Trustworthy messengers can help disenfranchised communities overcome vaccine hesitation

MINNEAPOLIS – Gloria Torres-Herbeck receives the flu vaccine every year, but the 53-year-old teacher in Rochester, Minnesota, is not yet convinced that she wants to be first for a potential COVID-19 vaccine.

“I’m not super old, but I’m not as strong as other people,” she said. “So I have to be realistic about my own situation. Do I want to participate in something that poses a great risk to me? “

This month, the Food and Drug Administration granted emergency use approval for a vaccine and is considering approving another vaccine. As a result, public health officials across the country are preparing for what could be as challenging as figuring out how to store a vaccine at 70 degrees below zero. You need to convince people who are part of communities severely affected by the virus – low-income families and some minority groups, especially black and Latino residents – to take a vaccine that will develop and be imminent in less than a year Emergency Authorized Use Permission.

However, there are a few places where officials believe they have a head start. Rochester, Minnesota, home of the Mayo Clinic, is one of them. The Rochester Healthy Community Partnership has been working for 15 years to reduce the health disparities in the area’s immigrant communities, including Somali, Hispanic, Cambodian, South Sudanese and Ethiopian residents.

The partnership consists of Mayo health care providers and researchers, county public health officials, and community volunteers like Torres-Herbeck, who immigrated to the United States from Mexico 27 ​​years ago. One of the first of its kind, other similar endeavors have sprung up across the country, but no one officially pursues such partnerships.

“When the pandemic came to its knees in March, we realized that with long-standing partnerships we were in a unique position to capitalize on the trust built over the years between Mayo experts and their community partners,” said Dr. Mark Wieland, who leads the program, helps group and examine the effects of such partnerships. “We realized that we have to step in with two feet.”

Although preliminary evidence has been gathered so far, there is evidence that since the effort began, Rochester has stepped up COVID-19 testing, improved contact tracing and increased preventive behaviors such as wearing masks, hand washing and physical distancing in these vulnerable communities, he said. The group hopes that these early successes speak well for vaccine acceptance.

Learning from a measles outbreak

The Rochester partnership takes a sensible approach that focuses on shared values, transparency and clear communication.

It’s a strategy that has worked in the past.

When a measles epidemic hit the large Somali population in Minneapolis-St. Paul in 2017 turned the Mayo Clinic to community leaders among the 25,000 Somali immigrants in the Rochester area. Many feared the measles vaccine through unsubstantiated claims that it could cause autism, and vaccination rates in the community were low. Medical experts held town hall meetings in mosques and community centers, answered questions about vaccine safety, and reassured people that there was no scientific evidence of an association with autism. Somali actors created YouTube videos to address general concerns. In the end, there were no cases of measles in Olmsted County, home of Rochester.

About a year ago, Dr. Robert Jacobson, medical director of the population health research program at the Mayo Clinic, told a rabbi to find an Orthodox Jewish community in New York where vaccine rejection sparked another measles outbreak. He helped local healthcare executives address the concerns.

“The Orthodox Jews in this community rejected this vaccine for the same reason we recommended it,” Jacobson said. “They tried to protect their children.”

Efforts by Jewish leaders, public health experts like Jacobson, and lawmakers tightening vaccine exemption laws helped quell the outbreak.

Since March, the Rochester partnership has been sending similar messages about COVID-19 to various audiences. Fear or misunderstandings were an issue at the beginning of the pandemic. Health officials found members of the immigrant communities hanging up when the health department called. So the partnership developed messaging in multiple languages ​​to explain the importance of phone calls. They have circumvented problems including the fact that other languages ​​do not always have terms that match English words for disease. For example, the word for “cold” and “flu” is the same in Somali.

Fewer people hang up now.

At the same time, these public health teams are reporting to medical experts on community needs. “They are the experts on the intricacies of their communities,” said Wieland.

When the group learned that many immigrants were intimidated by COVID-19 testing and unsure of the logistics, the group recommended simplifying the process: now, videos with community leaders on social media direct people to test sites. Anyone who doesn’t speak English is automatically tested there – no ID or insurance certificate required.

“We believe that this is one reason why we as a district have overestimated minority populations in relation to white population groups,” said Wieland.

The “why” was missing

Only 40% of older black adults and 51% of older Hispanics said they had some or a very high chance of receiving the COVID-19 vaccine – compared to 63% of older white people, a University of Michigan survey shows . Your concerns mirror those of Torres-Herbeck: How well will the vaccine work or how safe will it be?

An even recent poll of people of all ages for the COVID Collaborative, an advocacy group of national and state health and business leaders, the NAACP, and other groups, shows that confidence in vaccine safety is only 14% among black Americans and just 34% among black Americans. is Latinos.

Older adults said they’d like recommendations from doctors, health officials, or family members and friends – people they trust, according to the Michigan poll. And black Americans trust black messengers twice as often as white messengers, the other survey found.

“Even when people generally don’t trust doctors, they trust their own doctor,” said Dr. Preeti Malani, one of the authors of the Michigan survey and the university’s chief health officer.

The advantage of groups like the Rochester Partnership is that their members are also trusted ambassadors.

A few weeks ago, said Torres-Herbeck, she spoke to a landscaper who did not wear a mask when working with his business partner. She told him that COVID-19 was a virus and explained how it spreads. He was surprised and Torres-Herbeck understood. “When I came here 27 years ago, we weren’t that well trained,” she said. “When I grew up, people believed that walking barefoot would catch you with a cold.”

Often, she said, public health officials give instructions on how to act and what to do, such as using a mask and cleaning your hands, but fail to explain why.

“He missed the ‘why’,” she said.

Now when she talks to him he puts on a mask.

In mid-November, Jacobson visited with members of the Rochester Partnership through Zoom, which was part of the group’s initial effort to disseminate vaccine information.

The approval of a vaccine under emergency approval is no less strict than the normal procedure, he said. The process has been accelerated and shortened dramatically, he said, by the amount of money and newer technology – and by the increase in FDA resources.

It’s not just about spreading facts, however. Focusing on shared values ​​is key to building trust. When Adeline Abbenyi, Mayo Clinic’s program manager for the Center for Healthy Justice and Community Engagement, said her mom, who was never afraid of vaccines, was reluctant to get a COVID-19 vaccine, Jacobson understood.

“Many of us feel the same way,” Jacobson said at that Zoom meeting. “I am optimistic that we will have a vaccine that is safe and effective, but I will not use it until I see this evidence of safety and effectiveness that the FDA is reviewing.

It is normal for people to hesitate, he said, but this is very different from the anti-vaccine movement – and widespread than that. Doctors and nurses who receive the first doses are likely to help many people overcome this hesitation, he said.

Indeed, one thing that would convince Torres-Herbeck to be vaccinated? When she saw Jacobson getting the vaccine, she said.

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