Mark Jackson was born into relief work, literally. The son of a Peace Corps director, Jackson was born in Kenya and raised young in Liberia until civil war forced his family to return to Minnesota.
Jackson, who holds a biology degree from Macalester College and a graduate degree in global health from McMaster University in Ontario, worked for the National Institutes of Health as a researcher before becoming an aid worker for the World Health Organization and various non-governmental organizations. . It is a vocation that has led him to sites of earthquakes, typhoons and epidemics of viruses, mainly in Haiti and in the South Pacific.
Throughout his career he has searched mass graves in the Philippines with search and rescue dogs, delivered vials of polio and horse measles vaccine to East Timor, and negotiated with local governments who don’t always appreciate help.
On March 27, 2020, near the start of the pandemic, Jackson began a new job with Ramsey County Public Health as a COVID-19 program specialist at Mary Hall in downtown St. Paul, where the county was home to symptomatic homeless residents.
Since December, he has overseen the county’s community vaccination clinics, which cater primarily to populations that might otherwise be hard to reach.
All Minnesotans 12 and older are now eligible for the vaccine, but demand has plummeted in recent weeks, and clinics that once generated waiting lists and uninvited ‘vaccine hunters’ now attract just three. or four visitors. While 74% of Ramsey County residents aged 18 and over have received at least one dose of a COVID vaccine, the United States as a whole is expected to fall just short of President Joe Biden’s target to vaccinate 70% of the country’s adults by July 4. See ramseycounty.us/covidvaccine for links to vaccination sites.
The following interview with Jackson has been edited for length and clarity.
Tell me about the ups and downs of this job.
What is worth it is not the money, it is the satisfaction of being able to make a difference. In the beginning, a pandemic is that big outer cloud. At first, we weren’t sure if we should wear a mask or if we wash our hands enough. One of the ways to regain power is to be on the ground. I consider myself privileged. We had a really, really strong team, and it’s a pleasure to do the job. We are bringing out this vaccine, testing it, and hopefully saving the lives of our homeless.
The low point is generalized exhaustion. It’s six and seven day work weeks. I haven’t taken a full week off since March 27, 2020. But I couldn’t sit on the couch. It doesn’t feel right. If you can help, you have an obligation to do so.
Tell me about the early days of the pandemic when you worked with the homeless at Mary Hall. Until the pandemic struck, the county had not been a provider of residential homeless services.
In fact, I lived at Mary Hall for the first two months. It was 24/7. Literally the day I arrived was the day we got our first customer. Over the months, we have had more staff, people from social services to manage it rather than from public health. At the same time, we were running hotel programs. Our goal was to reduce population density and use CARES federal relief dollars to (help people) better isolate themselves. It’s still going on. As of June 2020, we saw the need for mass testing, so my role changed.
So you focused on testing until a vaccination became available in January?
We’ve done large drive-thru test sites with 500 to 1,000 people a day, and smaller ones in African American churches, homeless shelters, the Mexican consulate, community sites. It was all done with M Health and Black Nurses Rock and the state emergency operations center. The state had contracts with Mayo Labs to run all these nasal swabs that we collect, as well as PrimaryBio, a California start-up created to handle these massive testing operations and notification systems. They had a guy in the field here in Minnesota who literally changed the software for us on the fly while we were standing in the parking lot. Without all of that, we would have had a lot less impact than we did.
There has been a big shift towards state-run saliva testing at the Roy Wilkins Auditorium, which freed us up as the local public health agency to do the more agile work at these community sites. We went to the closing session at Roy Wilkins, and I think they did over 147,000 tests on this site alone. Without them, if the state hadn’t taken such a proactive approach and set up these massive sites for testing and then vaccines, we would have had a much higher and much steeper hill to climb into the country. Ramsey County.
And then you switched to vaccination?
We started to seriously vaccinate the first week of January. Our testing team was also our vaccination team. Nasal swabs now become needles. As soon as the vaccine was available, we simply changed directions. We were able to deploy it quickly because we knew the people, we had the locations lined up, we had the connections. These included the Hmong American Partnership and the Karen Organization of Minnesota.
It was quite difficult to get the vaccine just a few months ago.
In January, we had a certain shortage. The vaccine has been prioritized by age and profession. You’re basically trying to build the plane while flying it. The amount of pressure this pandemic placed on homeless shelters was insane. We wanted to make sure we had vaccines there immediately, as soon as we had it available in January and February. Fortunately, the vaccine shortage did not last too long. We’re getting more and more from the federal government at the state level, and it’s being rolled out county by county for the people most able to use it.
It really has become, how many clinics can you organize in a week? We had an amazing team that looked after the phones and maintained these huge lists of eligible people. It’s been 16 long months. We have given less than 1,000 doses of vaccine in the past year, and in the first six or seven months of 2021 we have given approximately 55,000 doses. There are countless people involved in this.
You said supply and demand changed at one point – people showed up uninvited, and now you can’t reveal that quickly enough. Did you have to push people back with a stick?
It didn’t go all the way, but there were moments of tension. There are a lot of social media groups, one was called “Vaccine Hunters”, and once a link was posted there it was like a game of hide and seek. For the first three months, it was quite difficult to deal with people who show up. There were quite lively people. We had a Ramsey County Sheriff’s Assistant on site. For the public health people working on a Saturday, pushing people away, it was a difficult thing to do. I would say this phase has been extremely stressful for me and my team. If you visit our website now, you can enter any clinic. You can even go up on foot, without an appointment. In fact, we are running more vax clinics than in the past, 52 in June alone. It’s about trying to catch as many hesitant people as possible or people with some kind of barrier. We now even do house calls for people who are housebound.
The county has spent a lot of time promoting equity in access to vaccines. Why is this so important?
A virus doesn’t care if you are rich, poor, or your race. But at the lower end of the socio-economic spectrum, or if you don’t speak English, or have transportation difficulties, or can’t take time off from work, it makes things a lot more difficult. The less well-off are disproportionately affected. If you are a janitor, you can’t miss the job. If you literally can’t take medical time off or take unpaid time, you’ll have to go to work and expose everyone. It is therefore a domino effect. Some people do not have internet access and therefore will not even be able to navigate the website to make an appointment. We tried to make sure our testing and vaccination sites were at transit sites. There are a lot of community groups that were helping to spread the word and promote these places, and more importantly, they weren’t going to be hit by a big medical bill.
Why do people who resist really resist?
I had a gentleman who was convinced that 10,000 people had died from the vaccine itself. How to counter that? If they already don’t believe the government, how do you quote the government data? I like to think of everyone who gets vaccinated as an ambassador. It can change people’s attitudes. Having someone you trust who has been vaccinated can make all the difference, as opposed to me sitting there with the written results of all these clinical trials. This is where Black Nurses Rock and the Oromo Community Center come in. We move there every two weeks. They know there is a translator there, and someone who is Oromo himself is helping them. You can’t just say “oh yeah, you got to get that”. It doesn’t work that way. There has to be trust.
How much have things slowed down?
Instead of 1,200 people per day in March, on Saturday June 17, we set up at four sites, with over 16 hours of clinic in total, and we vaccinated less than 100 people. This contrast is quite apparent there. At one point, online marketing doesn’t get any further. It becomes substantive work.
Are many vaccines thrown away?
I don’t manage the supply, but as far as I know we haven’t had to throw away a significant amount. But that moment is coming soon, especially for the Johnson and Johnson vaccine. The repercussions of when they put that 11-day break was pretty bad. This break discouraged many people. The rumor mill is going crazy. You can’t blame the average person for asking questions.
At some point, we should probably be shipping unused vaccines to the rest of the world, right?
Rich countries have an obligation – not only moral and ethical – but it’s also just a matter of self-preservation. These variations will continue to appear. Rich Western countries must protect themselves by vaccinating the rest of the world. Obviously any country is going to take care of its own citizens first, but nothing will return to normal until we send this coronavirus to the place where we sent smallpox and almost sent the polio.
These vaccines took almost a year to roll out, but it was faster than many experts expected. It’s a success, isn’t it?
More than 99% of people who have died since the onset of COVID were not vaccinated. I wouldn’t be surprised if these vaccines become the norm for all vaccines.