By Anne Blythe

Juan Diggs scrolled through his phone while he was being monitored with a dozen or so others inside a former department store after getting a first dose of the Pfizer COVID-19 vaccine.

The 47-year-old Greensboro resident was among the more than 3,000 people who booked and showed up for an appointment Monday at the federally supported mass vaccination clinic at Four Seasons Town Centre in Guilford County.

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Diggs, who makes car parts for a living, thought long and hard about whether he even wanted a vaccine.

“I was nervous,” he said through the blue face mask covering his mouth and nose, its straps looped around his ears. “You know all the basic stereotype of Black America.”

As Diggs sat in a folding metal chair, waiting for a member of the National Guard or Air Force staffing the Federal Emergency Management Agency site to bring him his second-dose appointment card, the Black father of two elaborated on what gave him that extra nudge to overcome his vaccine hesitancy and join the nearly 2 million people who have been partially vaccinated in North Carolina.

“I just kind of went with my gut,” Diggs said.

Hope to attract diverse crowd

Even before the state began rolling out vaccines in late December and early January, health care advocates cautioned that people in communities of color might be hesitant to get a shot.

In North Carolina, there has been a persisting mistrust of institutional medicine among Black people. They often cite a state-sanctioned eugenics program, which sterilized nearly 7,600 men and women from 1929 to 1974. Many bring up the Tuskegee Syphilis Study in which adequate treatment for the sexually-transmitted disease was withheld from a group of infected poor Black men.

Even as such episodes have sowed suspicion and possibly suppressed turnout for a jab, the Rev. William J. Barber II, former head of the state NAACP, has urged public health officials to question whether a lack of access to trusted resources and vaccine clinics might be a larger driver of why the numbers were lower in communities of color.

Man wearing blue face mask, black ball cap sits in chair with his phone out
Juan Diggs, a Greensboro resident, received a first dose of the Pfizer vaccine at the FEMA mass clinic at Four Seasons Town Centre. Photo credit: Anne Blythe

In Hispanic communities, some have raised concerns about having to show documents or IDs that might draw the attention of immigration officials.

Mandy Cohen, secretary of the state Department of Health and Human Services, has repeated many times that information being gathered at vaccine sites will not be shared with immigration officials.

At the FEMA site in Greensboro, which Cohen visited on Monday, no ID is required to sign in for an appointment.

Spanish speakers are on site to share important information and respond to questions.

By staging a massive vaccine clinic that is equipped to administer 3,000 doses each day of the week until late April, state health officials hope it might provide a missing piece to an accessibility puzzle that has long stymied health equity advocates.

“What I’m particularly proud of, not only are we getting vaccine out quickly, which is clearly, clearly top priority, but we’re also getting it out equitably,” Cohen told reporters gathered in the parking lot of the Four Seasons Town Centre in Greensboro, where FEMA staged the indoor and drive-thru clinics.

The Four Seasons Town Centre is nearly midway between Murphy in the far reaches of western North Carolina and Manteo at the eastern edge of the state. The shopping center is right off Interstate 40, where it intersects with Interstate 85.

Man in face mask, blue medical gown, purple gloves gently rocks Pfizer vaccine vials
Air Force member gently rocks Pfizer vaccine vials at Four Seasons Town Centre clinic. Photo credit: Anne Blythe

“We are seeing such a high rate of folks from our underserved communities being served here in Greensboro,” Cohen said. “We’re seeing more than 25 per

cent of our African American communities here. We’re seeing more than 15 percent of the appointments for the Hispanic or Latinx communities.”

The Black population in North Carolina is about 22 percent of the state’s nearly 10.5 million people. Hispanic and Latinx people make up 9.8 percent of that tally.

Cohen and her staff look at the daily numbers from the Greensboro site, as well as the information fed into the state’s newly created database, to closely monitor the race and ethnicity of those getting vaccinated in North Carolina.

Conversation in communities of color

“Fast and fair” is the mnemonic motto adopted by Gov. Roy Cooper and his public health team for their vaccine distribution plan.

The idea is to leave no distributed doses on the shelf between the weekly federal government shipments while also ensuring that doses go into arms representative of the state’s diverse population.

Cohen has been having Fireside Chats with pastors (called “cafecitos” in Spanish), civil rights advocates and leaders from underserved communities, answering questions and listening to ideas in hour-long sessions often posted to YouTube or social media channels.

Men and women in military fatigues enter information into computers
National Guard and Air Force members at the FEMA vaccine clinic in Greensboro collect information for the North Carolina COVID-19 database. Photo credit: Anne Blythe

On March 12, Cardra E. Burns, senior deputy director of the state Division of Public Health, moderated a discussion between Cohen, the Rev. T. Anthony Spearman, head of the state NAACP, and Barber, whose list of jobs and projects includes co-chair of the Poor People’s Campaign, president of Repairers of the Breach, architect of North Carolina’s Moral Monday movement.

Barber and Spearman both shared their vaccine experiences.

“I had the opportunity to get the Johnson and Johnson, the one shot,” Barber said. “I’d been studying the two.”

Barber has a daughter who has a public health doctorate and he discussed the different options with her before getting vaccinated at a mass vaccination clinic in Raleigh’s  PNC Arena in early March.

“She said, ‘Daddy, you know all of the three have great efficacy, and move forward.’ I was surprised by how once you get in line, it’s really not a long time,” he said. “I did not have any side effects. Just a little soreness for about an hour or so. The staff was great. You know, we did it outside.”

Recognizing fear of needles

Beyond the concerns of the often cited eugenics and Tuskegee experiments, Barber mentioned that there are many people who don’t like the idea of getting jabbed with a needle.

“You know, we need to take that seriously,” Barber said. “Many people are petrified of needles. I didn’t know when they stuck me. Literally, I was like, ‘what,’ because I was doing something else and the lady was talking to me and she said, ‘finished,’ and I mean literally it was that quick.

“You think about that. That quick so you don’t end up on a respirator for that long. That quick so you don’t have to go see are your oxygen levels staying at a rate that can keep you alive. That quick so that other variants of this disease can’t touch you. Just that amount of time to extend your time, to extend your time with others around you.”

Man in blue medical gown loads COVID vaccine into a syringe
Air Force team members pay close attention to detail while loading the Pfizer vaccine into syringes at the FEMA mass COVID vaccination clinic in Greensboro. Photo credit: Anne Blythe

Spearman initially had a vaccine appointment scheduled in late January, but it was a week in which the state sent Guilford County’s vaccine allotment to a large event in Mecklenburg County.

“Here in Greensboro, about 10,000 people, their appointments were cancelled,” Spearman said. “We didn’t know when they would be getting back to bring another allotment into the Greensboro area so I was calling around — I was really acting like a chicken with his head cut off — calling around to Raleigh and the neighboring counties to see if I could get in there and get my shot because I was ready to go out and do the work encouraging people, having had a vaccination, to be able to encourage them to go forth and do the same.”

On Feb. 4, Spearman got his first dose at the Mt. Zion Baptist Church in Greensboro. It was a very cold day. He sat in his car for nearly five minutes before his appointment and then waited 15 minutes after the inoculation to be observed for any potential adverse reaction.

Blue and white syringes for Pfizer vaccine
Syringes for Pfizer COVID-19 vaccines. Photo credit: Anne Blythe

“I experienced a little soreness in my arm, but nothing more than that,” Spearman said.

When he got the second shot, three weeks later, Spearman again felt nothing.

“I was joking with the nurse about the needles that I had seen on television, and the needle, if it was as long as the needles that they showed on television, it didn’t feel as though there was a needle at all,” Spearman said. “So by the time she was finished, I didn’t even know I had had the vaccination. …I have not had one symptom.”

Spearman and Barber have committed to sharing their experiences with others while also incorporating information into their church services to build vaccine trust in trusted places.

‘Get on fire about getting these vaccines’

For the more than half a million people across the country who died from illness related to COVID-19, with more than 11,700 in North Carolina, Barber called on the living to go forward with a goal of making things better.

“We really, in the face of all this death, I think have a moral calling to live, and then I would add to live better, not just live, but live better,” Barber said. “The pandemic had its chance. Now we have to take our chance. It’s been on fire for a year. Now, we’ve got to get on fire about getting these vaccines.”

The flame needs to burn brighter if such efforts are going to bring true equity.

North Carolina has improved on its goal of getting Black North Carolinians vaccinated, now up to 16.5 percent of the population.

Greater strides are needed in Hispanic communities, with only 3.8 percent at least partially vaccinated.

Dark-haired woman wearing face mask talks with blond-haired woman
Mandy Cohen, secretary of the state Department of Health and Human Services, stops for a chat while touring FEMA vaccine site in Greensboro. Photo credit: Anne Blythe

Only .8 percent of the 166,400 people in North Carolina who identify as American Indian or Alaskan Natives have been partially vaccinated, even as they represent about 1.6 percent of the population.

Many more women than men have been getting vaccines, some 58 percent to 40 percent.

It was a woman who persuaded Diggs, a once hesitant 47-year-old Black man at the Greensboro FEMA clinic, to take a shot.

“My wife got it Saturday and she talked me into it,” Diggs said shortly before getting his second-dose appointment card. “I wanted to do this for my sons, too.”

Diggs has two adult sons. One is 27 years old. The other is  21. Now that he has gotten a shot, he plans to encourage them to get an appointment when their turn comes.

“It’s not bad,” Diggs said. “It doesn’t take too much time.”

A peek Inside the FEMA clinic

At the entrance to the clinic, a bank of National Guard and Air Force members collect all the necessary information for the state’s vaccine database, an archive system that North Carolina built so it would not have to rely on the federal government to give public health officials hard numbers that help them pinpoint communities where vaccine administration could be better.

In a smaller room of the former department store, a team from Langley Air Force base in Virginia filled syringes with the Pfizer vaccine.

It’s a well-coordinated process that takes into account the thawing time for the vials that have been kept in an ultra-cold freezer at 60 to 80 degrees below freezing.

While sitting at a folding banquet table with a black cloth draped over it, members from the Langley team collect several vials of vaccine in their gloved hands and gently rock them back and forth 10 times to mix the white to off-white solution inside.

A rigorous shake could destroy the delicate mRNA molecules in the vaccine.

The Air Force team then tries to get six doses from each vial into syringes, which must be used within six hours.

Woman wearing military fatigues checks in man in red hooded sweatshirt at a vaccine table
National Guard and Air Force members staff the federally supported FEMA vaccine clinic in Greensboro. Photo credit: Anne Blythe

The injection is the swiftest part of the process. Once sleeves are rolled up or jackets come off, an arm is swabbed and jabbed in seconds.

The FEMA site hopes to add the one-shot Johnson & Johnson vaccine to the mix toward the end of April, but until then they’re taking appointments for the Pfizer shots.

The mass clinic could see even more demand this week since the state has opened eligibility to people with chronic health conditions, such as asthma, autoimmune disorders, cancer, diabetes, heart disease and obesity.

People who have smoked at least 100 cigarettes in their lifetime, even if they are former smokers, also are eligible for vaccines.

North Carolina opens eligibility on April 7 to even more people — those essential workers in Group 4 who were not included in the frontline essential workers eligible in Group 3.

Last week, President Joe Biden said he expected all Americans, 18 and older, should be able to be vaccinated beginning May 1.

Though vaccine distribution got off to a bumpy start in North Carolina and elsewhere, the supply chain has improved under the Biden administration and states are notified earlier and more routinely about how many doses will be allocated on a weekly basis.

“We think we’re very much in line with President Biden’s announcement that we’re going to make every adult eligible by May 1,” Cohen told reporters at the FEMA clinic after thanking workers there and posing for photos with some of them. “We are very much on track to do that here in North Carolina, but we have a lot of work to do.

“This site is part of the reason we can be successful here in North Carolina and it takes that federal, state, local partnership to be able to ramp up our ability to vaccinate everyone.”

The Federal Emergency Management Agency vaccination center is open at the Four Seasons Town Centre in Greensboro for seven more weeks.

Vaccines will be available seven days a week with an expectation that up to 3,000 doses will be administered each day.

Appointments are required. No ID is required. Spanish speakers are on site to help.

You can schedule an appointment online or call the COVID-19 Vaccine Help Center at 888-675-4567.

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.