Increasing Vaccine Uptake in Diverse Communities

April 6, 2021

 – Episode #

67

The Health Evolution Forum has put out a document on increasing vaccine uptake in diverse communities that is worth a look.

FTA
Based on early data from 26 states, Black and Hispanic Americans are getting vaccinated at approximately half and one-third the rate of white Americans respectively.  This is true even after controlling for the demographic makeup of health care workers, who were first in line to receive the vaccine.  Meanwhile, Black, Indigenous, and (other) people of color (“BIPOC”) are contracting COVID-19 at nearly twice the rate, being hospitalized for COVID-19 at nearly four times the rate, and dying from COVID-19 at nearly three times the rate as white Americans.

Disparities in vaccine uptake stem from both lower confidence in and less access to the COVID-19 vaccination.
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They go on to layout a 10 step process for Healthcare CEOs to address this challenge.

Click to access 2021-Forum-Increasing-Vaccine-Uptake-Diverse-Communities-CEO-Guide.pdf

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Today in health, it, the story is increasing vaccine uptake in diverse communities. My name is bill Russell. I’m a former CIO for a 16 hospital system. And creator of this weekend, health it a channel dedicated to keeping health it staff current and engaged. I want to thank our sponsor for today’s serious healthcare. If they reached out to me about this time last year and said, we love what you’re doing and really appreciate your mission.

To develop the next generation of health leaders. The rest is history, as they say, if you believe in our mission as well, and want to support our show, please shoot me a [email protected] All right to today’s story. We said early on in the vaccination process that the first 150 million people were going to be pretty easy to get vaccinated. Once the supply of the vaccine was really there.

The next 20%, we’re going to take some time. They were in the wait and see category. And the final 30% may never take the vaccine that is playing out as we expected. And the situation is particularly acute. In diverse communities. The health evolution forum has published a document to address this titled increasing vaccine uptake in diverse communities, a working guide for healthcare CEOs. It was published on March 1st, 2021.

The document was created by the round table on community health and add advancing health equity. With support from several other groups. This includes former guests of this week in health. It rod Hochman, CEO of Providence, and several other prominent CEOs and including Wright Lassiter, the president and CEO of the Henry Ford health system.

I’m going to do a flyover on this document because it is really a great document. If your health system is struggling with this challenge. Let’s go ahead and jump right in

the problem. Based on early data from 26 states, black and Hispanic Americans are getting vaccinated at approximately half. And one third, the rate of white Americans, respectively. This is true, even after controlling for the demographic makeup of healthcare workers. Who were first in line to receive the vaccine, meanwhile, black indigenous and people of color.

 

Are contracting COVID-19 at nearly twice. The rate being hospitalized for COVID 19 at nearly four times. The rate and dying from COVID-19 at nearly three times. The rate as white Americans. All right. So that’s the problem. There’s a couple of graphics in here, disparities in vaccine uptake, stem from both

lower confidence in the vaccine itself and less access. These are two of the main problems that they’re going to discuss in this document. First many individuals in diverse communities are less confident than white Americans in the vaccine with 43% of black adults and 37% of Hispanic adults stating they would wait and see.

How does working for others before getting it, although the roots of this low confidence vary by community and individual, it often stems from distrust of the medical system, which has historically mistreated. And neglected these Americans and there’s a whole bunch of footnotes on that second fact scene distribution is commonly done in ways that are less accessible to this population in both obvious ways.

Distribution sites are placed farther from these communities and more subtle ways. Accessing the vaccine requires an individual to have resources, time, transportation, computer, and internet access, knowledge of how to get to the vaccination site. That are not equitably distributed by race and ethnicity.

 

Next, they talk about why healthcare CEOs are in a unique position to increase confidence in accessibility too. The vaccine. The first is the very mission of healthcare organizations is to promote a healthier community. Second healthcare organizations often have more access to resources, data, and expertise than government and community organizations. That’s true. Many healthcare organizations also have access to the vaccine and, or train vaccinators needed to support the critical community vaccination efforts. Healthcare professionals are often seen as trusted voices in their communities. And finally, healthcare organizations are often among the largest employers.

In their communities, providing an opportunity to have an outsize impact. In the vaccination efforts. All right. So that’s the reason the CEO’s are in a unique position. It then lays out a 10 step. Process over really three key areas. I’m just going to jump right into it, rather than giving you a big list.

First create an action plan. That’s the big category. Step one, empower a task force to provide oversight for those who have not already done. So set up an oversight committee or leverage an existing task force, and they want you to ensure that those on the oversight committee are demographically diverse and representative of the community that the healthcare organization serves. Ideally with some community member representation on that.

 

The second step is coordinate with community organizations and local government. That you’re looking for partners that brings strong cultural competence with the communities being served or targeted. The next thing is partner with local and state government

advocate for local government to use evidence-based messaging and evidence-based methods for making the vaccine more accessible as outlined in the COVID 19 vaccine toolkit for mayors, but you didn’t know all these resources existed, but they are out there and there’s a ton of them. The next step, step three, conduct a rapid root cause analysis, and they warn you right in the front. Do not skip this step.

Review national resources and research to provide context for vaccine concerns, especially of the underserved populations. Kaiser family foundation’s research highlights how black and Hispanic adults who indicated that they would like to wait and see before taking the vaccine are very concerned about the long-term effects of the vaccine, the potential for side effects and overall safety and effectiveness.

And that’s the number one concern long-term effects of COVID-19 vaccines. Are unknown. And this is not just in the diverse community, although it’s particularly high in that the diverse community, 65, 57% among the. Black and Hispanic communities, but it’s also close to 50% in the white communities. We really don’t know what the long-term impacts of the vaccine are going to be on people. And they’re concerned about it.

So let’s go on with this conversation should be ongoing occurring at regular frequent intervals because the community’s concerns may change rapidly,

bring in local community representatives and organizations to learn what concerns are specific in that communities around the vaccine.

They encourage you that the discussion should include topics such as how COVID 19 has impacted social and economic fabric of the community. What specific questions to community members have about the vaccine? What conceptions and misconceptions the community members have about the vaccine, which populations in the community have lower confidence in the vaccine. There’s a whole bunch of more questions. I’m just going to, again, I’m doing a fly over.

Please download the document. If this is something that you guys are struggling with as a health system, if you’re in a very diverse community, you should download this document. It’s just loaded with great information. The next step is step four is to identify and train trusted messengers. You need to locate them first, and then they suggest that you start with your own health care organization, employees. Good place to start, uh, reach out to additional trusted messengers. Which would include family, friends, local pharmacists, faith leaders, other community-based non-governmental organizations.

Who represent the people in that community. And also look for micro and local influencers, popular figures, and even national influencers as well in that community. It goes on. If people feel like their concerns are being downplayed unheard or unaddressed, they are less likely to listen to messaging about getting vaccinated.

The next thing. This is again, so sub point D equipped, trusted messengers to address the concerns of the communities. Established forums for members of the community to have their questions answered in nonjudgmental ways by and to have conversations with those trusted messengers. These conversations should utilize active listening.

It should be supportive, reflective, nonjudgmental, and without the intent to convince them to take the vaccine. All right. It goes on E encourage those with low confidence in the vaccine to reach out to a pharmacist or primary care physician for more information on the vaccines development and their perspective on its effectiveness.

Continuing with the flat of her step five, be transparent about vaccine allocation and distribution. This is one of the things. That has really frustrated people is not having the vaccine.

I think we’re getting on the other side of this. Now the quantity of vaccine in the pipeline out there is pretty significant. , but this was a problem early on, right. We were telling people to schedule, they couldn’t get in line. , we didn’t have a reliable. Quantity of the vaccine. Therefore people were even getting scheduled and being turned away at the door. So that is a problem.

And they suggest creating a distributed, clear information about the vaccine. Be sure to note the vaccine is free, be up front about who is getting the vaccine in what order and why, and make this information available in as many formats and places as possible. Again, I don’t think this is as much as a problem now as it was maybe even 30 days ago.

Because, In a couple states we’re now down to 18 and above are getting the vaccine. Step number six. Create personal messaging. This is always a great idea in communication. This is a great document. If you’re just studying how to communicate effectively with the community. This is a great guide to study and take a look at create personal messaging, ensure that vaccine messaging is personal, relevant and appropriate to the targeted artists.

Promote the experiences of those who look like those in target communities, get feedback on the messaging and you have to go beyond digital. I can’t tell you how many times. Especially technology. People get caught up in the digital messaging because that’s really, our job , is to facilitate the digital messaging, but they go on to say, digital messaging alone will not go very far and increasing confidence in the vaccine. As many of the people with low confidence in the vaccine are also not using digital technologies. Make sense.

When discussing vaccine development focused on the large number of people already vaccinated and on the large number of people in the clinical trials, because people are afraid of being Guinea pigs. And this is a valid concern. It’s one of my greatest concerns. Is that these people have a valid concern.

And I don’t want to coerce them into getting the vaccine and I don’t want to shame them if they choose not to get the vaccine. Look, we’re operating as a society. Pretty fine right now, outside of the people that are just flaunting things. We get on airplanes. I’ve been on several flights. We get on, we all have masks. We’re all fairly safe in that process. We go to sporting events. I watched the Baylor victory last night.

And at the end of the day, there was people in that stamps. There was people hugging after the process. My daughter was at a watch party at Baylor stadium in Waco, Texas, and a whole bunch of people were jumping around, hugging each other. Now we can operate safely. You know, to, to mitigate all risk in society is not really living.

And so to coerce these people and to create situations where they have to get the vaccine, I know we’re going to have to do it for international travel. I don’t think we need it for domestic travel. I don’t think we need to have it to go to our kids. Soccer game or basketball game at the local high school or even grade school. So , I’m a little concerned that we might overstep our bounds here by really pushing people. But with that being said, I’d like to see as many people as possible, get the vaccine.

And get on the other side of this, get to the herd immunity that we need to get to. And so, I’m getting the vaccine and I’m encouraging other people to get the vaccine. My parents have gotten it. Many of my family members have gotten it. So, , again, don’t hear me saying I’m an anti-vaxxer hear me saying, I think there are valid concerns that need to be addressed. And some people may never be comfortable with our, , explanations around that and they may choose not to get the vaccine and I do not believe they should be ostracized. Okay. Enough said on that step number seven.

Use evidence-based messaging, keep messaging simple, clear, and actionable.

Emphasize the specific people researching, taking and benefiting from the vaccine. Avoid shaming. Be visual and emotional and know the specific audience. And this is interesting. They have this chart on what exact language and messaging. You use depends on the political, racial and ethnic makeup of the community.

For a precise language for different communities. See the Dubbo. Foundation’s language of COVID 19 vaccine acceptance, which is broken down by race. If you wondered. How important the power of words are, this is a great example of it. When discussing the vaccine development, focus on how rigorous the trials were under the FDA’s scrutiny, focused on vaccine safety.

Then they have this chart. Which is interesting to me, the power of words. And if you don’t think people are thinking of what words should we use in order to frame this. For the population to accept it, you’re wrong because here’s the whole list. Use America’s leading medical experts avoid America’s leading health experts. Use research, avoid discover, create invent, study, use medical researchers, avoid drug companies.

Use damage. From lockdowns, avoid inability to travel easily and safely, and this list goes on and on. It’s , interesting. I

and I’m sure lots like this exist from both political parties on just about every topic out there. And this just shows the power of words. If you’re a leader in any capacity words, create worlds, words are important. The words we use are extremely important, and this is an example of that. It goes on to impact people’s behaviors. Messaging must be ongoing. Messaging must be repeated over time.

And it must be received from more and more credible sources. Setback, communicate through multiple touch points consistently connect with community members through multiple touch points consistently over time. Promote factual information continuously to counter specific viral misinformation. And promote trustworthy sources.

The final part of this is increasing accessibility. And this goes on onto the signup process. Make signups as easy as possible. Coordinate with community to centralize vaccine appointments. Sign-ups utilize multiple mediums for signup. Be proactive in addressing barriers. , consider notifying patients that they have an appointment to take the vaccine, rather than just telling them they can sign up.

But only after the vaccine supply is more predictable. And consider carefully providing financial incentives for getting vaccinated. And they say, this is interesting

incentives such as gift cards and cash compensation have been shown to increase uptake rates, including a study at Swarthmore college where a $30 incentive doubled flu vaccination rates from 9% to 19%. And finally distribute the vaccine in local places. And this is probably an obvious one, but we need .

To distribute the vaccine in these diverse communities, those giving the vaccine should be representative of the community.

Bundle the vaccine with other services, community members are already accessing

and bridge the specific barriers to access faced by the community and finally consider restricting access to certain vaccine distribution sites by zip code. And this is one of the problems probably more so 30 days ago. But. They were setting up vaccine distribution sites in these underserved communities and people were traveling in, and that those underserved communities were still not getting vaccinated because people were coming in from the outside.

I share this resource. It’s a good resource. If you are struggling. With getting over that hurdle, getting past the first. Easy 50% or even the first easy 70%, or if you’re dealing with a diverse community, this is a great document to start with. It’s a great. Work plan is a great. A strategy for addressing this specific problem.

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