After a year of fighting the COVID-19 pandemic, the teams at UVA Health are excited to partner with the Virginia Department of Health to coordinate the rollout of the vaccine for our community. The experiences we have had over the past year have been daunting, but the knowledge we have acquired is priceless. Unique challenges sparked innovation as we reinvented policies to address this threat to public health. We learned how to redesign public spaces to prevent the spread of infection, how to retrofit a hospital tower for negative airflow, how to make 3D-printed masks, and how to enlarge the role of COVID nurses to keep everyone safe. Now with the arrival of the COVID-19 vaccine, we must again reinvent our standard practices to support the health of our community.
While many people are eager to receive the lifesaving vaccine, there is still some vaccine hesitancy across the country. In late February, one-third of American adults said that they don’t want the vaccine or are undecided about whether they’ll get one. Earlier last year, Pew Research reported that Hispanic and white adults are far more likely to say they would get the vaccine, 74% in both groups say that they would. In Black communities, vaccine hesitancy is more significant. CNN reported that more than half of Black adults in the US remain hesitant to get the COVID-19 vaccine. Of those who are reluctant, concerns include possible side effects, a worry that they might get COVID-19 from taking the vaccine, and/or a general distrust in vaccines overall. This data confirms that we need to prioritize equitable access, and that health providers must work harder to build trust within these communities.
Sadly, there are many historical precedents for the lack of trust among communities of color. Racial inequity in healthcare goes back generations, with a pattern of discrimination that is hard to overstate. There is a grim legacy of forced sterilizations and eugenics enacted upon Puerto Rican, Native American and African American women. The infamous Tuskegee experiment recruited Black men for a syphilis study where the subjects did not have informed consent, and patients were left to suffer and die even after penicillin was determined to be an effective treatment.
Decades later, today’s healthcare community is still coming to terms with the implicit bias that negatively affects people of color. Black Americans die at a younger age and suffer from higher death rates for heart disease, stroke, cancer, asthma and diabetes. The Black infant mortality rate is twice as high as it is for whites, and Black women are more than three times as likely to die of childbirth-related causes than white mothers. With this kind of history, it is no wonder that there is a reticence in communities of color to place their confidence in the healthcare system.
Yet current CDC data shows that a disproportionate burden of coronavirus illness and death falls on racial and ethnic minority groups, so we must confront these issues head-on. To overcome vaccine hesitancy, we are engaging with community leaders to provide accurate, science-based information. Beyond that, we are listening. Each week, we visit churches and community centers, and we listen to community members’ concerns and ask how they would like us to work with them. In this situation, the messenger is as critical as the message. Therefore, Black and Latinx doctors from UVA Health are leading the charge, connecting with the community to instill confidence and engender trust.
Throughout this process, engaging with community members – rather than simply imparting information and urging them directly to get vaccinated – is crucial. One approach that centers community members’ autonomy is “motivational interviewing,” where instead of telling people why you think they should change their mind, you ask open-ended questions to help them discover their own motivation for getting the vaccine. By listening to people and engaging their decision-making process, we build trust and help people to approach vaccination from a place of autonomy and power.
The results have been rewarding. We are so inspired by the community leaders who continue to partner with us to create vaccination sites that are accessible and welcoming to all. The greeting tables are run by people that live in the community, who know the names and faces of their neighbors and are staffed with translators as needed. The more personal and familiar the outreach, and the more community-specific it is, the more successful the health outcomes will be.
Recently, I have taken on a new role as the CEO of UVA Health, and it is truly an honor to be a part of UVA Health and the thriving Charlottesville community. At the start of the pandemic last year, the community expressed fear and concern about developing the right practices to stay safe and healthy. Together, we addressed those fears and adapted our behavior accordingly. Today, we are entering a new period of hope. At our vaccination sites, we are hearing expressions of relief and happiness. Community members talk about the thrill of being able to see family again, and they are grateful for simply being able to leave the house without fear.
The UVA Health teams, volunteers and the community have been working side by side from the start. Our hospital staff have been combatting the virus with relentless dedication during very difficult times. While 2020 was a challenging year, I am hopeful and inspired by what we have accomplished, and I am honored to work with the communities that we serve. More than anything, I am grateful to work with the UVA Health team and all of our community partners. Successfully administering the COVID-19 vaccine can be a bookend to the entire pandemic experience. I know that this year will be a little brighter, and that we will emerge stronger and more resilient than ever before.
Originally posted on March 11, 2021, on LinkedIn.