When the COVID-19 vaccines FDA-approved for emergency use first arrived at Boston Medical Center in December, the health network collaborated with local partners with the aim to ensure they were distributed equitably. Due to systemic racism, hesitancy, and barriers to care, Black and Latinx communities were the hardest hit by the pandemic—and so BMC and its community partners opened six COVID-19 vaccination sites in some of the most vulnerable neighborhoods in Boston: Mattapan, Hyde Park, Dorchester, Roslindale, and on BMC's campus in the South End. That was in addition to pop-up sites, neighborhood canvassing, informational events, and other efforts to establish vaccine equity.
"We reached out to community partners in places where we knew that there was already established trust—churches, community centers, YMCAs, and the community ambassadors and stakeholders that we chose in these places," Petrina Martin Cherry, BMC's vice president of Community Engagement and External Affairs said in a recent panel hosted by CEO Kate Walsh. "They already were a beacon of light in the neighborhoods."
As of May 23, of the people vaccinated by BMC and its community partners, 40% are white, 22% Black, 13% Hispanic or Latinx, 7% Asian, and 18% represent all other races and ethnicities, which represents a higher percentage of people of color vaccinated than both the state and national averages. As of May 25, Massachusetts on the whole reports COVID-19 vaccinations as 69% white, 5% Black, 8% Hispanic or Latinx, 7% Asian, and 11% other. Since then, and as of June 21, the CDC reported that it has seen increasing rates of people of color being vaccinated across the U.S., with national data showing vaccines distributed as follows: 60% white, 9% Black, 15% Hispanic, 6% Asian, and 9% multiple or other races.
Community collaboration's effect on COVID-19 vaccinations
Boston's focus on vaccination and public health necessitated setting up structures for collaboration that showed how quickly and efficiently the community could address problems when working together. The question going forward, as Boston and the rest of the United States not only continues their vaccination effort, but addresses the health inequities that have perpetuated amid the pandemic, is, "Can this drive and energy of community collaboration toward equity continue?"
"As a result of this collaboration, we've learned so much about how we should collaborate, and we need to make sure we don't go back to our silence, and we don't go back to, well, 'I'm going to take care of my neighborhood. You're going to take care of your neighborhood,'" said Guale Valdez, MBA, the CEO of Mattapan Community Health Center and a panelist.
Addressing the deep-rooted, systemic inequities in healthcare and the social determinants of health will take longer than one community vaccination effort. But Elena Mendez-Escobar, executive director of Growth and Innovation at BMC Health System, hopes that it has shined a light on some of the problems we must work to solve.
"It's been very, very important over the last year to invest deeply in having better insights and understanding of what's happening because, structural racism, it's a problem that's hard to see. And we can't solve what we can't see," she said in the panel discussion.
Many patients are still undecided about the COVID-19 vaccine
While Boston has reopened its doors and lifted its COVID restrictions as of May 29, it may be easy to forget that there are still many people who haven't yet received a vaccine, and fears, hesitancy, and inaccessibility of vaccines still persist for some.
As new data shows that more than 99% of COVID-related deaths in the U.S. are among unvaccinated people, it's absolutely essential that people get vaccinated—for their own health and for public health.
In the spirit of investing in better insights, BMC conducted a survey among ambulatory patients on their perspectives of the COVID-19 vaccines. Even with recent work to collaborate with community leaders and set up neighborhood vaccination sites, as of June, only 11% of ambulatory patients who had a visit to the hospital within the last 30 days were vaccinated.
More than 40% of both Black and white patients surveyed said they are still undecided—compared to just under one-third who said they will not get the vaccine. And they expressed similar sentiments regarding the roots of their indecision and hesitancy. The biggest concern reported by Black, white, and Hispanic patients was that they were fearful or unsure about the long-term effects of the COVID-19 vaccine, followed by concerns over the side effects and worry about "how quickly" it was developed.
According to the survey, among Black respondents, more information about the possible side effects would increase their likeliness to receive the vaccine, including people with high-risk conditions, the elderly, and those with chronic illness. The survey data shows that there is still room for leaders, healthcare providers, and other advocates to have meaningful conversation with people to address concerns and encourage the vaccine in a respectful way.
"This crisis, we are still in," emphasized Reverend Walker in the panel. "Some of the people who are struggling right now, trying to make their minds up about this vaccine, it's not going to be resolved overnight. It's a marathon."
How to talk with concerned patients about the COVID-19 vaccine
Alongside low reported vaccination rates among ambulatory BMC patients, the youth COVID-19 vaccination effort for 12- to 15-year-olds just began in May, and there are already vast disparities in vaccination rates according to accessibility of a site in Massachusetts. With children, too, parents have additional fears compounding on their existing vaccine hesitancy and obstacles.
According to Cassandra Pierre, MD, an infectious disease physician at BMC, the reality is that because of the hospital's vulnerable patient population, it should expect to see the return of "largely preventable" COVID-19 hospitalizations in the fall and winter—though nothing like the surges last spring or this past winter.
Pierre and other BMC experts who conducted the survey emphasized the importance of all healthcare providers to feel empowered to have open vaccine conversations with their patients. In approaching the discussion, they stated that honesty and respect was crucial, to meet the patients in their fears and concerns where they are and acknowledge the realities of the valid distrust many people of color have of the healthcare system and medical research. Don't come from a place of authoritarianism, stick to facts remember this is a personal discussion. In addition to facts, rather than asking "yes" or "no" questions, they advised beginning the discussion with open-ended questions, such as "How do you feel about the COVID-19 vaccine?" or "What vaccine questions can I answer for you?"
"As healthcare workers who have knowledge and experience with the vaccine and who are also advocates for our patients, it is imperative that we continue to leverage every inpatient and outpatient encounter to disseminate vaccine facts, to normalize and translate public health messaging about vaccine benefits and to dispel misconceptions whenever possible," Pierre says. "The race is not over for our patients."