Since the COVID-19 pandemic swept the nation in March 2020, the United States has come a long way in not only reducing pandemic-related mortalities and morbidities but also developing vaccines to stop the spread of the coronavirus. After over two years of the pandemic, we have reached a sense of normalcy with vaccines and novel treatments to prevent disease transmission and severe hospitalizations. Despite this, the pandemic has revealed that many health disparities still exist. 

Since the previous article in Vertices’ “Pandemic and Inequities” series, the United States has substantially accelerated the development and distribution of additional booster vaccines to slow the spread of new coronavirus variants. The country has also implemented more lax pandemic policies as a result of the decrease in hospitalizations due to COVID-19. Nonetheless, it is important to continue addressing vaccine inequities, including the intervention strategies that have been implemented to reduce barriers to vaccine access. Specifically, vaccine hesitancy — whether due to misinformation or medical mistrust — is a critical barrier. Importantly, the complexity of issues such as medical mistrust, race, socioeconomic status, and cultural values cannot be captured beyond the introductory scope of this article (but were also discussed in the previous installment). This article will not only analyze solutions that policymakers have already implemented to address vaccine hesitancy but also provide insight into successful and unsuccessful efforts in improving vaccine access to date. 

According to the Strategic Advisory Group of Experts on Immunization of the World Health Organization, vaccine hesitancy is a “delay in acceptance or refusal of vaccination despite availability of vaccination services.” In other words, resources or vaccines are often available but certain populations choose not to access them for various reasons. Though the pandemic has exacerbated vaccine hesitancy, underlying mistrust and misinformation about immunizations extend beyond COVID-19. Thus, in understanding solutions that address vaccine hesitancy, it is important to understand the causes behind these beliefs. Additionally, misinformation on the purpose and science behind vaccines — along with mistrust of medical professionals and institutions — furthers vaccine hesitancy.

Particularly for communities of color, vaccine hesitancy often stems from the United States’ historical racial biases and injustices that are deeply rooted in our healthcare system. These historical causes and their modern implications create a level of mistrust that is justified among communities of color. In addressing vaccine hesitancy, crucial intervention strategies should target mistrust, misinformation, and cultural competence. A first step in addressing all three of these targets is collaborating with community leaders to improve vaccination rates. For example, community heads (such as religious leaders), educators (such as teachers), local business owners, and healthcare providers are all important figures that can foster trust within a community. In a recent study, researchers found that partnerships between public health sectors and community-level organizations can reduce vaccine hesitancy, especially for communities of color. The rationale behind these connections is that community leaders/members often have a better understanding of the dynamics within a community and have existing ties with certain groups. 

In fact, the Maryland Department of Health implemented such an intervention strategy through its partnership with local barbershops and salons to educate stylists on addressing vaccine concerns and providing accurate and reliable vaccine information. This approach provided barbershops with the funds to host vaccine sites as well, increasing the accessibility of vaccines. By collaborating with local workers, policymakers were able to transmit information through well-trusted and accessible members of the community.

To directly tackle misinformation on a larger level, an important intervention strategy is teaching community members how to decipher scientifically sound information from fake facts. This level of outreach would require a wider scope and more resources directed at improving science communication on a larger scale. At a local level, however, utilizing community leaders would be crucial in spreading accurate information. 

Another intervention builds on these concepts by facilitating physical access to vaccines at sites that specifically target hesitant populations. For example, mobile health units that function as vaccination and testing pop-up clinics specifically target vaccine-hesitant, rural populations. In a study that evaluated the efficacy of such mobile health units, the components of telemedicine and telementoring helped “provide guidance and education to frontline community healthcare workers” that helped “reduce vaccine hesitancy.”     

Intervention strategies that target the root causes of vaccine hesitancy are crucial in increasing vaccination rates. In considering the next steps, policymakers should look toward creating long-term solutions that address vaccine hesitancy on a larger scale.

‍

On Right: The Smart Pod, a mobile health unit designed and engineered by Baylor College of Medicine, in Harris County, Texas. Image courtesy of Baylor College of Medicine.