Barbershop offers coronavirus shots, in addition to cuts and shaves. Some see it as a national model.

But his best friend, a hair salon owner, kept telling him he was being shortsighted and maybe even a little bit selfish. What about his niece and her newborn who live with him? How would he feel if they became sick? Also, his job as a contractor and painter meant he was often going into other people's homes. Didn't he want to be protected?

By the time that friend, Katrina Randolph, told him about the nearby barbershop hosting a vaccination clinic, and offered to drive him there, Alston, 57, was far along on the journey to changing his mind.

"She really influenced me to get it," he acknowledged, standing on the sidewalk outside the Hyattsville, Md., barbershop earlier this month after getting immunized. "I listen to Katrina. I know she wants me to be around."

Alston got his jab of the one-dose Johnson & Johnson vaccine, along with a free fried fish sandwich and a $30 coupon toward a haircut and a shave, at The Shop Spa, a barbershop that serves a predominantly Black and Latino clientele. It's the first coronavirus vaccine clinic in a barbershop in Maryland and organizers hope it will become a national model. A newly formed partnership that includes Black community and business leaders, the University of Maryland and the White House covid-19 response team is working to make that happen by reaching out to barbers and stylists across the country, starting with a June 2 Zoom town hall.

"Why not go where people already have trust - the barbershop and the salon?" said Stephen Thomas, a health policy professor at the University of Maryland School of Public Health in College Park, who founded the barbershop initiative known as HAIR (Health Advocates In-Reach and Research) more than a decade ago. "These are the people who have street credibility and can educate folks enough so that they want the vaccine."

As the United States enters what is likely to be the toughest stretch of its ambitious immunization effort, health officials are moving away from mass vaccination sites and focusing instead on small clinics like The Shop Spa that rely on word-of-mouth and use trusted, often nontraditional messengers. With a month left to achieve President Joe Biden's goal of 70% of adults getting at least one coronavirus vaccine dose by July 4, experts say this critical next leg will depend increasingly on targeting those in the "movable middle," who might still be persuaded on vaccination.

Alston's friend, Randolph, 52, who sports an edgy, honey-blonde pixie cut, is part of the cadre of barbers and stylists trained as health educators through the University of Maryland program. The initial focus was colon cancer, diabetes and other diseases that disproportionately affect Blacks. But with vaccination levels lagging in Black and Brown communities, the program seemed a natural to persuade those who have been hardest hit by the pandemic but are often reluctant to get shots.

White House officials praise the initiative as an innovative way to reach underserved people, especially in the Black community, given barbershops' history as a trusted messenger dating to pre-Civil War times, when they doubled as sites on the Underground Railroad.

"It's important at this critical juncture to make sure we are using a full-court press to get good information to every community," said Cameron Webb, a senior health equity adviser on the administration's covid-19 response team, who is also an internist at the University of Virginia's School of Medicine.

Mike Brown, 49, The Shop Spa's lead barber, sees sharing such information as one more way to connect with regulars. "These are people we genuinely care about, and have become part of their family," he said. "Sometimes we're like marriage counselors, sometimes fashion consultants, sometimes drinking buddies. We're respected in the information that we give."

- - -

For Thomas, director of the Center for Health Equity at the University of Maryland, Prince George's County was a perfect target for his barbershop initiative. That was true before covid-19 and it is even more so now.

The community has the state's highest number of covid-19 cases. And while more than half of all U.S. adults have been fully vaccinated, Prince George's lags behind with a rate of only 39%. The rate is even lower In Hyattsville, where only about a quarter of the community is fully vaccinated, according to state data.

To get the word out about the barbershop clinic, Thomas and his team canvassed churches, local businesses and homeless communities and came up with about 100 people who hadn't been immunized yet.

Getting them to come to the clinic was another matter. During preregistration calls, Thomas said, some people hung up when they learned the vaccine being offered was from Johnson & Johnson. Others declined even after face-to-face conversations with the team administering the jabs.

"J&J is radioactive in the Black community because of the baby powder issue," he said, referring to the product the company stopped selling last year after it was ordered to pay billions of dollars related to claims the product causes cancer. The company has denied the allegations.

"They think, if you can't trust them on baby powder, how can we trust them on other things?" Thomas said.

Other people opted out of the clinic over worries about the rare but severe type of blood clot that has been linked to the vaccine, even though federal health officials have said the vaccines' benefits far outweigh those risks.

Still others expressed a distrust of the health care system that Thomas says can be overcome only by expanding these health care outreach efforts beyond coronavirus vaccinations. That distrust is evident in the large share of Black and Latino adults (22% and 15%, respectively) who want to "wait and see" how the vaccine is working for others before getting vaccinated themselves, compared with 10% for White adults, according to a Kaiser Family Foundation survey released Friday.

All in all, 35 people received the shots during that first clinic, Thomas said.

"These are not people who are getting vaccinated and then driving to Starbucks on the way to work," he said. "They came to the barber shop to find out what was going on. And in that moment, they found a trusting place and people who treated them with dignity and respect."

Despite the initial small turnout, the barbershop clinic is starting to generate buzz.

People are calling the organizers to ask when there will be more clinics to get shots for themselves or family members. As of Thursday, organizers had a list of about 15 people, five short of the threshold needed for Luminis Health, the hospital system that partnered with the shop to schedule another one - this time with the two-shot Pfizer-BioNTech vaccine. Other health systems have also reached out to offer help.

"Now we have demand," Thomas said. "People are bringing people."

Randolph figures she has changed the minds of at least 75 people. That includes Alston, her 63-year-old aunt who has such limited access to health care that she has no front teeth, and Jamar Gibbons, 36, a postal worker - all of whom showed up for a shot and a free fish sandwich.

Luz Castillo, 20, who works at the restaurant next door came to the clinic because she was worried about exposure to unvaccinated customers. She, too, was concerned about blood clot risks linked to the vaccine. But she said she was reassured after a Spanish-speaking health worker answered her questions and pointed to the millions of vaccinated people who have had no problems.

- - -

Elizabeth Estrada, 20, a day care worker, had already been searching for a place to get the shots when she heard about the clinic from her mother's friend who works in the laundromat a few doors away. She had not wanted the Johnson & Johnson vaccine either. But it was the one available and "the fact that it was here was, literally like, perfect."

Estrada admitted she was "very iffy" about the vaccine earlier in the pandemic. "I, myself, luckily didn't catch the virus," she said. "But it's just always that fear. . . . You never know, you'd rather be safe than sorry."

Her mother, who was still wavering, demanded answers about blood clot risks from Alexandra Moran, a community health provider with Luminis Health. Explaining in Spanish, Moran told her the risk was extremely low, noting the woman's risk of experiencing a clotting problem was higher from birth control.

"Tienes más probabilidad de un accidente de tránsito," Moran said, explaining the far greater probability of having a traffic accident.

Thomas believes barbershops and salons are the kinds of places where conversations like this can comfortably take place. "It is where people hang out," he said. Before the pandemic, customers might have spent hours there, listening to music, talking sports, sharing stories about their lives. The man selling tube socks might stop by, followed by church ladies selling cut fruit.

Randolph, who keeps neatly stacked pamphlets about oral health and tobacco on a table near the door of her Capitol Heights studio, The Shadez, said she talks regularly about health issues with clients.

"You talk to your doctor, what, once a year?" she said. "You see your stylist more than that. You get to have personal conversations."

Some of those clients share hearsay about the coronavirus or the shots, which she tells them is false. Others say they have no interest in the shots without offering a reason. She snips away at their mistrust, as at their hair, by talking about how a rampaging virus took nearly 600,000 lives in this country and how it could surge again. "Why not protect yourself?" she asks matter-of-factly.

And then there are the clients who see doctors rarely, if at all. Brown, The Shop Spa barber, said his customers run the gamut from "judges to trash men to common thieves to street guys to blue collars. Every walk of life, you name it, we cut it."

He figures he is able to change minds 60% of the time. "I'm reiterating the facts over and over and over," he said. For many customers, when he asks whether they'll take the shot, "the answer right now is not just 'Hell no,' but 'Hell no,' written in bold print," he said. His wife and children are among those he has been unable to persuade, including his son, 30, who has told him that a diet of seeds and nuts are the best protection.

But when he is able to persuade someone because they trust him, "it's an awesome thing."

The reverse is also true. During the recent clinic at the barbershop, Brown received a text from his wife telling him his brother-in-law had been rushed to the hospital with covid-19.

"He couldn't breathe," Brown recalled later. "He said it was like someone was standing on his chest." Every member of the family got sick, too, but the brother-in-law was the only one hospitalized.

Brown said he will wait for him to recover before talking about vaccination. "I'm going to be in his ear," he said.

- - -

To expand the reach of the barbershop clinic initiative beyond any one shop, Thomas and his team are also working to publish and distribute a graphic novel that will feature barbers and stylists and their shops to combat misinformation about the pandemic.

The idea is to depict the pandemic's effect through characters drawn from real life who are immediately recognizable in the Black community. Telling stories through pictures also reaches those who have trouble reading, stylist Randolph said.

"What better place to try to educate and encourage people to do something about" their health, said Joe Wade, 69, the artist behind the black-and-white charcoal drawings. "You got a lot of covid fears going on."

Wade, who has a college degree in commercial and fine arts, retired as a corrections officer and started sketching when the pandemic began. He drew first responders he saw on television who were overworked and overstressed. The pandemic changed so many lives, he said. "It's made victims of some and heroes of others, and I wanted to depict that."

Sometimes he can "whip out one in an hour or two." Other drawings may take a few weeks. He has made about 15 sketches, which he emails to Thomas. Thomas, meanwhile, is raising money to compile them in a passport-size book that can be in every barbershop and salon in the country. He needs $50,000 to $75,000 and has raised $5,000 so far.

Several drawings were on display along the walls outside the Hyattsville barbershop where people sat for their 15-minute post vaccination observation period. One features a barber who closely resembles Brown, giving a man a haircut. Both are masked.

Thomas wants to incorporate people's reactions into the images. If people see their own reality reflected in the book, they're more likely to share them with friends and families.

"What do you think they're thinking," he asks Clarence Cromer, 72, of Hyattsville, who was first in line to get the shot.

"They're hoping everybody's got their shot and they'll be good," Cromer replied.