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In a warehouse in northeastern Washington, Adedolapo Adegbite packed a portable refrigerator containing the coronavirus vaccine, and then stopped to take out a blue clipboard. She browsed a list of patients, took out her smartphone from her scrub pants pocket, and dialed the first number on the list. After three beeps, Peggy Omole answered the phone.

For nearly thirty years, Omole has lived in a fifth-floor studio apartment in the southwest corner of the capital. Although she used to greet guests on the nearby arena stage, watch dramas and world-renowned performers, she has not sat in the audience for a long time. Eight years ago, a doctor diagnosed Omole with chronic obstructive pulmonary disease, "an incurable disease," she said. Since then, Omole has been in and out of the hospital to treat her symptoms; her weight has dropped, and the constant coughing made her weak body rattle. Her illness and the coronavirus pandemic have confined the 73-year-old Omole at home.

On the phone, Adegbite told Omole that she was calling from the DC Department of Health to confirm her appointment and that she should wait for her to arrive at the apartment within an hour. Adegbite prepared and packaged the 13 doses of COVID-19 vaccine she planned to shuttle through the city that day. This includes Omole's.

Registered nurse Adedolapo Adegbite explained to Peggy Templeman, a 90-year-old Washington DC resident, the process of vaccinating COVID-19 at home. It is difficult for her to leave home. She and her home health assistant Lillian Bazemore will receive booster injections through a free plan. In addition to mass vaccination sites and temporary clinics, the country’s capital has also sent nurses to people’s homes to ensure that more people are protected from the virus. Photo taken by Cheriss May for PBS NewsHour

Before this sunny October, four in ten people in the United States (nearly 140 million people) had not been fully vaccinated against COVID-19, and Omole was one of them. But with one shot at a time, Adebit and three other nurses planned by the Washington, DC Department of Health at home are working to increase the city’s vaccination rate. The stay-at-home program was originally designed to allow people who cannot leave their homes to get the COVID-19 vaccine. It has now been expanded to include everyone in Washington, DC, including those with children and shift workers, whose work may prevent them from reaching the vaccination site in time.

The pandemic forces people to think about “how can we transform healthcare into more community-based healthcare than it is today,” said Tyson Bell, Ph.D., a critically ill physician and assistant professor of medicine at the University of Virginia Health System. Bell said that reaching out to people who are usually ignored by health care requires unconventional methods that may be more expensive, labor-intensive, or slow, such as home vaccination.

"It is not as effective as mass vaccination centers, but that doesn't mean it is less important," he said.

Read more: The United States ranks 48th in terms of per capita vaccination. Political polarization is one of the reasons

Long after the initial vaccination enthusiasm began to fade, this is not just happening in Washington, DC. Cities and states in the United States are working hard to increase the number of vaccinations in the country every day. President Joe Biden urged this summer that as the delta virus surges across the country, more work needs to be done "community by community, community by community, and usually from house to house" to notify more people and vaccinate them. Since then, from Charlotte to Chicago, various programs have emerged in many parts of the country to increase local vaccination rates, some of which are designed to provide clear and critical information about vaccines, while others, such as Washington The Special Zone’s plan aims to increase the local vaccination rate. In the delivery of the lens itself.

Biden said: "Look, fairness and equality-ensuring that the communities most affected by the virus have access to information and access to vaccinations remain at the core of our responsibility."

In the devastating awakening of the delta variant, public health experts warned that colder temperatures mean more people will spend time indoors. Those who have not been vaccinated are not only exposed to the lethal risk of COVID-19 infection, but also give the virus more opportunities to mutate into a more transmissible variant. Plans like DC's home vaccination plan represent a desperate race against time.

She said that as early as December last year, when the U.S. Food and Drug Administration began to authorize the use of vaccines to protect people from viral infections, Omole heard on TV and conversations about the differences in vaccines and their safety-usually Conflicting information. To her, there seems to be uncertainty about the coronavirus vaccine-it is very difficult for her to even leave the apartment-she said she "does not want to disturb them."

Read more: How "prebunking" fights fast-moving vaccine lies

Therefore, she stayed at home in a protective but lonely cocoon to avoid contracting COVID-19 and further tighten her already damaged immune system. Occasionally, her sister Toni Foster and her friend Thelma Jones, a breast cancer recovery survivor and a patient navigator, visit her. Jones urged Omole to get vaccinated and, with Omole's permission, called the District of Columbia Department of Health to arrange an appointment for home vaccination.

After the registered nurse Adedolapo Adegbite prepared and loaded the vaccine, she stood outside the Washington government vehicle and she will vaccinate the residents of the city. She is part of public health work to protect vulnerable residents from COVID-19 and increase local vaccination rates. Photo by Cheriss May from PBS NewsHour

Earlier this year, the city disseminated information through TV commercials, door leaflets and social media. I heard that residents of the program will contact the call center, where they will answer questions about their health and which vaccine they prefer. Adegbite said that people are still surprised to find that the vaccine can be given for free — a common misinformation that prevents some people from getting the vaccine. She said people usually don't ask their healthcare providers for advice, but instead turn to friends and social media.

Overall, 6 out of 10 people in Washington, DC were vaccinated, and 7 out of 10 people were vaccinated at least once. Most of them were vaccinated at one of more than 100 vaccination sites spread across the city. But Patrick Ashley, the department’s senior deputy director of the Health Emergency Preparedness and Response Administration, said the program has vaccinated about 1,500 residents with life-saving vaccines, and dozens of them have received boosters. It has worked so smoothly (so far) that the same model will be used this winter to get more Washingtonians vaccinated against flu.

"We will do everything we can to get people vaccinated," Ashley said.

Peggy Templeman and her full-time home health assistant Lillian Bazemore received COVID-19 boosters during their visit from Adegbite to Templeman's home near DC Brentwood. Her doctor advised her to use the plan because it was too difficult for the 90-year-old Templeman to leave home. The retired social work clinician needed Bazemore's help and an electric stairlift to go downstairs. Boosting doses at home can eliminate the risk while enhancing their protection against the virus.

Watch: how boosters can help protect Americans from delta variants

For several generations, factors that are usually beyond one's control—race, income, transportation, distance to medical treatment, and job protection—determine their ability to access health care. Dr. Leana Wen, a former public health commissioner in Baltimore, said that these systemic disorders collectively pose challenges for those who "have already had so many other things happening in their lives, and vaccines are not the first consideration."

But Ashley Hennigan, Adegbite's manager, said that after federal vaccine authorization and more workplaces requiring employees to be vaccinated in person, there has been a surge in requests for home visits.

Hennigan organizes and distributes appointment requests for nurses such as Adegbite. They load a cooler full of vaccines into a white DC government Honda Civic every day and drive up to 80 miles throughout the city. In some houses, multiple people are vaccinated within an appointment window. Adegbite said Friday is busy because people tend to leave work or have more flexible working hours.

"People finally realized that COVID is real," Adegbite said.

Out of the padded elevator, Adegbite turned right and walked briskly along the gray carpeted corridor of the Omole building. She carried a backpack filled with alcohol wipes, blank vaccination cards and Omole's single dose of Johnson & Johnson, packed in a brown disinfection bag.

Adegbite knocked on the door politely, and the cyan door creaked open. In the dim light, Omor sat on her love seat with Jones and Foster. A television set behind the black paint screen and white crane played the chatter and canned laughter.

After greeting the three ladies again and introducing herself personally, Adegbite told Omole that she requested the Johnson & Johnson vaccine. My friend Jones interjected that the Johnson & Johnson vaccine was not as effective as the existing two-dose mRNA vaccine. But Foster reminded her sister, "It's better than nothing." They asked Adegbite Omole what to do-get a different vaccine?

Dr. James Hildres, president and CEO of Mehari School of Medicine, a long-established black institution in Nashville, said such conversations are critical to increasing vaccination rates, especially in communities of color. Systemic racism puts people in these communities at a disadvantage and makes high-quality medical care more difficult to obtain or affordable. The history of abuse of the medical system has sowed a deep distrust of providers among many black Americans. The pandemic makes it harder for society to ignore these effects. Hildreth said that when health workers go out to meet patients in the communities they serve, especially if they are from these communities, patients will get evidence-based information about vaccines and viruses. In this way, they are better able to make decisions that are in their best interests.

Read more: Trust in the COVID-19 vaccine is essential to contain the pandemic. Why are some people hesitant?

Adegbite had had the same conversations with other patients about different vaccines many times before. She briefly listed the benefits of each-all of which are provided by the health department-but in the end, she told Omole, "It's your choice."

Omole supports her decision. She changed positions on the love seat and pushed up the sleeves of the ocher T-shirt. "They will go to hell if they want to find some muscles," Omole said with a smile, and everyone joined her.

For 28-year-old Adegbite, this plan is an opportunity to regain hope. About three years ago, she became a nurse and started her career in a hospital in Washington, DC, but then the pandemic disrupted everything. By early January, she was in depression — COVID had caused the death of a relative and a patient — and had to take a two-week vacation. Those moments made Adegbite struggle and wonder, "What else can I do?"

"Master, what will happen?" Adebit recalled. "He replied. The vaccine is out." A few weeks later, she quit her job in hospital care and applied to join the city's home vaccination program.

She opened the alcohol wipes and drew a sterilized circle on Omole's slender left shoulder. Adegbite makes the jab and Omole wince and yell once.

In addition to mass vaccination sites and temporary clinics, the country’s capital has also sent nurses to people’s homes to ensure that more people are protected from the virus. Photo taken by Cheriss May for PBS NewsHour

As she waited 15 minutes for any adverse reactions to begin, Omole began to talk about what she worried about what might happen if she chose not to be vaccinated. She didn't want her family to enter her apartment and found out that she was dead. "This is the worst thing you can do for your family," she said.

Her decision is very personal, but at the same time she has the support of the community around her. Now, she thought of the theater again, and even hoped that she could watch a performance at some point.

"I think I will go out more," she said.

Suddenly, she realized that the injection site in her left arm was no longer painful. Adegbite fills in the date and dose on Omole's new vaccination card and gives it to her. It's time to jump back into the white car and drive to another house elsewhere in Washington, DC, where another person is ready to be vaccinated.

Editor's note: Johnson & Johnson is a funder of PBS NewsHour.

Left: Registered nurse Adedolapo Adegbite brings a pair of Pfizer boosters to their home in Washington for Peggy Templeman and her family health assistant Lillian Bazemore. Adegbite drove up to 80 miles in the nation’s capital to provide home vaccinations for those who may not be able to fight off the virus and are vulnerable to life-threatening infections. Photo taken by Cheriss May for PBS NewsHour

Authors: Lauran Nelgard, Mike Staub, Associated Press

Associated Press Lauran Neergaard

Authors: Elisa J. Sobo, Diana Schow, Stephanie McClure, in conversation

Laura Santhanam is the data producer for PBS NewsHour. Follow @LauraSanthanam

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