As a Latina physician on the frontlines of COVID-19, it feels like a race against time to get as many vaccines as possible to the communities of color that are more likely to be infected, hospitalized, and die from the virus. A lot of effort right now is focused on the logistics of managing vaccines that need to be manufactured, stored, allocated, distributed, and administered by health care workers.
But all these efforts will be in vain if the needs of communities disproportionately impacted by COVID-19 are ignored or neglected. According to the KFF Vaccine Monitor, Black and Brown communities do not feel they have enough information on the vaccine side effects or effectiveness, don’t know when and where to get vaccinated, and are less confident that vaccine distribution is taking into account the needs of their respective communities.
The low confidence levels are not unfounded. Centuries of trauma and systemic racism from the U.S. government and medical community through events like the Tuskegee experiments, sterilization without consent, and, still today, the undertreatment of pain because of racist assumptions have broken Black and Brown communities’ trust in these institutions.
Now we are reaping the consequences of that history. Of those who received a COVID-19 vaccine in the first month of distribution, only 11.5 percent were Hispanic/Latino and just 2 percent were Black.
So how does the medical community work to earn the trust that we broke? In one word, transparency. Here’s what that transparency looks like in practice:
1. Acknowledge that the medical community broke the trust of Black and Brown communities. This can be as simple as stating, “Yes, the medical community has made mistakes, but we are making a conscious effort to do better and be better by working to get the vaccines to communities that need it.” This helps validate their experiences and works to earn back trust.
2. Don’t assume you know the reasons behind someone’s hesitancy. There may be questions or concerns specific to a community or individual that you have not identified or addressed yet. Rush University Medical Center’s Community Response Playbook shows how individuals from the community and health care institutions can come together to identify problems and develop solutions to a community’s unique needs.
3. Work with trusted messengers. A known partner, such as community and faith-based organizations, can help bridge communication and trust. A trusted messenger can also be a physician or health care worker from that community who understands the community and its culture. I am currently working with Enlace Chicago to train their Promotoras de Salud to respond to questions. This will be paired with Charlas, monthly virtual information sessions, so that the community can not only get information but also have questions answered by Promotoras and Spanish-speaking physicians like myself.
4. Information should be clear, consistent, linguistically appropriate, culturally appropriate, and in a channel of communication preferred by that community. For example, some individuals who are undocumented are hesitant to access any publicly-funded testing, care, vaccinations related to COVID-19 for fear of not being eligible to receive a green card due to the U.S. Citizenship and Immigration Service’s (USCIS) Public Charge Rule. When I speak to communities, I clearly and concisely state in Spanish that President Biden and Homeland Security want to ensure that everyone residing in the U.S. has access to the vaccine and that accessing care and vaccines related to COVID-19 will not negatively impact a person’s Public Charge analysis.
5. Meet communities where they are. We know that difficulties physically accessing health care negatively impact health outcomes, including outcomes of COVID-19. Vaccination sites should be easily accessible to the communities hardest hit by the pandemic.
6. Respect the decisions of individuals even if you disagree. As medical and government institutions, our role is to provide people with the information they need to make the best decisions for themselves and their families. If they decline the vaccine, we must respect that decision. We can still build trust by encouraging the evidence-based public health behaviors that will protect them from the virus.
There are still many obstacles to making earning the trust of Black and Brown communities. But by acknowledging that the trust is broken and being transparent in how we reach out to communities, we can work toward earning trust and doing better for these communities who have suffered so much from this virus already.
Susan Lopez is an internal medicine physician.
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