‘It’s critical to have cultural competency’: Suburban health care experts tackle vaccine mistrust

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The Montgomery County Immunization Coalition, the Pottstown Area Health and Wellness Foundation and the TriCounty Health Council assembled a virtual panel of community leaders and health care experts to discuss vaccine mistrust in communities of color.

“We want to discuss some of the history of and reasons for mistrust of the health system among communities of color and how that affects decisions about the vaccine,” said John Harris, moderator of the Tuesday night panel and director of Veralon, a health care management consulting firm in Bala Cynwyd.

Before the eight-person group addressed the direct concerns of communities of color, the health care experts explained the three-decades-in-the-making RNA technology that is behind the Pfizer and Moderna vaccines’ 95% efficacy rate.

“One of the things that is a little different about this vaccine is it works with a different type of technology than we’re used to seeing … and that technology uses what we call messenger RNA. And this is a different technology but not necessarily a totally new technology. In fact, it’s been being studied for about 30 years,” said Irene Shepherd, chief medical officer of Community Health & Dental Care in Pottstown. “This kind of vaccine, actually, when it’s injected allows our cells to make a little protein spike that you see … with the COVID virus, it doesn’t give you the virus.”

Though the vaccines can cause minor side effects like headaches and chills, the medical professionals on the panel wanted to be explicitly clear in establishing the safety of the vaccines.

“One of the questions we often hear is, ‘Am I going to get the disease from this vaccine?’ … and especially because of those symptoms, the fever and aches. And the other thing that’s the concern that people raise, and we need to be absolutely clear [about, is] that with these vaccines there is zero possibility of getting the disease from the vaccine,” said Dr. Richard Lorraine, medical director of the Montgomery County Office of Public Health.

The 1932 Tuskegee syphilis study, in which hundreds of Black men with syphilis were purposely left untreated without their knowledge despite the promise of free health care, has left a bad taste in the mouths of many Black Americans. The U.S. Public Health Service conducted the 40-year study, which has reverberated both through the medical field and the Black community at large.

“So that led to a fair bit of a reexamination of the process for doing studies, and led to a real transformation of that improvement in medical studies, but it also left a lot of mistrust — that and other situations left mistrust in the Black community and other communities of color,” panel moderator Harris said.

With that context, Jonathan Corson, president of the Pottstown NAACP, shared some statistics from the national organization that show just how deep the mistrust goes.

Fourteen percent of Black people “trust that shot will be safe, and 80% of them believe that if they do take it, it won’t shield them from the virus. Forty-nine percent of African Americans will not take it even if scientists deem it safe,” Corson said.

Considering those numbers, Corson said that through conversations with Black community members, it’s clear different age groups have different reasons for vaccine hesitancy.

“The older Black community members are afraid to take it, but they feel like they have to be forced to take it because of the underlying health issues,” he said. “The younger Black population, they feel that they do take it, they’re just being used as experiments, and [they feel] there’s not enough info for them to take it.”

Vaccine mistrust is not unique to the Black community. Some members of the Latino community have expressed concerns about the safety and efficiency of the vaccine as well.

“They’re trying to balance or measure how efficient, without the risk, and whether if the benefits will be better if they get the vaccine. We also have a lot of lack of trust and past trauma, so that’s part of it in the lack of understanding and mixed information from different venues,” said Nelly Jimenez-Arevalo, executive director and CEO of ACLAMO (Accion Comunal Latinoamericana de Montgomery County) Family Centers.

Stacy Woodland is the CEO of the Tri-County Area YWCA in Pottstown. She told the panel that trust in the health care system is tied to access.

“Families and people that I know that have trusted relationships with health care professionals are much more likely to say, ‘Yes, I’m going to get the vaccine.’ When there are families who I know that use the emergency room and don’t have trusted relationships with health care professionals, they are less likely to trust that the health care system is going to take good care of them,” Woodland said.

For health care providers to effectively get their point across to communities that do not trust the vaccine, Woodland said, there needs to be a level of cultural understanding.

“I think it’s critical to have cultural competency when you’re talking to people that are of a different culture than you, so that you’re able to address and assess fears, both stated and unspoken,” Woodland said.

Jimenez-Arevalo said bridging the language barrier requires more than a simple translation.

“The translation has to make sense. It has to talk to people in the language that they understand so it’s not only a translation in Spanish, it’s how do you, culturally, get to people to understand the message,” Jimenez-Arevalo said.

The messenger might be the key, according to Corson. Bringing in health care experts that are also members of the community could go a long way, he said.

He also addressed what he believes were health care inequities during the initial stages of the pandemic.

“And when COVID rolled out, even though it was affecting the Black and brown communities so much, it seems like the test centers were set up in predominantly white areas and conversations were limited or did not exist to get them into the Black and brown areas, for example, here in Montco. The first test center was set up in Blue Bell. It wasn’t set up in Pottstown, or I don’t believe it was set up in deep in the heart of Norristown, so Black and brown people were expected to travel all the way to Blue Bell,” Corson said.

At the conclusion of the town hall, the panelists were in agreement that defeating COVID-19 largely depends on arming people with correct information.

“I think one point that maybe hasn’t been made tonight is to just urge people to not believe what you’re reading on different social media. There is so much incredibly wrong information on social media platforms. So I really urge you to talk to your health care provider that you trust if you have one,” said Dr. Valerie Arkoosh, chair of the county commissioners.

Though Montgomery County is still in Phase 1A of its vaccine rollout, it expects to be holding Phase 1B vaccinations by February. Arkoosh said that the county is at the mercy of its supplier — and right now the vaccine stockpile is low.

That means a potentially long wait for the general population to receive vaccines.

“So we’re hoping that we’ll get more doses soon, and that maybe we’ll have another vaccine or two to put into the mix to get some more doses out there. But for the general, like healthy, younger population, we’re looking at late spring, maybe even early summer at the rate that we’re going for,” Arkoosh said.

In the meantime, health officials want to remind people that the vaccine is just one tool in the toolbox.

“So I know everyone is tired of hearing, `Wear your mask, wash your hands, keep distance,’ but they are still really key for keeping people safe,” said Meghan Smith, planning and promotion coordinator for the health department in neighboring Chester County.