Vaccine Hesitancy: Understanding Fears and Addressing Barriers to Access

More than 75% of the U.S. population has received at least one dose of the COVID-19 vaccination. While the vaccines are no doubt slowing the transmission of COVID-19 and contributing to lower rates of hospitalization and death, vaccine hesitancy remains a challenge in some areas of the country, among a variety of populations.

According to the Kaiser Family Foundation, Black and Hispanic people are less likely than other races or ethnicities to have received the COVID-19 vaccination, putting themselves and their communities at increased risk. The reasons for vaccine hesitancy vary. Worries that the vaccine was created too quickly, concerns over side effects, or the incorrect belief that the pandemic is over and the risk is gone top the list, but they don’t tell the whole story.

A history of vaccine hesitancy and mistrust

For some people, the hesitancy around vaccinations isn’t unique to the COVID-19 vaccination. Communities of color are more likely to mistrust clinical research and the medical community in general.

Institutional racism and a history of health inequities may contribute to vaccine hesitancy among communities of color and underserved populations. There is also a history of medical mistreatment dating back at least to the 1930s and the USPHS Syphilis Study at Tuskegee that may make some particularly cautious when it comes to participating in clinical research or even receiving a vaccine that results from clinical research. 

“People of color, along with immigrants and differently abled men and women have endured centuries of having their trust violated. We need to give people the facts about the vaccine’s safety and efficacy, and renew their trust toward healthcare in general,” said Sherita Golden, M.D., M.H.S., Vice President and Chief Diversity Officer at Johns Hopkins Medicine.

According to new data published ahead of print in the journal Academic Emergency Medicine, patients being treated in an urban emergency department who were hesitant to get the COVID-19 vaccine were also less likely to trust government sources of information, with approximately 60% reporting mistrust as the reason they are not vaccinated. 

Although the hesitancy is understandable, it is paramount that healthcare leaders do all they can to increase vaccination rates among all populations. 

Access challenges continue to present barriers

From the earliest days of the COVID-19 pandemic, we saw that certain communities were disproportionately impacted. According to the U.S. Centers for Centers for Disease Control and Prevention, people older than 50 are more likely to be hospitalized if they are infected by COVID-19. Likewise, African-American, Hispanic, Latino, American Indian, and Alaska Native persons are more likely to be hospitalized and die from COVID-19 than their white counterparts. 

Individuals who have certain medical conditions such as chronic kidney disease, diabetes, heart disease, obesity, and sickle cell anemia are also at greater risk of COVID-19 infection, hospitalization, and death. Those conditions are also more prevalent among racial and ethnic minorities. 

The same barriers to access and health inequities that drove an increase in COVID-19 cases among underserved communities are presenting access challenges regarding the vaccine. A lack of transportation, inaccurate or nonexistent information regarding the COVID-19 vaccine, and the inability to take time off of work to receive the vaccine are all reasons that people may not have received the vaccine. The same populations that have been so significantly impacted by COVID-19 and saw barriers to receiving care when the pandemic first began are now the same communities that are less likely to have access to the vaccine.

Addressing vaccine hesitancy through digital patient engagement 

Digital patient engagement is one way to address vaccine hesitancy. Through an investment from the Deloitte Health Equity Institute, CommonSpirit Health is responding to vaccine hesitancy and access challenges in some of the most vulnerable communities through a digital vaccine outreach program.

As the Delta variant continues to spread rapidly among many U.S. communities, the program is meant to engage rural communities that are being greatly affected and share information about the importance of getting vaccinated. 

The program, which was developed in partnership with GetWellNetwork’s Docent Health, will facilitate outreach to nearly 50,000 patients through early next year in California’s Central Coast and the areas of Arkansas served by CommonSpirit Health. 

Patients will receive a text message informing them that they are eligible for the vaccine and providing information on how they can sign up to receive the vaccine. If there are barriers to registering for the vaccine, such as digital literacy, or barriers to accessing a vaccination site, such as lack of transportation or if a patient is home-bound, the patient is connected to a digital patient navigator to help address these barriers directly.

“Intentional outreach that educates about vaccine safety and efficacy and also mitigates barriers to receiving the vaccine is one step toward addressing these issues of inequity and access,” said Dr. Alisahah Jackson, system vice president of innovation and policy for CommonSpirit Population Health. “We are thrilled to collaborate with other leading organizations to work on providing COVID-19 vaccines to all of our communities, especially our vulnerable populations.”

To assess the effectiveness of the program and help guide future outreach efforts to rural communities, CommonSpirit Health will be tracking how many patients were reached, how many vaccines were administered, and the types of barriers that were addressed.

One way to address barriers — whether they be barriers to access or barriers to adherence to care plans — is through frequent touch points. Docent, as well as GetWell Loop, helps care teams engage patients across their entire care journey using automated digital virtual check-ins. Patients receive information when they need it and clinicians can quickly identify patients who need assistance. 

The bottom line

With COVID-19 continuing to be a public health challenge — and with misinformation about COVID-19 and the vaccine becoming its own issue — addressing vaccine hesitancy is more important than ever. Although there are a number of reasons why a person may be vaccine hesitant, barriers to access and a lack of trustworthy information should not play a factor. Digital patient engagement that provides accurate and timely information can help promote vaccine availability and help increase vaccination rates in those areas that are struggling the most.

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