Middlesex County, NJ has about 150 Food Pantry programs throughout the County spread across 25 municipalities. These include faith based organization pantries, soup kitchens and social service organizations. Each month, more than 15000 residents are served by these organizations. These pantries provide services to underserved populations that have been hard to reach in other vaccination and emergency preparedness campaigns. Most of the residents served by the food pantries have trust issues (government), compliance difficulty, and lack opportunities for education about current events. All are food insecure, some have residency concerns, some have no identification.

In May, 2021, during the height of the covid vaccination effort, we reached out to the local food pantries to foster partnerships with the hopes of increasing covid vaccination rates in this underserved population.  We sent flyers and vaccination information in time for food pickup the week before we intended to offer vaccine so the residents would have a week to prepare for vaccination. When residents came to pick up their weekly food, we were there with education and vaccine in multiple languages, learning in advance by our partnership the languages we would need to communicate for that group. Some people who arrived for food and vaccine brought other people for a vaccine. These pantry administrators and staff know their clients well and were able to help us reach their populations by using strategies they knew to be successful. By partnering with some of these food pantries, we were able to reach and vaccinate residents that were previously unreachable. Having partners (their trusted peers) from the pantry was the key to the success of the program.

And now, moving forward post COVID19, the food pantry partners will remain a valuable connection to reach vulnerable populations in future public health emergencies.

There is a combination of factors leaves the most economically disadvantaged particularly vulnerable to COVID-19. Covid 19 does not discriminate and the most vulnerable and economically disadvantaged are usually sidelined.  At the start of covid vaccination, Low income communities initially were being left behind, hard to reach, unable to reach , unwilling to reach.  The are sometimes seen as the forgotten vulnerable.

Our Health Services Office is a large public health dept that serves a county of almost 840,000 residents.  Our County has a well establish food pantry program which  has more than 150 food  programs across 25 municipalities which include faith based, community and public  and consist of food pick up, hot meals, and delivery.  There is a rising number of people served by these food programs, estimated to be between 15 and 20 thousand, but likely higher.  Many of these people do not have proper identification.  Some do not trust  us.  Some have no access to education about vaccines and health.  Some have many other members of their families waiting at home for the same information. 

Our health dept knew that some low income communities in our County were not being reached for vaccination in the tradition ways.  We had clinics in every geographical part of the County and we were still unable to reach this “forgotten group”.  We reached out the many food pantries, some churches, some communities and agreed to target our vaccine efforts to their constituents for vaccination by partnering with the leaders of these programs.  We worked closely with the leaders of the programs to ensure the best outcome for vaccine success.  We gave advance notice, we weren’t sticklers on ID, we had language interpreters and we didn’t care about residency.  They could bring their cousins, family, friends.  The vaccine was given in a place they trusted with leaders they trusted. 

For us, this was a new practice, a new and innovative way to reach a population that we never serviced before.  But moving forward, this will be our resource for offering health services to this ‘hard to reach” vulnerable population. 

As with the rest of the Country, when mass covid vaccination was open to all adults, Black and Latino populations,  lower income groups were lagging behind.  The challenge at that time was reaching those populations.  We had already set up vaccine clinics in our urban cities, train stations, churches, even street corners, but we were still not reaching more vulnerable populations.   This practice of vaccinating through food pantry was successful in reaching these populations.  In many of the pantry pick up dates, we were able to vaccinate up to 40% of the residents.  Some came back after their shot with other members of their family. 

If we had sufficient staff to return every week at the same pantry, we believe we would continue to vaccinate unvaccinated residents.  When word gets around that we become a trusted entity, we have more success.  When we stand next to a trusted partner, and have the endorsement of the food pantry , we have a chance to become a more trusted partner.    

Our initial meetings were with our local government officials, the health department, the County Level Food Bank managers, and 2 local affiliates of large chain pharmacies.  We had all seen the statistics about the lower vaccination rates in some populations. Our goal was to devise an innovative approach to bring vaccination to underserved, often forgotten communities.  We were looking to building partnerships and expand our capacity to deliver vaccinations.  By using a pharmacy partner to deliver vaccine at some of the pantries, it freed up health dept staff to oversee other parts of the clinics and to have more clinics. The  community/faith based partners, the ones who ran the food pantries, were the most important partners.  They were the direct conduit between health and the community and were the main trusted source.  

Community foodbanks, church food banks, public food banks all have excellent processes to reach their populations.  These are poulations we don't regularly identify (by individual name or group).  So reaching out to them without the benefit of the church/community leaders would be extremely difficult.   

This process of delivering vaccine to beneficiaries of foodbanks, while innovative, would not work without the partnerships of the faith based organizations, the community food banks or the public food banks.   

"If you build it they will come" turned out NOT to be the motto of the Covid-19 pandemic regarding vaccine delivery in vulnerable populations.  No matter how many vaccination clinics we "built", offered, or staged,  our efforts to reach severely underserved and vulnerable populations were more successful when we brought the clinic to them.  And even more successful than when we popped up clinics on city street corners to catch day workers, these innovative clinics partnered with food pantries were not only trustworthy locations, but will now continue to be trustworthly locations for health delivery to those vulnerable populations.  We have already reached out to several of these systems to offer flu vaccination .

Because this was a partnership with several partners, resources did not deplete any organization.  The Health department, pharmacy, food pantry, law enforcement all dedicated resources so the full burden fell on no one agency.  

As barriers arose..language, ID proof, law enforcement, location of clinic, we were able to make changes to better serve the population.  Because residents need time to adjust to getting vaccinated, we started handing out information the week prior to the clinic.  Because many residents don't want to show/don't have ID, we decided not to make that a barrier to getting vaccinated.  Because locating the clinic across the parking lot allows residents to "ignore" the clinic, we moved the physical location closer to the food pick up.  By adjusting the details to better serve this vulnerable population, we think we were successful, even in a small way, in reducing inequitable health program distribution.  

Partnering with food pantries to reach vulnerable populations will be incorporated into our general emergency response programs.  It will also be incorporated into our health education outreach programs post pandemic.  

The easy part of public health is offering vaccination and services to people who want them. (maybe during the pandemic with limited hours and resources it's a little more difficult).  The challenging part is bringing public health to people who are hidden, hiding, vulnerable and distrustful.   Their good health is good for all of us.