Addressing Vaccine Barriers to Access and Lack of Trust

Vaccine hesitancy in communities of color has been widely discussed, but addressing structural and systemic barriers and working with trusted partners will help increase vaccination rates in these communities, according to two local doctors who spoke at the annual luncheon of the Fund for Women and Girls of the Princeton Area Community Foundation.

Dr. Richard Besser and Dr. Kemi Alli challenged members of the Fund for Women and Girls to think outside the box to understand the vaccine needs of communities hit hard by the COVID-19 pandemic during a Zoom discussion about healthcare and equity earlier this month.

“There was, I think, early on a false narrative, that the primary reason that you were seeing lower rates of vaccination, among Black Americans, Latino Americans, was this issue of hesitancy, rather than the fact that the barriers to vaccination weren’t being addressed,” said Besser, President and CEO of the Robert Wood Johnson Foundation in Princeton. “There was not enough effort early on to reach people where they were.”

He believes structural barriers, such as the location of vaccination centers and the times they are open, not numbers of vaccines given per day, reveal a lack of equitable access. Workers in low-income jobs often face higher exposure risks, yet many of those essential employees must choose between a paycheck and a vaccine because they cannot take time off from work and wait in line for a vaccine. “That is not a fair choice,” said Besser.

Many communities prefer trusted venues in their neighborhoods, such as places of worship and doctors’ offices, not “mega-sites” in outlying locations with fewer transportation options.

Alli, CEO of the Henry J. Austin Health Center in Trenton, said on average, one in five individuals in the City of Trenton have been fully vaccinated. “The health industry as a whole really needs to rethink the systems and practices we have in place that have disenfranchised individuals for so long,” she said.

Vaccines get in the arms of people when delivered to where people live, work and play. Besser noted that it will be a long time before we understand the impact of the pandemic on communities of color.

Reflecting on the high COVID-19 mortality rates in the African-American and Latino communities, and the impact of the pandemic on children, he added, “When you talk about losing so many Latino men, they are parts of families. That is children who are losing fathers.”

The doctors do see opportunities embedded in the tragedy of the pandemic. Besser and Alli discussed the rise of telemedicine as one positive outcome. Because most people have smart phones, underserved communities have increasing access to mental and behavior health services. This is one example of how reducing barriers allows access to the system.

They urged the audience to support new ideas in philanthropy that promote access and equity for communities particularly hard hit by the pandemic. Besser presented research and initiatives funded by the Robert Wood Foundation that analyze access to healthcare, education and job opportunities to create community driven policies that lead to positive health outcomes. Programs such as the Well Babies Well Moms initiative supported by the Henry J. Austin Health Center, and supported by the Fund for Women and Girls, underline the crucial impact of data to build a culture of health that highlights equity.

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