Navajo Nation President Jonathan Nez livestreamed his first dose of the Pfizer Covid-19 vaccine on social media during a town hall Dec. 31. The goal: promote confidence in a vaccine created by the same government that killed, stole from and hurt the community.
“As the leader of the great Navajo Nation I want to show our elders and also our Navajo people that we support our scientists and health care professionals by taking this vaccine,” Nez said during the stream.
Nez is among the many health care professionals and leaders who have sat in front of a camera to display their first dose of the vaccine. The strategy is one meant to build trust as many Americans are unsure or doubtful of getting the vaccine.
One of the obstacles in the distribution of the vaccine are the objections of minority demographic and political communities in the United States. Black, Native American and rural communities are diverse but share a common element: distrust in the institutions distributing the vaccine is frayed. In the Hispanic community and others, a different language creates a barrier, sometimes a high one.
Organizations and companies that serve those communities have been working for months to prepare for information campaigns — but the slow speed of the distribution suggests language barriers, misinformation and lack of trust remain major obstacles.
“People will care about what we know when they know that we care,” Dr. Giselle Corbie-Smith, the Chapel Hill Director of the UNC Center for Health Equity Research and Kenan Distinguished Professor at the School of Medicine said during an American Medical Association panel on creating trust last month. “We have a real opportunity to demonstrate our trustworthiness because we haven’t done it so far.”
Only about half of Americans are sure they’re going to get vaccinated, according to a study by The Associated Press- NORC Center for Public Affairs Research. About 40% of Black respondents said they were not going to get the shot. In the Hispanic community, 41% are unsure.
Lack of access and information, rather than mistrust in the vaccination, is a barrier in the Latino community, according to Ana Matiella, who founded Santa Fe-based social marketing firm ACMA Social Marketing in the early 1990s and later Latina health communications company Des Las Mias.
“Health literacy is a big deal, and the information that’s available on Covid right now, nevermind Covid vaccines, but Covid, is terrible, because they’re just translations,” she said. “We’ve been making this mistake in this country for a generation or more, and that needs to stop.”
When officials simply translate messages designed for the English-speaking, mainstream culture into Spanish, campaigns don’t often resonate with Latinos, It’s especially ineffective when higher-level English is translated, she said.
“Through information, using the right gatekeepers and the right approach, you can build confidence among Latinos to take the vaccine.”
One solution to make information more accessible to Hispanic communities is through fotonovelas, a storytelling method that uses a comic-book-style layout, but with photos instead of illustrations. The form started as a pop culture medium in Mexico.
The reason they’re effective is because their dialogue is easy to digest and stories are effective in getting messages across, she said.
What’s more, it could be a low-cost solution. Matiella has produced high-budget fotonovela campaigns, but over the last few months she’s been working with TK-based The Next Door, to produce a very low budget version that she said is just as effective. “It’s a humble production, but it’s very nicely done with all the right things: low literacy, easy to read and short,” she said.
Another method that could be more effective is spreading information within a community rather than simply entering one with expertise. “Trust is very important in the Latino community,” Matiella said. “It’s called confianza, it’s not just trust, but trust and confidence.”
Countering Misinformation Via The Grassroots
At Fort Hays State University in Hays, Kansas, a community-centered method of spreading information successfully fostered more scientific knowledge of the virus — potentially countering misinformation.
Hays, a town of about 20,000 people in Western Kansas, is a very close-knit community. People tend to know and trust one another because there’s likely a connection to a family member or old friend, said Jane Talkington, the interim director of the University’s Center for Entrepreneurship. But, this community is also struggling with the virus. The city began the year as one of the worst for death reports per capita, according to White House COVID-19 Task Force statistics.
The information initiative, called Get Smart, started after Talkington realized her family was constantly asking her for advice when it came to COVID choices. She rounded up a group of students to learn and spread accurate, science-based COVID-19 knowledge. In order to gain the insight, each student took the six-hour, free John Hopkins Bloomberg School of Public Health contract tracing course, Talkington said.
“The first cohort of students that we educated through Johns Hopkins became very savvy,” she said. “They were walking, amateur epidemiologists.”
From there, the students were able to educate their peers and demonstrate a method of spreading information from within a community, Talkington said. She noticed the students who took the course were better at following distancing guidelines themselves.
“The people that could actually spread the information are so educated that they know they shouldn’t be spreading anything,” she said. “A dorm full of entrepreneurship students turned … into introverts.”
Next semester, new students entering the initiative will only be required to complete one hour of the contract tracing class because that’s enough to create a common language, she said.
Any community or group could replicate Get Smart, Talkington said. All it takes is a champion that can get other people to join them, to become those trusted messengers.
A Legacy of Horrors
Part of the mistrust of health care in Black, brown and indigineous communities stems from historical treatments. Take the Tuskegee experiment, when 600 black men participated in a federal-funded study of syphilis and many became infected with the disease but were denied treatment when they began going blind, went insane or died. Or the vast history of colonialism and biological warfare on Native Americans.
“Distrust around research is grounded in their experiences within the clinical context,” Corbie-Smith, said during a Dec. 11 panel on misinformation. “This is not something that’s fabricated.”
Four other health justice experts spoke about mistrust of the vaccine at the panel hosted by the American Medical Association. The other speakers were Dr. Marcella Nunez-Smith, founding director of the Equity Research and Innovation Center, and associate professor at Yale University; Margaret Moss, the director of the First Nations House of Learning and an associate professor in the School of Nursing at University of British Columbia; Lauren Smith, chief health equity and strategy Officer for the CDC Foundation; and Kim Gallon, an associate professor of history at Purdue University.
In any community, people will have questions about a new vaccine or medical innovation, Nunez-Smith said. It’s part of the process. “Everyone needs to get their questions heard and answered about things like safety, efficacy, and cost, that’s everyone,” she said.
And across all communities, people want to get answers from those who have the credentials: science from scientists, health care from doctors, she said.
People tend to trust those who are part of their communities the most. Historically, black people trust black doctors and black institutions, Gallon, who is also the founder of COVID Black, a task force raising awareness about health disparities in black communities, said during the panel. Health campaigns originating from sources people have a deep trust for tend to create more confidence, she said.
“If we can reframe this notion of Tuskegee and Black health to one where we see Black doctors, and Black scientists, and Black health care providers and center them, I think we can have more complicated conversations where we are communicating to Black communities, that our history of Black health, isn’t always a history of deficit and medical experimentation,” Gallon said at the panel.
A problem that arises for indigenous people is that Americans don’t know the history. Moss said to assume trauma when speaking to Native American people, and then rule it out. “You need to approach with cultural safety, humility, respect measures and an understanding, and that’s where the gap is, that’s the problem,” she said during the panel.
The health disparities that exist in these communities are a repeating story and health care professionals are “setting these terrible milestones over and over again” as Black and Brown lives are lost, Nunez-Smith said during the panel.
“I worry that people become numb to understanding the grief and the suffering and the loss behind each one of those lives that we lose in our country,” she said.
With officials and professionals receiving their vaccines on camera, we see a unified message: take the vaccine. But this hasn’t always been the case during other rampant diseases. For instance, when the vaccine for H1N1 became available, health care workers had a lot of pushback taking it, Smith, who worked at a state health department at the time, said during the panel. It’s important to have every official and professional on the same page because it creates confidence, she said.
Of course, it’s important to avoid teetering over the line between education and coercion, Smith said during the panel. Instead, conversations should be informational and give agency to people.
The historical horrors that are colonization and enslavement were all structural programs. So any changes must be structural as well, Corbie-Smith said during the panel.
Funding grassroot organizations and media in black and indigenous communities may be a solution to spreading accurate information, Moss said during the panel. “If we can get some more resources into the hands of the people that are on the front lines, literally, I think we could start really seeing some change happen,” she said.
‘We might as well get good at this’
When Talkington and her colleagues were running Get Smart’s initiative, she noticed a wave of pandemic fatigue gripped her students and the community. She continued to have conversations with her students and push them to keep spreading information. “I know you’re done with a pandemic, the pandemic isn’t done with you,” Talkington would tell them. “It’s still here, it still has to be dealt with.
“It’s not a three month problem, it’s not a six month problem, it’s going to be a year or two. So we might as well get good at this, right?”
It’s up to each individual’s own personal behavior to fight this virus, a new challenge for the U.S., Talkington said. “We’ve been able to compartmentalize and say, oh, the experts will take care of this. And it’s come right down to grandma, grandpa, uncles, cousins. It’s just every single one of us.
“We’re in the COVID superbowl of disease and we got a bunch of people on the field who never played the game. It doesn’t matter. We still have to become experts, all of us have to become very savvy about this.”