How Trust Can Help Combat Vaccine Hesitancy Among Non-English Speakers

Gloved hand lining up five vials of COVID-19 vaccine.

Vaccine hesitancy among minority communities remains high. This is not surprising, considering the historical mistreatment, bias, and systemic racism BIPOC and limited English proficient (LEP) individuals have faced from government and medical institutions in the U.S. In addition, Black and Latinx populations have been two of the hardest hit by the pandemic, disproportionately so.

According to a September 2020 study, 34% of Latinx American respondents “mostly or completely trust” the COVID-19 vaccine’s safety, compared to only 14% of Black American respondents. 

These numbers are problematic; in order to achieve herd immunity to the coronavirus, experts say that somewhere between 70% and 90% of the population will need to be inoculated. This means that health officials will have to cut through the vaccine skepticism to reach higher vaccine acceptance. And to do that, they have to gain the trust of the most vulnerable communities.

What is vaccine hesitancy?

The World Health Organization (WHO) defines vaccine hesitancy as the “delay in acceptance or refusal of vaccines despite availability of vaccination services.” This attitude differs from vaccine opposition, or “anti-vaxxers,” who straight-up refuse vaccination for a variety of reasons.

Those who are vaccine hesitant are more cautious, more wary. They are open to getting vaccinated, but generally need more information about the vaccine in order to make their own determination of whether it’s safe and effective for them or their family. 

Why are people hesitant to get the COVID-19 vaccine?

Generally speaking, reasons for vaccine hesitancy fall into three buckets: 1. Lack of confidence in the system, the efficacy of the vaccine, or in policy/policymakers; 2. Complacency (i.e., “I don’t need it because I’m healthy and won’t get sick.”); and 3. Lack of accessibility, availability, and appeal, which includes time, place, language, and cultural contexts.

Along with mistrust in the medical system as a whole, religion, culture, safety concerns, lived experience, language barriers, low health literacy, and immigration status also play a role in vaccine hesitancy among LEP and minority communities. 

At the start of the pandemic, many state agencies struggled to reach these communities with accurate, culturally sensitive information about COVID-19. Myths and misinformation circulated, and created confusion over preventative measures and of the seriousness of the virus. Since there was a lack of translated and/or culturally adapted information, people who didn’t speak English didn’t even have the opportunity to research and find more accurate resources. 

Officials also didn’t take into account how different communities lived and worked. Not everyone lives in a single-family residence; many diverse communities live in multigenerational households and are frontline workers, meaning messaging like “social distancing” didn’t resonate.

Related: Community-Oriented Strategies that Can Help Deliver Effective Communication and Language Access

Two vials of the COVID-19 vaccine surrounded by a needle and cotton rounds on a pink background.

How can I help LEP populations overcome vaccine hesitancy?

Health officials have the opportunity to instill confidence about the COVID-19 vaccine within members of their LEP populations, but they cannot do it alone, and they cannot do it without first earning the trust of each community they serve.

“People are sometimes confused about what they read or hear on the television,” states Paschal Nwako, Camden County health director, in an interview with Vox. “So when somebody in their community calls them on the phone, or sends them a text that will end up with a phone call to discuss the vaccines with them, that is more effective.”

Social circles can influence vaccine acceptance, so building partnerships with credible messengers can help shift attitudes. 

Credible messengers share experiences, values, ethnicity, language, and culture with their neighbors. They already have the trust of their communities, and people are more likely to listen to them than a scientist or physician talking at them through a screen. And in turn, credible messengers are more likely to know what the concerns of their community are. They can provide valuable information on how vaccines are perceived, the best communication channels, and any nuances or local contexts at play that health officials would otherwise not know.

Related: Free Multilingual Coronavirus Resources

The problem of vaccine hesitancy with COVID-19 is not unlike the resistance Dr. Heidi Larson, an anthropologist who studies vaccine rumors, observed in Nigeria with the polio vaccine. 

“I saw how much of the communication strategies were very much driven by what the public health community and immunization people thought the public needed to know,” Dr. Larson told the New York Times. “But they weren’t responding to what people’s concerns were, or issues, or questions.”

A partnership in action

Vaccines were well-received in the Somali community in Minnesota, until baseless claims that the MMR vaccine caused autism began circulating. This led to a dramatic decrease in immunization rates in the community. From 2004 to 2010, the vaccination rate dropped from 94% to 54%.

In 2017, an outbreak of measles hit the Minneapolis–St. Paul metro area. Out of the 79 confirmed cases in the state, 64 of them were Somali residents. But none of the confirmed cases came from Olmsted County, home of Rochester and around 25,000 Somali immigrants. 

That’s because when news of the outbreak hit, the Mayo Clinic reached out to Somali leaders in the area and began working on a plan. They held town hall meetings at community centers and religious institutions to engage with people who were fearful. Health officials answered questions and concerns about the safety of the vaccine, and distilled the myths about the link to autism.

They were able to do so because of an established, trusted collaboration called the Rochester Healthy Community Partnership. The Rochester partnership — a Minnesota-based group made up of Mayo Clinic researchers and clinicians, public health officials, and community members — has been working to improve the health outcomes of the area’s diverse populations, which includes Somalis. 

Who are credible messengers and where can I find them?

Credible messengers include local advocates, ambassadors, community-based workers and organizations, and local leaders. They may be obvious, like a politician, but they may not be. The key is to find the most appropriate person for the audience you’re trying to reach. Your best bet is to reach out to well-connected non-profits in the area, and start there. 

The following organizations and people are also good leads to contact:

  • Academic institutions 
  • Libraries
  • Community centers
  • Churches, mosques, and synagogues
  • Local professionals (e.g., barbers, hair stylists, business owners)
  • Elders
  • Non-English-speaking media outlets (e.g., newspapers, radio, etc.)

One step at a time

Building trust to shift the cultural tide toward vaccine acceptance won’t happen overnight, so commit for the long term. Patience, perseverance, and partnerships will be key in this endeavor. Involving your BIPOC and LEP communities in every step of public health efforts to widely educate and administer COVID-19 vaccines is not only advisable, it’s pivotal. 

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