a people of events,” said Rasulo Rasulo, a navigator originally from Somalia who spent most of his early life in a refugee camp in Kenya before coming to Colorado.

“It was a moment for me to explain and to give them the reality from a cultural aspect and a religious aspect.”

But as the pandemic shifted, so did the work. Navigators helped community members find testing and helped coordinate food deliveries to people quarantining. They arranged medical appointments for those who were sick. They offered comfort.

“We had community members die,” said Kuang Oo, a navigator originally from Myanmar who came to Colorado after living in a refugee camp in Thailand. “We were traumatized a little bit. The community was a little traumatized.”

And, then, the work shifted again. The navigators became Denver Health’s frontline representatives for the vaccination campaign in their communities — fielding questions, scheduling appointments and, as fully vaccinated individuals, serving as walking embodiments to the vaccines’ safety.

It was a uniquely challenging job. Some members of the refugee and immigrant community come from countries where routine vaccination is rare and unfamiliar. Others are from places where previous vaccination campaigns for different diseases have been botched — leading to deaths or injuries.

Ethan Flores, 14, receives an initial dose of the COVID-19 vaccine on Wednesday, August 11, 2021, at a Denver Health mobile vaccine clinic. (Olivia Sun, The Colorado Sun)

The navigators also had to counter misinformation across dozens of languages, often originating in countries far away and for murky geopolitical reasons.

“Sometimes, it was like, wow, where are they getting all these things?” Oo said.

But the approach never wavered. The navigators met regularly with a doctor to go over the concerns they were hearing. They returned to the community with answers and with ears open for more concerns. This would be a long process, they understood.

“It is not a convincing thing for me,” Rasulo said. “It’s giving the correct information so they can understand it and make their own decision.”

And even if that decision wasn’t what they hoped, the navigators knew they had done their jobs.

“I know that I’ve conveyed the correct message and that message is going to travel within the community,” Rasulo said.

A call from Papa Adrien

Slowly, but surely, the work paid off.

In February, when only people in the general population ages 65 and older were eligible for vaccination, Denver Health looked at its rates. It found that 46% of English speakers and 51% of Spanish speakers had received at least one dose of vaccine. But the rate was only 34% for its non-English, non-Spanish speakers — a group Denver Health uses to approximate the community its RIM navigators work with.

By August, though, the rates had increased. Now looking at its patient population ages 12 and older, Denver Health found that 52% of its non-English, non-Spanish speaking patients have received at least one dose of vaccine, compared with 45% for English speakers and 55% for Spanish speakers.

Dr. Kristine Rodrigues, the medical director for the RIM program, was in awe.

“In the work that they have done this year, they have saved more people than I ever will in my entire career,” she said.

This approach is the epitome of the right-place, right-time, right-messenger method to vaccine persuasion.

The navigators are all highly respected in their communities — some used to work for Lutheran Family Services, literally greeting refugees as they arrived in Denver. They regularly attend events in their communities. People trust them with their lives and the lives of their loved ones.

Oo tells a story about trying to persuade an elderly woman to get vaccinated. The woman asked him to call her son, who lived in another state and didn’t plan to get vaccinated himself. But, after a conversation, the son asked Oo to schedule an appointment for his mother.

“He said, ‘I trust you. You have been helping my family have access to care for a long, long time,’” Oo said.

Matadi is so well-known in Denver’s refugee community that he’s often referred to by the title of Papa — an honorific bestowed upon esteemed community leaders. He’s made thousands of phone calls during the pandemic, and he said 70% of the time people recognize who he is before he says his name.

He counters misinformation by offering up himself as an example. Look, he says, I work in health care, I’m seeing what’s happening on the ground. I got the vaccine, and I’m fine.

And, when he’s successful, people will say back to him: OK, but I want to get the vaccine you got.

“That brings joy,” Matadi said. “I feel I can exhale. I’ve done my job.”

One more person protected in the battle against coronavirus.

Jen is a co-founder and reporter at The Sun, where she writes about mental health, child welfare and social justice issues.

Her first journalism job was at The Hungry Horse News in her home state of Montana, before moving on to reporting jobs in Texas and Oklahoma. She worked for 13 years at The Denver Post, including several years on the investigative projects team, before helping create The Sun in 2018.

Jen is a graduate of the University of Montana and loves hiking, skiing and watching her kids' sports.

Email: Twitter: @jenbrowncolo

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage.

Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior to that, he held internships at the Rocky Ford Daily Gazette, the Colorado Springs Gazette and the Rocky Mountain News, among other publications. He also interned one summer in the public relations office at the Cheyenne Mountain Zoo, where he got to sit on an elephant's knee and get his photo taken.

John was part of The Denver Post's 2013 Pulitzer Prize-winning breaking news team for its coverage of a shooting at an Aurora movie theater, and, in 2015, he was a Pulitzer finalist for a series he wrote on parents whose children suffer from a rare form of epilepsy and the help they hoped to find through Colorado's medical marijuana system.

Email: Twitter: @johningold