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Improving Vaccine Uptake Requires More Than a ‘One Size Fits All’ Approach

Addressing hesitancy is more than just offering pertinent information.

Although vaccine hesitancy or refusal has been on the rise for years, the COVID-19 vaccine and its uptake highlighted potential areas to improved. During a session at the American Public Health Association’s 2022 Annual Meeting & Expo, held November 6 to 9, 2022, in Boston, Massachusetts, researchers discussed outreach for the Latinx community, ensuring an equitable response in an area where the pandemic had exacerbated inequities, and addressing historical barriers in the Black commu nity.

The County of San Luis Obispo Health Agency was faced with numeroushurdles to improve vaccine uptake, according to Sophie Glazebrook, BS, CHES, Health Education Specialist, County of San Luis Obispo Health Agency in California. The county is not close to large cities like San Francisco or Los Angeles; much of the population is Latinx, had limited access to vaccine distribution centers due to both to time and transportation needs, and many Latinx people in the community speak Mixteco, the language of the Mixtec originating in the Puebla and Oaxaca states in Mexico. Mixteco has no written form, meaning that instruction sheets or pamphlets were not available.

To address these issues, the health agency used a 2-pronged approach. They offered pop-up clinics (76 in total) in communities like Shandon, California, which have no pharmacies and lacked other brick-and-mortar facilities where vaccines would be provided. Additionally, there were canvassing teams that had at least one bilingual/multilingual promotor, who went on 75 canvassing trips. As a result of the efforts, the Latinx vaccination rate increased by 11.1%, in comparison to a 7.4% increase in the White community.

For Glazebrook, the key lessons on the program are invest in trusted messengers, door-to-door outreach may be nontraditional, but can be effective in reach populations most at risk of poor outcomes. Canvassing also offered “an opportunity to strengthen partnerships with our participating organizations and to build rapport within the community.”

Washtenaw County in Michigan represents a study in contrasts: It’s the wealthiest county in the state, but in certain areas of the county with the highest poverty rates, people of color have a life expectancy that is 20 years less than their White peers. As happened all over the country, the initial vaccine roll-out was slow, particularly for the Latinx community. Maria Militzer, PhD, MA, CT, discussed Team Vacunas, a heath program put together by community members to improve vaccine uptake in the community. The program used bilingual volunteers to do community outreach and help get people scheduled for future vaccines. Vaccine clinics were held at trusted location, on a consistent date, and in the evening. Fifteen vaccine clinics were held at churches, restaurants, and mobile home clinics. Masks and at-home testing kits were also provided at the clinics.

As a result of these efforts, the Latinx population—which represents 4.8% of the county’s population—represented 5.8% of those who had received COVID-19 vaccine doses. The results of this program suggest “that these institutions need to trust community leaders and the resist regressing on power dynamics,” Militzer said.

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Many headlines during the pandemic underscored that Black communities were disproportionately impacted by the disease. When the vaccine became available, uptake rates were low in these communities, often assumed due to vaccine hesitancy. Using this term neglects the systemic barriers the community faces as well as the well-earned distrust of public institutions, according to Susan Watson, MPH, of the Public Health Institute. The Institute’s Initiative Together Toward Health funded community-based organizations to help address concerns.

The program was led by 3 guiding principles: listen and acknowledge, which addressed people who want to come in with pre-packaged solutions; represent, which meant that community members were hearing public health messages from someone who looked like them and understood their challenges; and inform and share power, which meant community members were in control of their own medical care, but had the necessary information, offered without an agenda. Some of the approaches used by community programs included staffing clinics with Black health workers, developing materials with an appropriate cultural lens, and holding vaccination concerts with local hip hop artists.

Watson boiled down the major lesson as, “the core of our approach is in the end: trust. Trusting communities to articulate their own needs, trusting community members to help drive and execute outreach efforts, and trusting people to make their own decisions once we've given them the information they need.”

Reference

1. Glazebrook S, Militzer M, Watson S. Vaccine uptake: Lessons learned 1. Presented at: APHA’s 2022 Annual Meeting & Expo; November 6-9, 2022; Boston, MA.


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