Last year, ECU Health (formerly Vidant Health), a nine-hospital health system serving more than 1.4 million people in Eastern North Carolina, took on the enormous task, in concert with the NC Farmworker Health Program, of vaccinating migrant farm workers in this largely rural part of the state against COVID-19.
By mid-summer of 2021, through collaborations with other academic health systems, state agencies, and community health centers, the ECU Health team managed to vaccinate a whopping 96% of its targeted population of workers that year.
But that early success story was just the beginning. Although most of the migrant farm worker population got vaccinated, it wasn’t enough. As the Delta variant swept through these farm communities, it became clear that boosters would be critical to keeping everyone safe.
Complicating the effort, the North Carolina Department of Health and Human Services (DHHS) issued new guidelines during the season requiring workers who had received the Johnson & Johnson vaccine to be re-vaccinated with an mRNA vaccine, due to safety concerns. Some were getting boosters, while others were getting a shot of another vaccine.
Nevertheless, the project’s team of health care staff and volunteers faced down these unpredictable obstacles to safeguard the health of workers and the community.
“We were very, very busy,” says Juan Allen, a patient navigator with Access East, a nonprofit affiliate program of ECU Health, which provides health services to vulnerable populations in the area and spearheaded COVID-19 testing and vaccination.
Going above and beyond
Every year 17,000 to 18,000 farm workers come to this part of North Carolina under the H-2A visa program, which gives them temporary employment status. As frontline essential workers, they were eligible for vaccination very early in the vaccine roll-out. Access East and its partners pulled every lever at their disposal to get shots into arms.
The ECU Health team set up shop in Vass, NC, called the “hub,” where busloads of migrant workers travel from Mexico in late winter and early spring to start preparing the ground for crops like sweet potatoes and cucumbers. The team offered vaccines to the workers as they stepped off the bus.
The team didn’t just vaccinate H-2A workers, however. Where they had opportunities, they also vaccinated farmers who live in the U.S. with their families year-round, as well as undocumented agriculture workers.
Mobile units were sent to migrant farm camps in remote corners of the state. And the team went county to county and worked with community partners like growers’ associations, restaurants, and local churches to promote and administer the vaccines.
“We made it easy for them,” says Allen. “We would make announcements in the community when we were having events and a lot of people came to us. The churches were absolutely fundamental to our efforts.”
In the beginning, the one-dose J&J vaccine was the favored choice, as tracking the farm workers for second doses would have presented logistical challenges. Those challenges came anyway.
The headaches grew when guidance from DHHS changed, Allen says. Teams were directed to give doses of the mRNA vaccines — Pfizer or Moderna — to those who had received J&J vaccines to bolster their protection against illness.
“We needed to start a new series of vaccines,” says Allen. “We’d get them first doses then had to track them down again for the second. Every month there was something new — different rules that we had to be aware of.”
When new workers arrived in late summer, many came vaccinated. However, often the vaccines they’d received, such as the Chinese-made Cansino vaccine, widely available in Latin America, were not recognized by the U.S., and they needed to get an accepted vaccine.
That coincided with the Delta variant surge, and even those farm workers who had been vaccinated were getting sick, as immunity from the vaccines began to wear off.
“Whole farms had to be shut down,” says Shantell Creek, RN, director of uninsured programs for Access East. “Dormitories were quarantined, because COVID-19 ravaged through the camp.”
These circumstances, nevertheless, had a galvanizing effect on the team’s efforts. When boosters were authorized in October, growers — even some who initially had been hesitant about vaccination — clamored for the shots.
“They’d ask us, ‘Hey, can you push the boys to get a booster?’” Allen says.
The team retraced its steps to give workers the shots. For the most part, they were eager to roll up their sleeves, Allen says.
“We educated them about the benefits of being protected from COVID-19 and also to avoid issues in crossing the border in the future, if boosters become mandated for entry,” he says.
After the season’s harvest in October and November, many migrant workers travelled back through Vass en route to Mexico. Again, ECU Health was on site at this rendezvous point to give shots — second doses, if still needed, or boosters — whatever individual workers required.
Because most workers had returned to their homes in Mexico in November, they largely sidestepped the Omicron surge in the U.S. But new wrinkles emerged in December, when the U.S. began to issue new visas to workers for the 2022 growing season. By then, the visa program required everyone to be fully vaccinated before crossing the border.
In January and February 2022, the first of these visas were processed — these for a small number of workers who operate heavy farm equipment and who travel ahead of the season to break the ground for planting.
Almost immediately, Allen began getting frantic phone calls from workers who had lost their vaccination cards somewhere along their transcontinental journey. Although vaccination records are in national and state databases, processing units at the border weren’t able to access them.
Allen had worried about just this circumstance.
“To be honest, when the workers were leaving, we told them, ‘Please take a picture of the card, laminate it, tattoo it to your arm,’” he says. “’Do whatever you need to not lose this card.’ But some still lost it.”
When the calls started, Allen’s team devised a solution. It required locating a worker’s vaccine record and transferring an image through a What’s App account he created to facilitate the communication.
“When we talked to the farm workers, they gave us verbal consent to retrieve the information from the state DHHS database,” says Allen.
In early April, the organization was bracing for more lost cards as the bulk of these seasonal farm workers began to arrive en masse.
“We have several agencies working, trying to print them down there,” Allen says.
Coming together to care for migrants
At least one positive result of the pandemic may be a new spirit of cooperation between the different health agencies supporting migrant farm workers in Eastern North Carolina, including federally qualified community health centers.
“Three years ago, there was competition between us about who we were helping,” Allen admits. Health care organizations were territorial, claiming populations of farm workers as their exclusive responsibility.
But the pandemic crisis has led such organizations to join forces.
“Now everyone is on the same page,” Allen says. “Everyone’s doing the same job. If we get overwhelmed, we can rely on the other agencies to move forward.”
Allen expects this “kumbaya moment” to continue, which should enable the health system to better care for the workers who support the state’s economy and maintain its food supply.
“Everyone has grown and learned,” he says. “And now there’s a system in place in case we have another crisis like COVID-19. We’re going to want to keep the momentum going.”