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AAMC - Association of American Medical Colleges

01/21/2021 | News release | Distributed by Public on 01/21/2021 14:20

Doctors forge ahead to allay fears about COVID-19 vaccines

Baseball great Hank Aaron gets a COVID-19 inoculation at a Morehouse Healthcare clinic in Atlanta this month as part of a campaign to promote the vaccines' safety. Credit: Jack Dunham

Baseball legend Hank Aaron was a game-changer in his prime, but the retired slugger didn't imagine he could come off the bench to help defeat COVID-19.

'I'm 80-something - there's not much I can do to help,' the Hall of Famer says.

But when Morehouse School of Medicine (MSM) in Atlanta asked Aaron to join other Black civil and human rights leaders in getting inoculated at a Morehouse Healthcare clinic in front of TV cameras as part of MSM's campaign to combat vaccine hesitancy among communities of color, the former Atlanta Braves star stepped up.

'I can understand the hesitancy' about getting a vaccine that has not been widely used before, Aaron says a few days after the media event earlier this month, which drew coverageby news outlets throughout the country. 'I did it so that other people can feel comfortable' about getting the vaccines, he explains. 'The most important thing is to get the country back to where it's supposed to be.'

Public vaccinations of trusted figures are among the countless ways that medical schools and university hospitals are working to combat skepticism about the safety and effectiveness of the first two COVID-19 vaccines among racial and ethnic communities, especially Black, Latinx, and immigrant populations. Doctors are speaking at online community meetings, appearing on radio and TV shows that serve minority audiences, and using websites and social media to explain how the Pfizer and Moderna vaccines were developed and how they work - and to answer questions from nervous listeners.

In Wisconsin, doctors at UW Health routinely go on Spanish-language radio stations to field questions about the vaccine, including whether people must provide proof of citizenship to receive it. In Los Angeles, a professor at the Charles R. Drew University of Medicine and Science (CDU) explained the vaccine to a support groupfor gay Black men. The Ohio State University (OSU) Wexner Medical Center will address vaccine hesitancy in minority communities at an upcoming online roundtablethat features a pastor alongside scientists.

The communication strategies build on the recognition that scientific explanations about the vaccines will not suffice to overcome fears. Doctors say the messages must address the concerns of specific groups, come from messengers those groups trust, and be presented in venues where the audience feels comfortable.

'There is an assumption sometimes that if we can just get people to understand the science,' their skepticism will disappear, Meredith Li-Vollmer, PhD, risk communication specialist at the Public Health Department of Seattle and King County, Washington, said in a webinarlast week for health care providers about discussing the vaccines with patients. But the key to success 'is much more about trust.'

Earning that trust requires myriad strategies, because 'one size does not fit all,' says Shiva Bidar-Sielaff, vice president and chief diversity officer of UW Health.

Recognize specific community concerns

When Bidar-Sielaff listens to the concerns of racially diverse communities in and around Madison, Wisconsin, the fears start with the basic safety concerns that many Americans share: that the two vaccines available now were developed too quickly and use genetic technology (messenger RNA) that hasn't been sufficiently tested.

Those concerns are then exacerbated by some communities' experiences with medical science and government.

About half (48%) of Black adults say they are not confident that the development of COVID-19 vaccines takes their needs into account, and 36% of Hispanic adults say the same about their needs, according to the Kaiser Family Foundation's (KFF's) KFF COVID-19 Vaccine Monitor project. One-third of Black adults say they probably or definitely won't get the vaccine, which is a higher hesitancy rate than among White adults, the project says.

'The most important thing is to get the country back to where it's supposed to be.'

Hank Aaron
Former Atlanta Braves star

The distrust that many Black Americans feel toward medical science stems largely from a history of mistreatment and deception - such as the infamous Tuskegee experiment that secretly tracked Black men with syphilis rather than treat them - but 'it's important to acknowledge that these issues are not only historical, but also contemporary,' says Keith Norris, MD, PhD, executive vice chair for equity, diversity, and inclusion in the Department of Medicine at the University of California, Los Angeles, David Geffen School of Medicine (DGSOM).

For example, Black people, as well as Latinx people, do not routinely get access to the same quality of health care that White people do - and that affects their perception of the COVID-19 vaccination risk, says Cynthia Baur, PhD, director of the Horowitz Center for Health Literacy at the University of Maryland (UMD) School of Public Health.

Many of those people wonder, 'If I get vaccinated and something goes wrong, will there be good health care available?' Baur said at last week's webinar about discussing the vaccines with patients, which the UMD School of Public Health hosted.

In addition, the paucity of Black and Hispanic doctors - who account for 5% and 5.8%, respectively, of all physicians in the United States, according to the AAMC - creates a trust barrier for patients in those groups, says Nina Harawa, PhD, MPH, a professor at DGSOM and CDU who works extensively with minority communities.

'People feel more comfortable when they see health providers who look more like them,' explains Harawa, an epidemiologist. In addition, she says that the lack of Black and Hispanic doctors means that people in those populations have few doctors in their families and social networks - which many people rely on for information they trust, including about illness and remedies.

Communities with a large share of immigrants have other worries about getting vaccinated. In Madison, Bidar-Sielaff of UW Health says that when she discusses the vaccines on local Spanish radio (a recent two-hour segment ran on Facebook Live), many callers ask whether people have to provide personal identification, such as social security numbers or proof of immigration status. (No, she says.) When she talks to people in Hmong communities, where many families have struggled after fleeing Southeast Asia, they often express a general distrust of government and concern about not getting adequate information about the vaccines because of language barriers.

Team up with trusted leaders

To overcome such barriers in educating audiences about COVID-19 and the vaccines, academic medical centers are partnering with organizations and people who are trusted by the communities they are trying to reach. These joint efforts include holding events where academic medical experts speak alongside community leaders and sharing explanatory resources and social media messages from university hospitals for community organizations to distribute through their networks.

For example, the upcoming vaccine hesitancy roundtable hosted by the OSU Wexner Medical Center features not only doctors from that health system but also the pastor of a local Baptist church and the president of a service organization for Ethiopian immigrants. In Wisconsin, the pastor of a large Black church moderated a Zoom meeting for its members to hear UW Health doctors explain the disease and vaccines.

Importantly, Bidar-Sielaff notes that the 'pastor chose who he wanted to invite' to speak.

'People feel more comfortable when they see health providers who look more like them.'

Nina Harawa, PhD, MPH
University of California, Los Angeles, David Geffen School of Medicine professor

The endorsement of trusted leaders is essential, even though the hospitals and doctors come to the table with medical credibility - and even though the participating doctors usually reflect the communities they're addressing. In Los Angeles, Norris says that when he talks about COVID-19 and the vaccines at online gatherings - such as one hosted by Black Women for Wellness Action Project- he cannot assume that his race (Black) conveys full trust to everyone who tunes in.

'Regardless of our background, we are still part of the medical community,' Norris says of Black doctors. 'The question [among some listeners] is, 'I don't know if Dr. Norris has sold out.''

A few examples of such suspicions surfaced in online town halls hosted by the Black Coalition Against COVID-19, which consists of health, faith, and social organizations that include MSM, Meharry Medical College, and Howard University. Although the audiences appeared to be very appreciative, one person wrote in a chat, 'How much kickback were these Black experts, clergy ppl [people], and community leaders paid? Shame on you Howard. You all would push a 1st gen vaccine on your own damn ppl.'

Go where people feel comfortable

While academic medical experts are using every format and venue open to them to explain COVID-19 and the vaccines, some communication channels work particularly well for certain audiences.

Bidar-Sielaff believes the appearances by herself and other UW Health colleagues on Madison's Spanish radio stations reach large Hispanic audiences not only because much of the conversation occurs in Spanish but also because many people in that community listen to the radio extensively during the day.

'A lot of our Latinx workers are in environments where they can listen to the radio during work,' she says. 'For the dairy farm worker, factory worker, worker in an office, listening to the radio is embedded in the Latinx culture.'

Similarly, the presentations at online meetings held by community-based organizations allow doctors to follow the adage to 'meet people where they are,' rather than asking people to join an event held by a large academic medical institution that some of them may have no relationship with. That's the thinking behind plans by MSM President and Dean Valerie Montgomery Rice, MD, to soon start talking about the vaccines at town halls run by Atlanta's neighborhood planning units - citizen advisory councils where residents regularly gather to discuss issues in their communities.

Show personal faith in the vaccines

One of the most common ways for doctors and other health care workers to communicate the safety of the vaccines is to get inoculated and share the experiencethrough social media, posting photos, providing updates about how they feel, and urging others to get vaccinated.

Soon after the Pfizer vaccine arrived at Grady Memorial Hospital in Atlanta last month, the hospital invited news outlets to come and record Rice getting inoculated alongside Sanjay Gupta, MD, the nationally known surgeon and medical correspondent. With TV cameras rolling, Rice and Gupta talked about why the vaccine is safe. Rice stressed that Black scientists and doctors helped to develop the vaccine and sat on the federal advisory boards that recommended its approval for public use.

'We are in the rooms where it's happening,' Rice said. 'So, we clearly are not going to go against ourselves, because we understand how critical this is for Black America and Latinx America, who have been disproportionately impacted by the virus.'

Weeks later, news crews went to the nearby Morehouse Healthcare clinic to film the vaccinations of Aaron (now a senior vice president for the Braves), former U.S. Ambassador to the United Nations Andrew Young, broadcasting executive Xernona Clayton, and former Health and Human Services Secretary Louis Sullivan, MD.

Aaron says he hopes his vaccination conveys a message that will save lives: 'Believe in the science.'