Bridging the COVID-19 Vaccine Gap in Underserved Communities

Announcer:
You’re listening to VacciNation on ReachMD, and this episode is sponsored by Pfizer. Here’s your host, Dr. Charles Turck.

Dr. Turck: 
Although millions have been vaccinated for COVID-19, glaring gaps in access remain, especially in marginalized communities. So how can we turn awareness into action when it comes to making vaccines more equitable?

This is VacciNation on ReachMD, and I'm Dr. Charles Turck. Joining me to discuss barriers to COVID-19 vaccine access in underserved communities is Dr. Diego Hijano. He's an Associate Member of Pediatric Infectious Diseases and the Medical Director of Occupational Health at St. Jude Children's Research Hospital in Memphis. Diego, welcome to the program.

Dr. Hijano:
Oh, thank you for having me.

Dr. Turck:
So let's start with the big picture, Diego. What have we learned about vaccine equity during the COVID-19 pandemic, and why is this still such an important and urgent issue today?

Dr. Hijano: 
Thank you, Charles. I'm glad that you bring up that subject, because the pandemic certainly showed things that were already there but not properly highlighted. So we learned that there are a lot of communities within the US that actually struggle to get access to healthcare, particularly when it comes to vaccines. So people in rural areas, immigrants, individuals that have a different race or language, and individuals that may not be able to either through insurance or not being able to understand that they need a vaccine, have really suffered through the pandemic. But again, it's things that we've known that have been there for quite a time.

Dr. Turck: 
And with that important context in mind, would you walk us through some of the key barriers that underserved communities face in accessing vaccines?

Dr. Hijano: 
The lack of access to vaccination is really a network of complex problems that sometimes are intertwining in getting individuals to receive the vaccine.

The first thing that one should consider is access to a vaccination site. So we know that there are a lot of areas that don't have a vaccination center for many miles, so transportation and access can be a problem. We also know that these individuals often have issues taking days from work or from school to actually go and get vaccinated, so time and days availability of a vaccine center, even if close, are also important to consider.

Another important problem is the lack of insurance. While the US provides vaccines free for all children, that's not true for adults. So when we talk about parents needing to get vaccinated, they may not have access or not know how to navigate the complexity of getting a vaccine free of charge. We know that during the pandemic, the vaccines were available for free for a long period of time, then that was discontinued and people were quite confused about that.

And I think the last thing I would like to point out is information, mistrust, and lack of confidence in the healthcare system and in vaccines. Certainly, that continues to be a challenge where individuals—particularly those who are underrepresented in the healthcare community—do not have a clear message from someone who they can relate to, either through race or culture, to understand the importance of receiving vaccines.

Dr. Turck: 
For those just joining us, this is VacciNation on ReachMD. I'm Dr. Charles Turck, and I'm speaking with Dr. Diego Hijano about COVID-19 vaccine access and equity in underserved communities.

So Diego, now that we've discussed some of the barriers that marginalized populations face, let's shift gears and talk about strategies for addressing them. What role do community-based approaches like mobile clinics and grassroots partnerships play in improving vaccine uptick?

Dr. Hijano: 
I think those are critical to the success of COVID-19 vaccine, any vaccine, and most medical interventions that require screening or preventive medicine. We learned that having someone from the community that you can relate to has a lot of sway in talking to and pushing people to get vaccinated. So we certainly implemented this in our institution; we had champions within departments that could go and talk about the vaccine and tell their story on how they got vaccinated and what their experience was. And that had a lot of impact within each department. And I think we also know that from communities: so local tribe communities, grassroots organizations, being able to have a mobile clinic, this is important, but also it addresses these cultural differences that sometimes are a main barrier in going to. So I think those are critical ways of addressing this problem.

Dr. Turck: 
And is there anything else you can tell us about how local leaders and peer educators help boost vaccine confidence?

Dr. Hijano: 
Yes. Certainly. I think there is a trust already in place, a relationship that has preceded this problem, and that is key in being able to have a conversation and talk about this issue. Certainly, it has become a barrier in itself to even bring it up, to the point that a lot of healthcare providers say, “I don't even want to bring up COVID vaccine because I think I'm going to get yelled at or people are going to get angry.” So I think that the importance of these key individuals in the community is that they already have a trusted relationship that they can lean on to have these difficult conversations.

Dr. Turck: 
And taking a bird's eye view, what's the importance of tailoring outreach efforts to each community's unique needs, rather than using a one size fits all messaging approach?

Dr. Hijano: 
That's such an important topic, particularly because public health tends to give broad recommendations that often try to apply to a whole country or a whole state, and we need to remind ourselves that we have a lot of diversity in our communities. And each race, ethnicity, culture, age group, and religion may have specific concerns about a vaccine that may be completely different from others. So what I think is critical is for us to get to the communities, find local leaders that understand the concerns that their group are having specific to the vaccine, to be able to help them and facilitate the information and access to vaccines, and address specifically what they are anxious about, rather than just throw facts about safety and efficacy that everyone can sort of recite by memory and that don’t really get us anywhere.

Dr. Turck: 
And before we wrap up, Diego, let's look ahead for a moment. What do you believe healthcare professionals should prioritize to ensure vaccination equity remains central moving forward?

Dr. Hijano: 
I think that when we look at the problem, it can be very overwhelming right away. It's, “How can I fix this from my private office or my practice?” But I think we need to consider that every patient matters. Every family matters. And what you can do today is make sure that you listen, apply empathy and kindness, and are authentic with your patients, because you will not know all the facts. You will not be able to address a lot of the cultural barriers that are out there, but at least if you can rely on those traits and you can make a difference in that patient and that family today.

Dr. Turck: 
Great comments for us to consider as we come to the end of today's program. And I want to thank my guest, Dr. Diego Hijano, for joining me to discuss challenges and solutions for improving COVID-19 vaccine access and equity in underserved communities. Diego, it was great having you on the program.

Dr. Hijano: 
Thank you so much for having me. It's always a pleasure, Charles.

Announcer:
This episode of VacciNation was sponsored by Pfizer. To access this and other episodes in our series, visit VacciNation on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!