Here in Hawaii, and across the country, COVID-19 is resulting in the death of large numbers of nursing home residents. Some studies document that nursing home residents account for 40% of all deaths from COVID-19. This is terrifying to older adults and their families.

In response, the federal government is giving priority status for vaccinations to these residents when they become available. Hawaii’s Department of Health is developing the state’s strategic plan for COVID-19 vaccination with high-risk older adult residents of nursing homes and other congregate living sites given priority.

This is an urgent step in reducing the risk to this endangered group.

Additionally there are thousands of older adults in our state who live at home and are as disabled as those in residential facilities. Because of their high risk factors, they are equally in need of vaccination.

Related to this we have learned that seniors are not getting as many flu vaccinations this year as in years past, which does not bode well for efforts to vaccinate them for COVID-19. Reasons for hesitancy over a flu vaccine include fear of leaving home to get vaccinated, long waiting lines, fear of the shot itself and its side effects, and concern over potential costs that may also translate to fears over COVID-19 vaccines.

We urgently need information on potential side effects so we can prepare should they occur, and we need a phone number to call following vaccination should a side effect be worrisome to us and our families. We also need professional and community help to advise on efforts to reduce COVID-19 racial disparities in response, care and treatment.

The rate of vaccinations in general will improve when the Federal Drug Administration, the Centers for Disease Control and Prevention, our physicians and other health care professionals give us the confidence we need to trust vaccination. The state can help by making vaccination convenient, comfortable, free and delivered close to home.

There is currently limited information on how we will get this critically important vaccine to our population. Large community- based flu and COVID-19 vaccination clinics in communities around the state have been suggested. Pharmacies, hospitals and other venues have been used in the past, but given the numbers who will need vaccination, we may need creative avenues and sites as well, such as places of worship, mall parking lots and parks. Since many older adults are home-bound, it may also be necessary to take the vaccinations to individual homes.

A good place to start would be to reach out to the many excellent public and private in-home care providers who offer a variety of services such as meals, personal care and custodial service. We fully recognize this kind of outreach will be challenging given the requirement for refrigeration but will greatly expand protection for critical populations. We ask that these suggestions be part of the state’s discussions and plans.

Much work needs to be done ahead of the vaccinations’ arrival in the islands. That is only the beginning. Real control of COVID will only be possible when 70% of us are protected. Let’s set this as our goal.

Marilyn R. Seely, MPH, is former director of the state Executive Office on Aging, with 40-plus years working in gerontology and long-term care; Colette V. Browne, Dr.PH., MSW, is professor emerita at the University of Hawaii, Myron B. Thompson School of Social Work.