Irene Webster is trying her best to persuade her community to get a Covid vaccine.
The case manager for AALV — a Burlington organization that works with New Americans — has translated Department of Health vaccine information into her native Swahili and helped facilitate question-and-answer sessions for Chittenden County residents from East Africa.
In her off-hours, she and her band KeruBo put out a song titled “Chanjo,” which means “vaccine” in Swahili, hoping the upbeat melody would help persuade reticent neighbors.
“Music is beautiful; it’s something that feeds the soul, and it can also be a powerful tool when it comes to disseminating information that’s otherwise dry,” Webster said. It’s only natural that she use her platform to promote the cause. “I can use my voice because my community trusts me, even though they are hesitant to get the vaccine,” she said.
Health department officials are relying on people like Webster in a decentralized community outreach strategy, trying to ensure an equitable vaccine rollout.
Vermont has given at least one vaccine dose to about 152,000 Vermonters, but vaccination rates for residents of color and New Americans have lagged behind. While a quarter of non-Hispanic white Vermonters have received at least one dose, roughly half that, 14%, of people of color have gotten a dose, according to data from the Vermont Department of Health.
“I think part of what we’ve had to come to grips with is this public mistrust of public health intervention and vaccine, and why,” said Sara Chesbrough, who has been helping to oversee the health department’s outreach effort. The question becomes, “How do we help people become more comfortable? How do we build trust? And that doesn’t happen in one phone call, obviously.”
The reasons for those discrepancies are complicated and varied, said Dr. Maria Mercedes Avila, a professor of pediatrics at the University of Vermont Larner College of Medicine.
In some cases, the difficulties are technical ones. The vaccine registration process, for instance, “has caused so many barriers,” Avila said — especially for people who speak limited English. Some people don’t have their own email addresses; others don’t have a primary care doctor to verify the preexisting conditions that qualify a person for vaccination. Even with a translator, identifying and naming those conditions can be difficult.
For other people, the reluctance stems from philosophical objections, disinformation on social media or historical distrust. Among African communities, where uptake has been low, they cite a 1996 clinical trial for antibiotics in Nigeria, in which the drug company Pfizer didn’t seek permission from families and didn’t provide adequate medical treatment to kids suffering from meningitis, according to a subsequent lawsuit. Eleven children died as a result.
“They hear that name; of course, they connect it with what happened in the past,” Webster said.
Repairing those longstanding breaches of trust will take time — and a constant drip of reminders and science-based persuasion.
“I know if I keep preaching from the rooftop, they will listen to me eventually, or they will listen to others, and over time, they will progressively have their minds persuaded,” she said.
National polls show that vaccine hesitancy and distrust is roughly equal between Black and white Americans. A March NPR/PBS NewsHour/Marist survey showed that 25% of Black respondents and 28% of white respondents did not plan to be vaccinated. A slightly higher portion of Latino respondents said they would not get a dose, at 37%. Republican men expressed the greatest hesitance, with about half saying they did not want the vaccine.
A personalized touch
The Department of Health has learned that a targeted, personalized approach is necessary, given the breadth of needs and questions between communities, according to Chesbrough.
The department, in partnership with Avila, UVM Medical Center doctor Kristen Pierce and local nonprofits, has organized more than 15 information sessions about the vaccine, including events in Swahili, Vietnamese, Lingala, and Maay Maay, as well as sessions targeted to specific subcommunities, such as Nepalese elders. The state ran one with a Black church and scheduled a southern Vermont event in Mandarin Chinese next week.
The cities of Burlington and Winooski have offered weekly vaccination clinics specifically targeting New Americans and non-English speakers, providing in-person translation at familiar locations — the Association of Africans Living in Vermont in Burlington and Winooski High School.
Community leaders successfully lobbied to allow Black, indigenous and people of color to have their entire household vaccinated if one member met the state’s eligibility criteria.
As misinformation has proliferated on social media, “we made every effort to make sure that we have the right information reaching the community so they can make an informed decision about accessing the vaccine,” Avila said.
She has also learned to rely on social media, posting pictures on WhatsApp and Facebook. People will ask her if her 77-year-old mother will get the vaccine. “If your mother gets the vaccine, we’ll bring our parents,” they tell her. The photos, she said, serve as evidence.
‘Lives at risk’
The state’s rollout hasn’t come without criticism. Health department officials and advocates alike say gaps remain in the state’s response. Chesbrough, of the health department, acknowledged the state has done a poor job reaching out to Abenaki communities.
Mark Hughes, executive director of the Vermont Racial Justice Alliance, said the state had at times focused on New Americans at the expense of outreach to Black Vermonters. The department has worked to remedy that gap, he said, but not without pressure.
“If we keep silent, it puts a lot of people’s lives at risk,” he said.
According to Webster, while the Health Department has conducted initial information sessions, officials haven’t done enough to continue to persuade skeptics. The state should be asking, “How will we overcome this for the sake of public safety?” she said.
Currently, the process feels like it’s been created by a well-meaning bureaucrat, she said. She urged the state to “revamp from the perspective of the recipient.”
The state’s vaccination strategy also disproportionately disadvantages the state’s minority residents, said Wichie Artu, a member of the Vermont Racial Equity Task Force and who serves on the NAACP of Windham County.
The state has prioritized vaccinating the oldest Vermonters in order to reduce deaths due to Covid. But Vermonters of color are younger on average, making many of them ineligible for the vaccine, he said.
Artu suggested that the state could prioritize essential workers or groups who have been infected at high rates.
People of color have suffered disproportionately due to the coronavirus. According to data from the Centers for Disease Control and Prevention, Black and Hispanic Americans are roughly three times more likely to be hospitalized by the virus than their white counterparts. They’re also twice as likely to die from Covid.
Black Vermonters have contracted Covid at a rate three times higher than that of white residents.
“We created a system that intrinsically created a barrier to vaccination for BIPOC people,” Artu said.
The state’s approach will be further tested as younger Vermonters — and a greater proportion of people of color — become eligible for the vaccine, Artu pointed out. In spite of the shortcomings, he and others said the state’s vaccination outreach and partnership with local community groups could be a model for future public health efforts.
Covid has pulled back the curtain on longstanding health inequities, he said.
“The way that we’re going to look at public health, I think moving forward, is going to be a lot more intersectional and I think a lot more effective,” Artu said.
For now, he’s taking matters into his own hands. In advance of a vaccination event next week for Windham County residents of color, he and other community members are reaching out to local Black business owners, cultural centers, homeless nonprofits and other groups to build interest.
Artu has been calling each person who’s expressed interest and registered them himself. That contact in itself has been a success, he said.
“The BIPOC community sees the BIPOC community coordinating clinics and being able to have that one-on-one” to connect to resources has helped to build bridges and trust, he said.
“People have the right to choose whether to receive the vaccine or not,” he said. Most importantly, “whatever that choice is, people have a right to be informed.”
