The coronavirus pandemic magnified health disparities among racial and ethnic groups. Some experts say using trusted community voices could help close gaps not only in vaccination rates but in overall health.
Even before the pandemic, public health experts knew that people from historically underrepresented and underserved populations were less likely to receive preventive care, including vaccines, said Dr. Andrew T. Chan, a professor of medicine at Harvard Medical School and Massachusetts General Hospital in Boston. Often, these communities have less access to vaccines and greater mistrust of the medical system, which contributes to lower rates of vaccination, he said.
Some gaps in COVID-19 vaccination rates have closed over time. In mid-2021, Hispanic and American Indian/Alaska Native people lagged white and Asian people in percentage of those who had received at least one vaccine dose, according to Centers for Disease Control and Prevention data for people whose race and ethnicity were known. (The CDC lacks such data for about a quarter of vaccine recipients.)
But more than a year later, as of Oct. 12, 75.5% of American Indian/Alaska Native people had received at least one dose, as had 70.7% of Asian people, 65.2% of Hispanic people, 55.2% of white people and 49.8% of Black people.
With the annual flu vaccine, CDC data consistently show lower rates of vaccination among Black, Hispanic and American Indian/Alaska Native adults, who are more likely to be hospitalized with flu.
People 65 and older account for most flu-related deaths and hospital admissions, but a 2021 study in The Lancet Healthy Longevity found only about 33% of Black and 29% of Hispanic Medicare recipients were vaccinated during the 2015-2016 flu season, compared with 49% of white and 48% of Asian beneficiaries. The researchers concluded that although many factors may be involved, overall, the lower flu vaccination rates were "driven by deeply ingrained and often subtle systemic prejudices" in the medical system.
Chan agreed. "Institutional racism has led to disparities in access to vaccines and less willingness to receive vaccines," he said. But research shows people are more receptive to getting vaccinated when trusted members of their community speak about the interventions and alleviate concerns, Chan said.
That's the approach the Partnership for a Healthy Lincoln is taking in Lincoln, Nebraska. With a CDC grant, the nonprofit focused on improving local COVID-19 vaccination rates among Hispanic and Black residents, who had significantly lower rates of vaccination compared to white and Asian residents, according to county health department data.
Beginning in April 2021, the organization worked with El Centro de las Américas, Lincoln's Hispanic community center, to design posters, bus ads and social media posts encouraging vaccination against COVID-19 and the flu. The Spanish-language displays featured photos of community members and their own words, said Dr. Bob Rauner, the partnership's founder and president.
"Our Hispanic vaccination campaign was very successful," he said. "El Centro de las Américas really bought in quickly, and their director and several of their staff appeared on early versions of the bus ads." Hispanic residents now show the highest two-dose vaccination rate among the city's racial and ethnic groups, at more than 81% as of July.
However, Rauner and his colleagues had difficulty connecting with Black leaders. Some were wary of the COVID vaccine due to the history of medical racism in the U.S., Rauner said, and his organization's numbers-driven message wasn't convincing.
"As an analytical person, I just thought it was what you said. But no, it's how you say it, and who says it," Rauner said.
He reached out to Teresa "Buffy" Lewis-Hunt, a family nurse practitioner at a local health clinic, who became one of their first allies. She and Renée Massie, a retired health department employee and pastor, helped Partnership for a Healthy Lincoln make inroads with a group of Black clergy who agreed to appear on the campaign bus ads – a key way to appeal to hearts and minds, Rauner said.
"(The public is) not going to listen to clip-art people," he said. "They'll listen to Pastor Myles or Buffy."
Massie, who now works part-time on Partnership for a Healthy Lincoln's campaign, suggested its next phase: reaching folks in Lincoln's Black barbershops. "A lot of conversations take place at the barbershops," Massie said. "It's the perfect place to have conversations about COVID and vaccinations."
She visited 14 barbershops to speak with the owners, who said their clients were already talking about vaccines and COVID. With feedback from three shop owners – one of whom is Massie's son – Partnership for a Healthy Lincoln created a brochure with answers to barbershop clients' frequently asked questions, vaccination clinic addresses and photos of the barbers themselves. When customers picked up the brochures, "what drew them in were recognizable faces and the fact that they had already been asking these questions," Massie said.
The two-dose vaccination rate among Black residents rose to nearly 65% in July, up from about 51% in August 2021.
Earlier research has demonstrated the potential of using Black barbershops and churches to address health concerns. Rauner and Massie believe their approach can be adapted to other health issues, such as diabetes education and blood pressure screening to prevent heart disease and stroke. Black adults are disproportionately more likely to be diagnosed with Type 2 diabetes or to have high blood pressure.
"The lessons learned (from COVID) can apply to cardiovascular disease and cancer prevention," Chan said. "For colorectal cancer screening, for example, one really important place to do outreach and education around screening is at churches. It can be a great place for people to talk about their experiences and for leaders in the community to make a powerful pitch."
Massie concurs, saying that if people agree to get their COVID and flu vaccine – as doctors and public health officials are urging people to do ahead of winter – they'll likely become more interested in their overall health. They'll share that attitude with their cousins, aunts, uncles and friends and build a heathier community.
"When you start with trusted voices," Massie said, "you can begin to change people's minds."
Editor's note: Because of the rapidly evolving events surrounding the coronavirus, the facts and advice presented in this story may have changed since publication. Visit Heart.org for the latest coverage, and check with the Centers for Disease Control and Prevention and local health officials for the most recent guidance.
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