News from the Department of Medicine

A Matter of Trust: Bringing Vaccine Education to New American Communities

February 24, 2021 by Jennifer Nachbur

One of the most alarming realizations of the past year has been the clear link between structural racism in the U.S. and the racial and ethnic health disparities that have led to a disproportionate impact of COVID-19 on communities of color. Thanks to the collaboration of numerous partners in Vermont, members of the New American community are getting the education they need to make informed decisions about their health and the COVID-19 vaccine.

(Top, l-r) B. Dahal; M. Avila; K. Pierce; (middle, l-r) S. Chesbrough; D. Sherpa; K. Vastine; (bottom, l-r) A. Merdzanovic; T. Ratsebe.

One of the most alarming realizations of the past year has been the clear link between structural racism in the U.S. and the racial and ethnic health disparities that have led to a disproportionate impact of COVID-19 on communities of color. According to the Centers for Disease Control and Prevention, compared to white, non-Hispanic persons, COVID-19 infection, hospitalization, and death rates are three to four times higher in BIPOC (Black, Indigenous, People of Color) communities.

It’s a grave statistic — and one that is concerning for members of Vermont’s BIPOC community, including New Americans and those who work with them.

Over the last two decades, members of the VT LEND program, including its director, Maria Mercedes Avila, Ph.D., have built connections with the New American community as they research health disparities within Vermont and work to build community trust.

Trust is a critical factor when it comes to administration of COVID-19 vaccines. Focus groups conducted with Black, Indigenous, Hispanic/Latinx, immigrant and refugee community leaders, including Dr. Avila, serving on Vermont’s Health Disparities and Cultural Competence Committee, revealed that New American community members had a general sense of distrust, based on the long history of unethical medical research involving underserved communities across the globe, and concerns about the vaccine. Those findings encouraged Avila and partners, including Karen Vastine, a senior officer in the UVM Health Network’s Government and Community Relations Office, Amila Merdzanovic of U.S. Committee for Refugees and Immigrants-Vermont (USCRI-VT), and Thato Ratsebe of Association of Africans Living in Vermont (AALV-VT), that a proactive educational approach was needed to ensure vaccine adherence in the communities that needed it most.

The partners acted quickly to identify a vaccine expert – a role filled by Kristen Pierce, M.D., a professor of medicine, infectious disease specialist, and Vaccine Testing Center researcher who is one of the lead clinical investigators on UVM’s AstraZeneca vaccine trial. In collaboration with community leaders, they lined up dates for virtual education sessions, hired interpreters and cultural liaisons, and rolled out the first four evening educational sessions in December. This month, they’ve already held a staggering seven sessions – each in a different language – with two more on the schedule this week and four more in March.

The format and goal of the sessions are simple: share the reasons why it’s important to get the vaccine and answer questions to encourage community members to get the vaccine. The role of the cultural brokers – who are trusted members of their respective communities – is critical. If they say, “I'm taking the vaccine,” that positively influences community members' decisions to get the vaccine.

“As an infectious disease physician and vaccine researcher, it is worrisome to see so much misinformation about the pandemic, and the current vaccines,” says Pierce. “Any opportunity I have to answer questions, and hopefully dispel some of the myths about the vaccines, is really important." 

To date, the group has delivered sessions targeting the following communities/languages: Nepalese-Bhutanese; Congolese (three separate sessions – one each for Swahili, French, and Lingala languages); Somali (three separate sessions – one each for Somali, Maay Maay, and Kirundi languages); Arabic-speaking; Nepalese elders; Karen Burmese; Vietnamese. Vaccine information flyers translated into all the different languages have been developed and will be distributed to communities.

Vastine credits the deep trust Avila has built over time in the community and Pierce’s clear, concise and to-the-point educational approach with making the sessions successful. “Kristen is effective because she uses plain language and cultural leaders like that – it's very effective with non-English proficient folks.” Avila says community members respond well to Pierce, who introduces herself as “Kristen” during the sessions, because of her approachable demeanor and “culturally, when you’re a doctor, you’re a doctor” – there’s high regard for the position she holds.

Typically, two to three cultural brokers participate in each community group session, gathering questions and bringing them to the education outreach team following the events. Other key partners include the UVM Vaccine Testing Center; Vermont Department of Health; Spectrum Youth and Family Services; the Winooski School District – which Vastine and Avila agree has served as a “big ally in advocating for systemic change;” Community Health Center of Burlington; and the New American Clinic at UVM Medical Center’s pediatrics outpatient clinic, which is run by UVM faculty members Andrea Green, M.D., and Stan Weinberger, M.D.

“This group’s work is an example of effective community partnerships for engagement regarding the vaccine,” says Vastine, who recognizes that while the group’s current focus is on vaccine adherence, their work to maintain strong community partnerships and continue educational outreach is an excellent approach for addressing health disparities.

Pierce is grateful for the opportunity to meet and work with individuals from the many different agencies that are working to ensure all Vermonters have the information they need to make an informed decision about vaccination.

Avila’s advice for creating alliances and building trust is to “Be an advocate for the community, use your privilege and power to raise concerns.”