Public Health

Companies Pan for Marketing Gold in Vaccines

For a decade, Jennifer Crow has taken care of her elderly parents, who have multiple sclerosis. After her father had a stroke in December, the family got serious in its conversations with a retirement community — and learned that one service it offered was covid-19 vaccination.

“They mentioned it like it was an amenity, like ‘We have a swimming pool and a vaccination program,’” said Crow, a librarian in southern Maryland. “It was definitely appealing to me.” Vaccines, she felt, would help ease her concerns about whether a congregate living situation would be safe for her parents, and for her to visit them; she has lupus, an autoimmune condition.

As the coronavirus death toll soars and demand for the covid vaccines dwarfs supply, an army of hospitals, clinics, pharmacies and long-term care facilities has been tasked with getting shots into arms. Some are also using that role to attract new business — the latest reminder that health care, even amid a global pandemic, is a commercial endeavor where some see opportunities to be seized.

“Most private sector companies distributing vaccines are motivated by the public health imperative. At some point, their DNA also kicks in,” said Roberta Clarke, associate professor emeritus of marketing at Boston University.

Among senior living facilities — which saw their largest drop in occupancy on record last year — some companies are marketing vaccinations to recruit residents. Sarah Ordover, owner of Assisted Living Locators Los Angeles, a referral agency, said many in her area are offering vaccines “as a sweetener” to prospective residents, sometimes if they agree to move in before a scheduled vaccination clinic.

Oakmont Senior Living, a high-end retirement community chain with 34 locations, primarily in California, has advertised “exclusive access” to the vaccines via social media and email. A call to action on social media reads: “Reserve your apartment home now to schedule your Vaccine Clinic appointment!”

Although the vaccine offer was a selling point for Crow, it wasn’t for her parents, who have not been concerned about contracting covid and didn’t want to forgo their independence, she said. Ultimately, they moved in with her sister, who could arrange home care services.

This marketing approach might sway others. Oakmont Senior Living, based in Irvine, reported 92 move-ins across its communities last month, a 13% increase from January 2020, noting the vaccine is “just one factor among many” in deciding to become a resident.

But some object to facilities using vaccines as a marketing tool. “I think it’s unethical,” said Dr. Michael Carome, director of health research at consumer advocacy group Public Citizen. While he believes that facilities should provide vaccines to residents, he fears attaching strings to a vaccine could coerce seniors, who are particularly vulnerable and desperate for vaccines, into signing a lease.

Tony Chicotel, staff attorney at California Advocates for Nursing Home Reform, worries that seniors and their families could make less informed decisions when incentivized to sign by a certain date. “You’re thinking, ‘I’ve got to get moved in in the next week or otherwise I don’t get this shot. I don’t have time to read everything in this 38-page contract,’” he said.

An Oakmont Senior Living advertisement touts access to covid vaccines to attract new residents.(Oakmont Management Group)

Oakmont Senior Living responded by email: “Potential residents and their families are always provided with the information they need to be confident in a decision to choose Oakmont.”

Some people say facilities are simply meeting their demand for covid vaccines. “Who is going to put an elderly person in a place without a vaccine? Congregate living has been a hotbed of the virus,” said retired philanthropy consultant Patti Patrizi. She and her son recently chose a retirement community in Los Angeles for her ex-husband for myriad reasons unrelated to the vaccines. However, they accelerated the move by two weeks to coincide with a vaccination clinic.

“It was definitely not a marketing tool to me,” said Patrizi. “It was my insistence that he needs it before he can live there.”

The concept of using vaccines to market a business isn’t new. The 2009 H1N1 pandemic ushered in drugstore flu shots, and pharmacies have since credited flu vaccines with boosting storefront sales and prescriptions. Many offer prospective vaccine recipients coupons, gift cards or rewards points.

A few pharmacies have continued these marketing activities while rolling out covid shots. On its covid vaccine information site, CVS Pharmacy encouraged visitors to sign up for its rewards program to earn credits for vaccinations. Supermarket and pharmacy chain Albertsons and its subsidiaries have a button on their covid vaccine information sites saying, “Transfer your prescription.”

But the pandemic isn’t business as usual, said Alison Taylor, a business ethics professor at New York University. “This is a public health emergency,” she said. Companies distributing covid vaccines should ask themselves “How can we get society to herd immunity faster?” rather than “How many customers can I sign up?” she said.

In an email response, CVS said it had removed the reference to its rewards program from its covid vaccination page. Patients will not earn rewards for receiving a covid shot at its pharmacies, the company said, and its focus remains on administering the vaccines.

Albertsons said via email that its covid vaccine information pages are intended to be a one-stop resource, and information about additional services is at the very bottom of these pages.

Boston University’s Clarke doesn’t see any harm in these marketing activities. “As long as the patient is free to say ‘no, thank you,’ and doesn’t think they’ll be penalized by not getting a vaccine, it’s not a problem,” she said.

At least one health care provider is offering complimentary services to people eligible for covid vaccines. Membership-based primary care provider One Medical — now inoculating people in several states, including California — offers a free 90-day membership to groups, such as people 75 and older, that a local health department has tasked the company with vaccinating, according to an email from a company spokesperson who noted that vaccine supply and eligibility requirements vary by county.

The company said it offers the membership — which entails online vaccine appointment booking, second dose reminders and on-demand telehealth visits for acute questions — because it believes it can and should do so, especially when many are struggling to access care.

While these may very well be the company’s motives, a free trial is also a marketing tactic, said Silicon Valley health technology investor Dr. Bob Kocher. Whether it’s Costco or One Medical, any company offering a free sample hopes recipients buy the product, he said.

Offering free trial memberships could pay off for providers like One Medical, he said; local health departments can refer many patients, and converting a portion of vaccine recipients into members could offer a cheaper way for providers to get new patients than finding them on their own.

“Normally, there’s no free stuff at a provider, and you have to be sick to try health care. This is a pretty unique circumstance,” said Kocher, who doesn’t see boosting public health and taking advantage of an uncommon marketing opportunity as mutually exclusive here. “Vaccination is a super valuable way to help people,” he said. “A free trial is also a great way to market your service.”

One Medical insisted the membership trial is not a marketing ploy, noting that the company is not collecting credit card information during registration or auto-enrolling trial participants into paid memberships. But patients will receive an email notifying them before their trial ends, with an invitation to sign up for membership, said the company.

Health equity advocates say more attention needs to be paid to the people who slip under the radar of marketers — yet are at the highest risk of getting and dying from covid, and the least likely to be vaccinated.

Kathryn Stebner, an elder-abuse attorney in San Francisco, noted that the high cost of many assisted living facilities is often prohibitive for the working class and people of color. “African Americans are dying [from covid] at a rate three times as much as white people,” she said. “Are they getting these vaccine offers?”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Vaccine Hesitancy vs. Vaccine Refusal: Nursing Home Staffers Say There’s a Difference

CONCORD, N.C. — It had been months since Tremellia Hobbs had an excuse to bring out the pompoms. Before the pandemic, they were a crowd favorite at movie nights and bingo tournaments that Hobbs organized as activities director at the Brian Center Health & Retirement/Cabarrus nursing home.

On Jan. 14, she finally had a reason. After nearly a year of living with pandemic restrictions and a summer outbreak that killed 10 residents and infected 30 staff members, the nursing home was hosting its first covid-19 vaccine clinic.

So Hobbs lifted the red and silver tassels into the air and cheered as her co-workers lined up to get shots from two visiting CVS pharmacists. “Stewart, Stewart, he’s our man! If he can’t do it, no one can! Goooo, Stewart!”

But even as Hobbs rooted for her colleagues, decorated the dining hall with green and blue balloons, and assembled goodie bags with Life Savers gummies for those who received their shots, she knew she wouldn’t be getting the vaccine herself.

“Being able to diagnose, come up with a vaccine and administer it all within the same year just seems a little puzzling,” she said. “I would like to see, give it a little more time.”

Hobbs’ hesitancy has been echoed by nursing home staff members across the state and country. But her reasoning — as well as that of her colleagues who also opted against the vaccine that day — goes far beyond a simple yes or no. The decision is complicated and multifaceted, they said, which means persuading them to say yes will be, too.

In North Carolina, the health secretary has said more than half of nursing home workers are declining the vaccine. A national survey found that 15% of health care workers who had been offered the vaccine said no, with nursing home personnel more likely to refuse than hospital staffers.

The trend has concerned public health officials, who say vaccines are among the best ways to protect vulnerable elderly residents who may be infected by asymptomatic staff members. Although long-term care facilities house less than 1% of the nation’s population, they’ve accounted for 37% of covid deaths, according to the COVID Tracking Project.

Tremellia Hobbs, activities director at the Brian Center/Cabarrus nursing home, cheers on her co-workers as they receive the covid-19 vaccine at the Brian Center/Cabarrus nursing home. (Aneri Pattani)

Early reports suggest nursing home residents are getting vaccinated at a higher rate than workers. A CDC analysis of more than 11,000 long-term care facilities found that in the first month of vaccinations, about 78% of residents got at least one dose, but only 38% of staffers did.

But some nursing home staffers say their reluctance is being misconstrued. Most are not saying they’ll never take the vaccine, but simply that they have concerns about such a new product. They understand it went through months of clinical trials, but what about possible long-term side effects, for instance? Or how did politics play into the development process? For communities of color, their historical mistreatment by the medical system can also factor into the decision.

“We should stop saying that people are just saying no,” said Dr. Kimberly Manning, a professor at Emory University School of Medicine who is participating in the Moderna vaccine trial. A Black physician herself, she has been speaking with many Black Americans about the vaccine and instead refers to people as “slow yeses.”

“We just are too impatient to get to the point where we let them get to their yes,” she said. “We’re like the used-car salesman. We’re just trying to close the deal.”

But human beings respond better to empathy and patience than to pressure, Manning said. She tries to ask people about their individual concerns and work from there. Sometimes it’s skepticism about the government’s intentions. Other times it’s worry about how the vaccine may interact with fertility treatments.

“It’s important to not lump anybody into a group and say ‘How dare you just not get vaccinated?’ because you’re a health care worker,” she said. “You’re still a person.”

Vials of the Moderna covid-19 vaccine thaw before they can be administered to residents and staffers at the Brian Center/Cabarrus nursing home. (Aneri Pattani)

Hobbs, at the nursing home, is not against immunizations in general, she said, and her decision has nothing to do with distrusting the medical system as a Black woman.

“I totally trust the science. I love Dr. Fauci,” Hobbs said. “My thing is the timing.”

She wants to wait and see how others who get the shots fare. In the meantime, Hobbs said, she’ll continue masking, physical distancing, and sanitizing — all of which have kept her covid-free for 10 months and which she hopes will continue to protect the residents, each of whom she knows by name and favorite activity.

Caitlyn Huneycutt, a certified nursing assistant at the center, also opted out of getting a shot — but for an entirely different set of reasons. She expects covid vaccinations will be mandated for health workers in the future, much like other immunizations. And she’ll get them then. But for now, she’s still weighing the risks.

She recently started a new medication and is not sure how it’ll interact with the vaccine. She doesn’t want to bring covid home to her 1-year-old daughter, but she’s also heard of people who received the vaccine and fainted or developed kidney infections. (The Centers for Disease Control and Prevention does not list either of these as common side effects for the two covid vaccines in use.)

“I want to make sure I’m going to be healthy if I take it,” Huneycutt said.

A CVS pharmacist prepares doses of the Moderna covid-19 vaccine during a clinic at the Brian Center Health & Retirement/Cabarrus nursing home on Jan. 14, 2021. (Aneri Pattani)
Josiah Howard (right) was one of two CVS pharmacists who administered the Moderna covid-19 vaccine to staff members and residents at the Brian Center/Cabarrus nursing home on Jan. 14, 2021. (Aneri Pattani)

Across the country, nursing homes are taking different approaches to persuade their staff to get vaccinated. SavaSeniorCare, which owns the Brian Center/Cabarrus, has offered cash to its 169 long-term care homes in 20 states to pay for gift cards, parties, or other incentives. For over a month now, the company has also been hosting weekly phone calls to educate staffers about the vaccine and making Sava doctors and pharmacists available to answer questions.

At least one nursing home chain in the U.S. announced it will require all employees to receive a vaccine, but most others, including Sava, have not yet done so.

Stewart Reed, the administrator for the Brian Center/Cabarrus, is hoping to lead by example instead.

Reed experienced the harsh reality of covid firsthand and was out of work for two weeks in the fall. In January, he was among the first in line to get the vaccine. For the rest of the day, he popped in and out of the dining hall where shots were being administered to thank staff members for doing their part.

In total, about 48% of staff members and 64% of residents at the center received their first dose of vaccine that day. The numbers are well below Sava’s goal of 90%, Reed said, but the pharmacists will return for two more clinics in the coming months.

“The people that didn’t get it [today] will see that the guys that got the shot are OK,” Reed said. “When the next clinic comes up, they will not hesitate to get their first shot. It ought to go much better.”

After Nearly 60 Years of Marriage, This Missouri Couple Stayed Together to the End

Arthur Kelley could barely raise his voice above a whisper last fall when he told a nursing assistant he never wanted his wife, Maggie, to be alone. After almost 60 years of marriage, five children and a lifetime filled with more victories than defeat, Kelley wanted to be there for his ailing wife, even if she didn’t know he was there.

He got to be there for her. But like so many other people who have died of covid-19, he died without his family.

Dementia had stripped Maggie Kelley of her memory, so her family had moved her into a nursing home in 2015. Arthur, who had received care for Parkinson’s disease at home, moved to the same facility in the St. Louis suburbs two years later to be closer to Maggie.

“It was a literal choice to go be there with Mom,” said their youngest son, Kevin Kelley. “He really desired to be there.”

Their parents shared meals, watched television and slept in the same room for three years. They were separated only once, when Maggie, 81, contracted an asymptomatic case of covid early in August.

“He protected her like Superman protects Lois Lane,” said their oldest daughter, Lisa Kelley-Tate. “That’s how he was with her.”

Arthur and Maggie Kelley celebrating an anniversary leading the Greater Faith Missionary Baptist Church. The couple died 30 days apart in 2020. A double funeral marked the end of nearly 60 years together as a married couple.(Derrick Varner)

Arthur, 80, would often ask when he could see his wife again.

“He wanted to make sure he didn’t pass before she did,” Kelley-Tate said a staffer at the nursing home told her. “It was his job to make sure he was there for her. Maybe he knew then that his time wasn’t going to be long.”

Maggie finished her quarantine and they reunited. But only briefly. She died of complications of dementia on Nov. 2.

That afternoon, Arthur held her hand as long as he could. When Kelley-Tate arrived, he was still holding on, so she took her mother’s other hand. She carefully painted Maggie’s nails red, her favorite color. But Arthur still wanted more time with Maggie.

“It took a while before he had me call the mortician to come pick her up,” Kelley-Tate recalled. “He said, ‘I want her here with me just a little longer.’”

Maggie and Arthur grew up together in Coffeeville, Mississippi, a small town about 90 miles south of Memphis, Tennessee. Maggie was the daughter of a teacher and a farmer. Arthur helped his family run its dry-cleaning business. He also learned to play the piano well enough to perform in juke joints and churches.

Their relationship bloomed in high school. Arthur took Maggie to the prom before they headed off to college. Maggie attended two historically Black colleges in Mississippi: what’s now known as Alcorn State University in Lorman and Rust College in Holly Springs. Arthur left the South for the Midwest, where he attended Southern Illinois University in Carbondale.

After their wedding on June 3, 1961, in Coffeeville — Maggie walked down the aisle in a lace dress with a sweetheart neckline; Arthur wore a white jacket and a wide grin — the couple decided to put down roots in St. Louis. Their lives revolved around the children they soon had, church and music. Maggie taught elementary school and took care of the children while Arthur studied speech pathology.

“They would always talk about how they would work together,” said their youngest daughter, Gina Kelley. “They worked as a team.”

The couple attended Central High School in Coffeeville, Mississippi, a small town about 90 miles south of Memphis, Tennessee. Maggie graduated with the class of 1956. Arthur earned his high school diploma in 1957. (Kelley Family)
Arthur Kelley became the pastor of Greater Faith Missionary Baptist Church in north St. Louis in 1977. Arthur and Maggie Kelley pose for a photo in the early 1990s at the church. (Erma Moore)

Arthur became the pastor of Greater Faith Missionary Baptist Church in 1977. He juggled life as a speech pathologist and minister, their children said. Maggie, who at this point was home raising the kids full time, established a routine for them that included prayer time, gospel music and home-cooked meals, including her beloved “Heath bar cake.”

Arthur and Maggie Kelley stayed dedicated to each other, in good times and bad. One of their toughest moments was the death of their 3-year-old son, Arthur Jr.

In their final years, both struggled with their health, but they never complained about their conditions. They leaned on their faith instead as he pushed through the challenges caused by Parkinson’s disease while her dementia progressed.

“At times, I said if my father had my mom’s body and my mom had my father’s brain we would be all good,” their son Kyle Kelley said.

After Maggie died, Arthur helped his children make funeral arrangements for her. He picked out her casket, and then he selected one for himself. Two of his children lifted him out of a chair so he could see the inside.

“He said, ‘I like that,’” Kelley-Tate recalled. “I said, ‘OK, we’ll keep that in mind,’ not thinking it would happen 30 days later.”

He too had contracted covid, one of the more than half-million nursing home residents nationwide to catch the contagious virus. Arthur wanted to attend his wife’s service, so his family decided to hold off on the funeral until he got better.

He never recovered. Exactly one month after Maggie’s death, he died in the covid ward of a nearby hospital. No family was allowed to be with him. A nurse called Kelley-Tate by video after he died.

But the family came together for what was now a double funeral with the caskets close to each other — the mauve one Arthur had picked for Maggie and the mahogany casket he had picked for himself.