How Community-Based Organizations Can Help Address Vaccine Disparities

Understanding and engaging with community-based organizations (CBOs) that serve and influence vulnerable populations could assist public health officials and health care providers in dispersing accurate information and addressing disparities surrounding COVID-19 and routine immunizations, according to a study published in Vaccine.

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States compared with White Americans, and Black and Hispanic Americans have received fewer vaccinations compared with their proportionate number of COVID-19 cases, deaths, and population share, according to the study authors. One way for public health and emergency response officials to address barriers to vaccination in these populations is through engagement with CBOs.

The current study aimed to explore how CBOs develop trust in their communities and how collaboration with CBOs may help tailor vaccine and public health messaging to their respective populations.

The researchers found CBOs serving vulnerable communities based on the CDC Social Vulnerability Index. Fifteen CBOs within 5 miles of 3 Children’s Hospital of Philadelphia urban primary care sites were identified for the study and contacted between March 15, 2021, and April 12, 2021.

A total of 15 informants from 9 CBOs were interviewed for 60 minutes each. Researchers asked about the impact of COVID-19 on communities, methods for cultivating trust and influence, their communities' trusted sources of information, and their communities' perceptions about vaccines. Informants’ opinions on barriers to immunization, perceptions of risk of routine immunizations, receptivity of vaccines, and misconceptions about vaccines were also included.

The CBOs had an average community presence of 53 years (range, 11-151 years) and all of them either offered programs or provided health services, advocated for community participants, or helped to serve life needs. The CBOs included in the study predominantly served Black and Latinx communities and vulnerable individuals.

Informants felt that the COVID-19 pandemic exacerbated existing social determinants of health. Problems such as substance abuse and language barriers were still prevalent during the pandemic, and socioeconomic problems were magnified during the pandemic, they said. Fewer people could be seen at CBO facilities due to pandemic-related limitations, such as social distancing. Emotional issues were also magnified by the pandemic, such as a fear of death and feelings of instability.

Building trust in the community comes down to having a daily, reliable presence in the communities they serve, according to the informants. Because they are often seen as a trustworthy source of information within their communities, CBOs can be important vessels for dispersing accurate information and influencing decision-making when it comes to receiving COVID-19 vaccines, the authors noted.

Informants believed that community members most often got their information on vaccines from family and friends, CBOs, and sources that were shared by CBOs along with primary care providers. They also found that beliefs held by the elders in families were often passed down.

According to the informants, people needed to hear information multiple times in a way that was appropriate for their culture and was done competently for it to be effective, and CBO events offer opportunities to deliver these messages. Providing information in a respectful manner is also important, they added.

The informants felt that the community members they serve were more aware of vaccine-preventable diseases the importance of vaccines in the wake of the COVID-19 pandemic. They also felt that community members had a broad range of ideals, from mistrust of institutions to conspiracy-related ideologies, and feelings of invincibility or vulnerability depending on the age group. Some informants reported feeling that their communities fundamentally supported science.

Key community values were family, community connection, rule of law, religious institutions, and freedom, with freedom resonating due to the lockdowns and quarantines experienced early in the pandemic. The authors noted that freedom could conflict with rule of law in situations such as mandatory vaccination, which warrant further research.

Informants reported feeling that their community members would be open to vaccination against COVID-19 for both themselves and their children based on factors related to both routine and COVID-19 vaccinations. These included compliance to other medical interventions, the passage of time, freedom, social norms, and past experiences. Those who had experienced severe illness in the past may be more likely to get vaccinated for the future, some informants noted.

The sample size for this study was small at 15 participants, and the scope of the study was limited because individuals served by CBOs were not interviewed in favor of informants.

The researchers concluded that understanding CBOs would assist public health and medical care providers in partnering with these organizations to spread accurate information and messaging more effectively both during and outside of public health emergencies.

Reference

Shen AK, Browne S, Srivastava T, Kornides ML, Tan ASL. Trusted messengers and trusted messages: the role for community-based organizations in promoting COVID-19 and routine immunizations. Vaccine. Published online February 16, 2023. doi:10.1016/j.vaccine.2023.02.045