PHILADELPHIA — Only a trickle of people had visited her community vaccination site seeking a first coronavirus shot last Monday when Dr. Ala Stanford, a local pediatric surgeon, seized on an unexpected opening.
Across the street from the church parking lot where she had set up shop, a funeral home was holding a trio of services, including one for a victim of Covid-19. She mocked up new fliers, then delivered them to the funeral home. By the afternoon, several workers and guests had crossed the street to get inoculated, including Justin Larkin, a funeral attendant who stuck out his arm for the single-dose Johnson & Johnson vaccine, then hustled back to his job.
The scene, at Victory Christian Center in southwest Philadelphia, underscored what the Biden administration has called a new phase of its vaccination campaign.
The federal government has set up mass vaccination sites at stadiums, sent doses to pharmacies and clinics serving lower-income Americans, and, on Friday, enticed the unvaccinated with the prospect of finally being able to shed their masks.
But with the ranks of the willing and able dwindling, the campaign has in many places already morphed into a door-to-door and person-by-person effort.
“We’re in the recruiting phase,” Dr. Stanford said. After dropping off the fliers, she approached a man watering his backyard adjacent to the parking lot site, pleading with him through a chain-link fence. He declined.
The Black Doctors Covid-19 Consortium, which Dr. Stanford leads, is one of about 11,000 members of what the Department of Health and Human Services is calling its Covid-19 community corps, a loose constellation of volunteers, corporations, advocacy groups and local organizations working to vaccinate Americans often left behind by the nation’s health care system.
Begun last month, the network operates on the belief that once the people most eager for a shot were done, those left unvaccinated will prefer to get their shots by or around people they know. It holds weekly calls with department leaders in Washington to share tips on what is working to reach those still unvaccinated.
The vaccination campaign has been flipped on its head, Dr. Stanford said last Monday. “People were going crazy. They were willing to trade things and pay for it,” she said of bigger events her group sponsored.
A recent survey published by the Kaiser Family Foundation found that only 9 percent of respondents said that they had not yet gotten a shot but intended to do so right away, suggesting the nation could be approaching saturation.
A slowdown in vaccinations has often been attributed to vaccine hesitancy, an opposition to or skepticism of vaccines. But a large group, about 30 million American adults, say they are open to getting a coronavirus vaccine but have not managed to do so, according to a U.S. Census Bureau estimate. Their ranks are larger than the outright hesitant.
Andy Slavitt, a White House pandemic adviser, described in an interview last week three categories to organize the unvaccinated: those making a choice at their own pace, those who need easier access to a vaccine and those under 30 who are open to getting a shot but not rushing to.
“The reality is many people exist along a spectrum. Some have access issues, some have awareness issues,” he said. “People are complex.”
Even as some organizations publicize free beer and sports tickets for vaccinations, and as states increase their incentive-laden pleas — a weekly lottery in Ohio is giving five people $1 million each in return for being vaccinated — the quieter work of local leaders like Dr. Stanford will be key to reaching President Biden’s goal of 70 percent of adults partly vaccinated by July 4, federal officials say. (The rate now stands at more than 59 percent.)
“Local is incredibly important. Respecting people’s decision-making process is very important, that people are not just cogs in a machine,” Mr. Slavitt said. “You can’t just say, ‘I want to fully process x number of people in a given day.’ You have to respect the fact that people have decision-making processes that are unique to them.”
Dr. Stanford said Philadelphians who had struggled to find a time or place to get vaccinated but finally managed were “messengers for the next people.”
Often a vaccine’s appeal turns on convenience, especially for those who cannot easily take time off from work. Consortium workers and volunteers last Monday discussed outings to vaccinate dialysis patients, then teens at a different church before they finish the school year. That morning, the group prepared vaccine kits they would take to homebound residents of the city, a core part of the group’s attempts to methodically expand the city’s pool of vaccine recipients.
Dr. Stanford’s group has been prolific for a city-level organization, vaccinating nearly 50,000 people at almost 70 clinics. She said the federal government was talking to her about expanding to Baltimore, Virginia and Washington, D.C. Dr. Rachel Levine, Mr. Biden’s assistant secretary for health, visited the consortium last month and praised its vaccination efforts as a model for the country.
Dr. Stanford said her group brought a vaccination site to the southwestern part of the city because of how little access it previously had to vaccines. Underneath tents in small rows of folding chairs, visitors had their choice of all three federally authorized vaccines, an indication of the nation’s staggering and still-growing surplus, with over 70 million doses delivered that have yet to be used. Without enough arms to deliver them to, mass vaccination sites at convention centers and sports stadiums have closed or announced plans to, including one federally run site in Philadelphia, which is scheduled to shutter by the end of the month.
But in their pursuit of Mr. Biden’s objectives, which include fully vaccinating 160 million adults by July 4, administration officials say that a sizable chunk of the adult population is still reachable.
At the Temple of Praise, a predominantly Black church in southeast Washington, D.C., clergy, church volunteers and local doctors and pharmacists have worked to vaccinate more than 4,000 people, many in the congregation. The church is still using up its weekly allotments of the Moderna shot, with lines snaking through the parking lot every week leading to portable booths used for vaccinations.
Church leaders were vaccinated from the pulpit this year, leading to a surge of interest, said Bishop Glen A. Staples. But he and other clergy members said after Sunday services this month that for those now getting the vaccine, Covid-19 was a component of a larger public health crisis.
“It’s not just getting the shot,” he said. “It’s about developing faith and trust in the system.”
Dr. Jehan El-Bayoumi, a professor of medicine at George Washington University and founder of the Rodham Institute, an organization working on health equity issues in Washington, has advised the church and its community. She said this phase of the vaccination campaign required a shift in the “locus of power” to sites like the church’s, where vaccine recipients were certain to be treated with patience and empathy about their health more generally.
Dr. Stanford said that guests to her vaccine sites with otherwise little access to health care sometimes ask for help with medical problems unrelated to Covid-19.
Dr. El-Bayoumi, who goes by Gigi, said simple tools of convenience — free Uber rides to a vaccine site or blood pressure cuffs donated to vaccine recipients — had been enough to draw in some of those looking to get a shot in Washington. The Temple of Praise serves tens of thousands of meals each week to community members, including to those who come to receive a vaccine.
“The federal government is playing catch-up to what works,” she said. “People trust their spiritual leaders more than doctors and government leaders.”
Scenes like those in Washington and Philadelphia have played out across the country, with a get-out-the-vote-like sweep. In southwestern Florida, Detroit, New Orleans and Kansas City, teams have gone door to door to explain the vaccines and how to get them, or even administered them in homes.
A similar door-knocking effort began recently in Toledo, Ohio, where the city’s Fire and Rescue Department has used a roving medical unit to vaccinate people on the street. In Maine, medical interpreters have worked to inform immigrants and minority populations about the safety of the vaccines.
Antoine Blount, an Amazon delivery driver who chose the Pfizer vaccine at the Philadelphia site, said he was skeptical of the vaccine at first — he had seen videos of people with difficult side effects — but was reassured by seeing family and friends get it. Amazon, he said, was offering bonuses to vaccinated employees.
“A lot of people, they just don’t know about it,” he said of getting the shot.
Nardea Smith, a chef, said she had been going back and forth in recent weeks while researching the vaccine. She chose Moderna’s vaccine after seeing her parents get it. She was eager to travel again to see family and wanted to protect her grandchildren.
“I want to make sure that they’re safe, first and foremost,” she said. “I feel more at ease.”
Mr. Larkin, the funeral attendant, listened carefully to one of the vaccine site workers as she explained the different shots, then chose Johnson & Johnson’s for its one-and-done ease. He said that getting the vaccine was like getting a new phone, which required waiting some time to see how it worked for others. He planned to prod others in his life to get the shot, including the director of the funeral home.
After getting the shot, Mr. Larkin put his suit jacket back on and raced across the street, helping arrange cars along a curb for one of the funeral services. “With all of the cases that we get, now I know that I can’t hardly get it,” he said, smiling.
Kitty Bennett contributed research.