Vaccination Campaigns Move At The Speed Of Trust

Christian Amuli, a Congolese immigrant and medical assistant at Neighborhood Family Practice said he was wary of the COVID-19 vaccine until he talked one-on-one with a doctor he works with. Now he's vaccinated and is using social media to encourage others to get the shot, too.
Christian Amuli, a Congolese immigrant and medical assistant at Neighborhood Family Practice said he was wary of the COVID-19 vaccine until he talked one-on-one with a doctor he works with. Now he's vaccinated and is using social media to encourage others to get the shot, too.

By Marc Lefkowitz and Sydney Kornegay, for the Northeast Ohio Solutions Journalism Collaborative

Robyn doesn’t doubt the dangers of COVID-19. As a medical assistant at a Cleveland hospital, she witnessed the virus’ impact firsthand.

“I’ve been on the front line since day one,” said Robyn, who requested her last name and employer's name be withheld out of fear of losing her job. She’s seen a coworker’s grandmother pass away from the COVID-19, and has cared for patients suffering from severe symptoms.

Robyn does have doubts about the COVID-19 vaccine, however. While she acknowledges it’s an important step in fighting the coronavirus and saving lives, she’s skeptical about the positive numbers Pfizer and Moderna are reporting. 

While she hasn’t seen specific data showing that the Pfizer and Moderna vaccines are unsafe, Robyn still fears the companies might not be reporting honestly. She points out that drug companies helped drive the opioid epidemic by hiding details about the high risk of addiction, and therefore shouldn’t be trusted. 

“Medical companies like Pfizer, of course they tell you all the risks, and the risk is [bigger] than the benefits,” she said.

Mostly, though, Robyn worries that the vaccine was developed too quickly to ensure its safety. 

“Nobody knows anything for sure,” Robyn said.  “I would rather not be a guinea pig in the medical setting. I'll take my chances and do the best I can to prevent getting [coronavirus].” 

Robyn is not alone in her fears. An estimated 28 percent of American healthcare workers have said they will “wait and see” before they get the vaccine, despite working on the front lines, in a high-risk field. While this hesitancy rate is slightly lower than that of non-healthcare essential workers (31 percent), it is significant because 80 percent of Americans in a January poll conducted by Kaiser Family Foundation said they would seek the advice of healthcare providers when deciding whether or not to get vaccinated. 

Sources Of Mistrust

Amanda Mahoney, chief curator of the Dittrick Museum of Medical History at Case Western Reserve University, believes healthcare workers’ mistrust is partially rooted in misinformation from the early days of the pandemic. 

“Healthcare workers benefited... and suffered from speed of exchange of information,” said Mahoney, who is also a registered nurse. She said early studies about COVID-19 — such as those which claimed that the severity of the disease was based on people’s blood types — later turned out to be questionable. 

“The lack of cohesive messaging eroded what little trust we had,” Mahoney said.  

But Mahoney emphasizes that vaccine hesitancy — both among healthcare workers and others— isn’t just about lack of information. Rather, it is rooted in two different streams of history that have prompted mistrust across different groups, albeit for very different reasons. 

One of those histories is that of the “anti-vaxxer” movement, which was flamed by false studies linking autism to vaccination. 

“There has always been the anti-government, anti-regulation involvement,” Mahoney said.  “[Anti-vaxxer movements] use fear around the safety of vaccines to get support from white, middle-class mothers to fight against regulation of any kind.”

The other history, though, is that of decades of unequal healthcare systems discriminating against minority communities. Mahoney points out that minority groups have long been abused by the medical system, and not just in historical instances like the Tuskegee Syphilis Study. 

“Our entire healthcare system massively abuses Black people by not listening to Black women’s pain,” Mahoney said. “[There are] algorithms used to triage patients that prioritize white patients with the exact same symptoms as Black people. A lack of trust in the healthcare system is warranted.”

A pilot study by Rubix Life Sciences found that during the pandemic, medical professionals have been six times more likely to provide treatment and testing for the same COVID-19 symptoms to white patients than Black patients.

This lack of trust influences people working within the healthcare system as well. It’s one of the primary reasons Sherena Williams, a dentist office employee, has decided to wait on the vaccine. 

“You can’t put something out there and expect us to trust it,” Williams said. “The government are the people behind COVID and the death toll. [People won’t get the vaccine] until we feel in our hearts that we trust the government enough.”

Building Trust

Still, a recent poll suggests that while people might not trust the government or healthcare system in general, they do trust their healthcare providers. Eight in 10 people said they would turn to a doctor, nurse or other healthcare provider to decide whether or not to get a vaccine. 

That personal trust is something Carla Harwell, a physician practicing at the University Hospitals Otis Moss Jr. Health Center in Cleveland's Fairfax neighborhood, said she can build on.  

Harwell said the key to getting patients to take the vaccine is to acknowledge their fears while gently pushing back against rumors or misinformation they might have received on social media. 

“You can’t just go from zero to 60,” Harwell said. “Sometimes I’m able to say, 'that [rumor] is not true and hasn't been proven.' You have to be able to empathize with your patients. When [you] empathize with somebody you are saying ‘I can understand why you feel this way. I hear what you’re saying.’”

Harwell believes empathy and compassion is crucial for her to build trust with patients. 

“I know I just try to educate,” Harwell said, “and be what I call a trusted voice for my community.”

Lessons from prior disease outbreaks show that trusted messengers like Harwell — whether they are doctors, religious leaders or even social media influencers — can be effective in overcoming vaccine hesitancy. 

In 2017, for instance, a measles outbreak hit the Somali population in Minneapolis-St. Paul, where mistrust of the government’s immunization efforts led to low vaccination rates. In response, the Mayo Clinic collaborated with Somali community groups in nearby Olmstead County to change messaging in an attempt to stop the spread. Mosque leaders and healthcare providers hosted town halls to address community concerns. Somali actors created YouTube videos. The result: vaccination rates increased, and of the 25,000 Somali immigrants living in Olmstead County, not a single case of measles was reported from 2017-2019. 

Groups in Cleveland have used similar methods, relying on social media and trusted messengers to build momentum for the vaccine. 

Harwell, for instance, appears in a YouTube video produced by UH to address coronavirus vaccine hesitancy among the African American community. In it, Harwell acknowledges the history of abuses, while also reassuring community members of the need to get the vaccine.

MetroHealth, likewise, collaborated with 20 Cleveland clergy to create a video to encourage congregation members to get vaccinated. The video includes interviews with faith leaders who acknowledge the history of inequality in healthcare, but say they are “putting their faith in science.” They try to allay fears by taking the vaccine on video, and urge their congregations to do the same. 

Broader information campaigns, like The Conversation, a video series featuring W. Kamau Bell and Black healthcare providers addressing concerns about coronavirus and the vaccine, are showing signs of effectiveness. A Marist poll last week conducted by NPR/PBS NewsHour found there is no difference between racial groups planning to receive a COVID-19 vaccine, a change of significant proportions from polls conducted in December.     

Healthcare Providers Take The Lead

Individual healthcare providers have also taken steps to encourage hesitant community members. Medical assistant Christian Amuli of Neighborhood Family Practice said he was initially wary of receiving the vaccine, despite having had COVID-19 earlier in the year. 

“One of the doctors [at Neighborhood Family Practice] came and talked to me and said that the vaccine was okay, and that it would help protect my family,” Amuli said. “He told me he had taken the vaccine and nothing had happened.”

Originally from Congo, Amuli said many people from Cleveland’s Congolese community had received false information about COVID-19. They’d seen videos on social media saying that the disease wasn’t real, that it was merely a rumor being used by the government as a form of control.

Now, Amuli says many in the Congolese community are concerned about the vaccine because of similar rumors they’ve read on social media, and because of videos being shared about people getting sick after the vaccine. 

“When I decided to get the vaccine, at first I did it in secret. I knew [my community] would tell me not to do it,” Amuli laughed. “I actually waited to text my mom from work saying ‘I’m getting the vaccine.’”

Amuli shared his experience a few days later on the messaging app Whatsapp and to his 10,000 followers on Instagram. His friends all watched carefully to see if he developed side effects. After a few days, he reported that nothing had happened. As a result, Amuli said several of his friends told him they’ll take the vaccine once their age group is eligible.

While these efforts by community messengers such as Amuli and Harwell won’t undo the decades of misinformation, they can begin to reframe the conversation around provider compassion

For Harwell, this means addressing her patients’ fears while also framing the conversation as a personal decision.

“I’m more afraid of Covid than I am of this vaccine,” Harwell said. “When I saw my cousin on a ventilator, COVID had a face for me.”

She said that experience and her care for her patients made her decide to get the vaccine. 

“To be honest with you, I didn’t get vaccinated for myself; I was getting it for my elderly parents,” Harwell said. “I wake up as Carla Harwell with the same thoughts and fears as everybody else. I’m not going to lie and say I didn’t have any concerns. But I follow the science. The human part of me said, 'you have to take care of your parents.' I can’t afford to go down and end up on a ventilator.”

This story is sponsored by the Northeast Ohio Solutions Journalism Collaborative, which is composed of 20-plus Northeast Ohio news outlets, including ideastream.

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