Building COVID-19 vaccine confidence: Here’s what three doctors say needs to be done

By Asif Dhar, M.D., US Life Sciences & Health Care leader, Deloitte Consulting LLP

The COVID-19 pandemic further exposed health inequities that have existed for decades if not centuries in the US. These inequities, which have long been apparent to front-line medical professionals, are having a negative effect on vaccination rates within certain communities.

Despite the disproportionate impact the virus has had on predominantly Black and Brown communities, white individuals are being vaccinated at higher rates across the country. In March, white people accounted for nearly two thirds of people who had received at least one dose of the vaccine, according to data from the Centers for Disease Control and Prevention. By contrast, 9% were Hispanic and 8% were Black.

On March 23, I moderated a fascinating Dbrief that examined the pandemic and vaccination trends through the lens of health equity. The webinar appropriately took place during Women’s History Month, and I was fortunate to have had a panel made up of three of the smartest women I have ever met. They are frontline workers, they are making a difference, and they are my heroes.

Dr. Eugenia South is assistant professor of emergency medicine at the University of Pennsylvania’s Perelman School of Medicine and vice chair for Inclusion, Diversity, and Equity. She has seen a disproportionate number of Black and other minority patients hospitalized with COVID-19. Dr. Lisa Fitzpatrick, an infectious diseases physician and epidemiologist in Washington, D.C., says she grew up in an under-resourced community and has worked with underserved communities from since she can remember. Dr. Megan Ranney is an emergency physician, director of the Brown-Lifespan Center for Digital Health, and associate dean for strategy and innovation at the School of Public Health at Brown University. She was a Peace Corps volunteer in West Africa during the height of the AIDS epidemic and saw the connection between structural inequities and poor health outcomes. Since leaving medical school, she has worked to destigmatize disease and advocate for both education and expanded access to treatment.

Five strategies to improve health equity and build vaccine confidence

The term “vaccine hesitant” is often used to describe someone who is reluctant to get a vaccine. The panelists agreed that this term is a misnomer because it implies something is wrong with that individual. Dr. Fitzpatrick explained that everyone is at a different point along the vaccine-acceptance continuum. “Not everyone will ever be in the same place at the same time philosophically or emotionally,” she said. “It’s important to understand and accept the reasons people have for being skeptical. We then have a responsibility to meet them with the information they need."

Our panelists suggested the following strategies to improve health equity and build vaccine confidence:

1.   Use facts and data to address misconceptions: As an emergency room physician, Dr. South was among the first people eligible for a COVID-19 vaccine. But she wasn’t sure she wanted it. She initially thought it had been developed too quickly and had become politicized during an election year. During the three weeks before the vaccines were made available to hospital staff, she embarked on a mission to educate herself. “I tried to talk to as many people as I could—particularly my Black colleagues in the Emergency Department,” she recalled. “I shared my own concerns and hesitancies.” As she and her colleagues asked questions and found answers, their confidence in the vaccine grew.

Dr. Fitzpatrick, who conducts regular Ask the Doctor sessions in her community, said people who don’t want the vaccine might not have access to the trusted information they need to make an informed decision. In the early months of the pandemic, she said most of the questions she fielded were about the virus and COVID-19 tests. These days, most questions are related to the vaccines. During the course of a session—as people get answers—the line of questioning typically evolves from “is the vaccine safe?” to “where can I get the vaccine?” she said.

When talking with patients or members of the community, Dr. Ranney cautioned that physicians should be aware of the language they use and avoid overly technical terms. “It’s important to use words that make sense to the people we are trying to reach, rather than forcing them to understand the words we want to use.”

2.   Try to make vaccine distribution more equitable: Central Falls, Rhode Island had the state’s highest rates of infection, hospitalization, and mortality related to COVID-19. It now has the state’s highest vaccination rate—more than one-third of the population has received at least one dose.¹ Central Falls takes up a little more than one square mile and is made up largely of Black and Brown people and immigrants, many of whom live in multi-generational homes. People who live in this community often work in essential front-line jobs that don’t allow them to work virtually. The state made the town an early priority for its vaccine program. In the first months of the program, vaccine-distribution sites were set up in the community and representatives from the Department of Health went door to door to get the word out. While this strategy slowed the state’s rate of vaccine distribution in the early months, it reduced the number of COVID-related hospitalizations and deaths, Dr. Ranney said. The state is currently among the nation’s best in both the percent of population vaccinated, and the equity of vaccine distribution.²

3.   Educate clinicians and other medical professionals: We typically tell people to talk to their primary care provider if they have questions. But sometimes the primary care provider doesn’t have all the answers. During one of her Ask the Doctor sessions, Dr. Fitzpatrick recalled a man who said his doctor told him not to get the vaccine. “I was stunned,” she said. The question made her realize that there can be a disconnect between some primary care providers and medical professionals involved in research. “We take it for granted that just because you are a physician that you are on board with all of this,” she said. Dr. Fitzpatrick said she joined a clinical trial for one of the vaccines because she wanted to be able to offer transparent, first-hand information about the process. Explaining that vaccines and prescription drugs go through the same process of testing can help remove some of the skepticism.

4.   Consider using tech-appropriate outreach strategies: In Philadelphia, a city that is 42% Black, nearly 90% of vaccines distributed by a pharmacy chain went to white residents.³ Dr. South said these percentages are inevitable when health equity isn’t at the forefront. Communities that have larger white populations tend to have more medical facilities and pharmacies. Access to health care also tends to favor people who have access to transportation. In addition, most states require people to visit websites to schedule vaccination appointments, which requires reliable internet access and a phone or computer. Dr. South discussed how the University of Pennsylvania partnered with a community hospital and community leaders to establish three vaccination sites aimed at predominantly underserved Black communities. About 85% of the nearly 3,000 people vaccinated were Black. That success is the result of intentionally understanding the structural barriers and designing a low-tech vaccination sign-up process. Rather than relying on a website, the vaccination sites used an automated text-messaging system, which meant anyone with a phone could sign up multiple people. Automated phone messages were also used to reach older people who might not have a cell phone. This was a blind spot pointed out by some faith leaders in the community. Dr. Fitzpatrick noted that “tech-quity” is a term that is being used to describe disparities related to tech-reliant access.

5.   Infuse equity into everything: Dr. South noted that while many health organizations have an office for diversity, inclusion, and equity, those offices tend to be separate from the rest of the organization and typically lack authority to implement change. Instead, every department—from research to clinical operations to the C-suite—should have an equity expert on its team. 

Deloitte identifies vaccination deserts

In February, a state-funded report from my Deloitte colleagues analyzed COVID-19 vaccine-distribution efforts in Missouri. The state recruited Deloitte to identify and evaluate vaccine deserts in the state—areas where residents have little or no access to vaccines—and recommend strategies to close those gaps. During a meeting of the Missouri Advisory Committee on Equitable COVID-19 Vaccine Distribution, my colleague Andrew Miller reported vaccine deserts in two metropolitan areas—St. Louis and Kansas City. The report also noted that about 30% of Missourians had traveled outside their county of residence to receive the vaccine. The report suggests the need for mass vaccination events, mobile vaccination units, and enhanced outreach to build trust.

Deloitte is also working with a large teaching hospital to stand up vaccination clinics aimed at lower-income and/or mobility challenged residents to help ensure the vaccines are delivered more equitably. We developed a Playbook that outlines the steps, processes, and resources needed to set-up and run these clinics.

President Biden recently set a goal of administering 200 million vaccine doses by his 100^th day in office. I’m confident that this goal will be met. But I also expect vaccination rates will plateau unless clinicians, faith leaders, and trusted community voices can help educate the public and instill a sense of vaccine confidence.  

Endnotes

^{1.        For Central Falls, Rhode Island’s COVID-19 hot spot, some hope after a long, dark year, Boston Globe, March 1, 2021}

^{2.        RI vaccine campaign continues to gain speed, The Providence Journal, March 26, 2021}

^{3.        Rite Aid gave 21 Philly vaccine doses to white people for every on it gave a Black person, The Philadelphia Inquirer, March 6, 2021}

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