While vaccination rates have been trending positively — demand outweighing supply — that pendulum is beginning to swing in the other direction. Washington State, for example, recently started turning down doses from the federal government. Iowa, Wisconsin, and Kansas have adopted similar practices.
It’s not unexpected; vaccine manufacturers continue to ramp up output while the people who were eager and able to get vaccinated have done so. But this fact doesn’t mean the work is over. Far from it, in fact. According to the CDC, only 35% of the U.S. population is fully vaccinated (46% of the U.S. population has had at least one shot).
In order to reach the other half of the population — specifically those who want to get vaccinated but are met with barriers preventing them from getting one — government and health officials will need to shift their strategies and begin to meet patients where they are.
The barriers to vaccination
In early April, we had the pleasure of hosting SameSky Health (formerly ConsejoSano)’s CEO and founder Abner Mason in a webinar focusing on vaccine access in populations with limited English proficiency (LEP).
As an expert in multicultural patient care, Abner describes three main reasons why so many people aren’t yet vaccinated but want to be.
Many organizations have been slow to provide their LEP communities with linguistically and culturally appropriate COVID-19 resources. In some cases they’ve cut corners using inadequate tools. Earlier this year, the Spanish-language version of the Virginia Department of Health’s vaccination FAQ page mistranslated a key phrase that changed “the vaccine is not required” to “the vaccine is not necessary.” The department used Google Translate to create the page. Some sleuthing by WebMD/Medscape found that three states — Alabama, New Jersey, and South Dakota — had no options for translation on their vaccine-finder web pages.
Many vaccination sites require online registration. Not only that, but each vaccination site has their own scheduling process and website. An individual might have to visit several different sites to check for an appointment slot. Without a centralized scheduling calendar, online navigation and registration is difficult to impossible for individuals who don’t use technology or the internet independently. And a 2015 survey found that fewer Latinx and Black households had access to a computer and the internet compared to Asian and white households.
According to the American Hospital Association, common transportation issues include lack of access to a vehicle, poor infrastructure, extended travel times to get services, transportation costs, and policies that negatively affect travel.
In a 2005 analysis, transportation challenges prevented around 3.6 million people in the U.S. — predominantly individuals who were female, older, less educated, and from an ethnic minority group — from receiving medical care. Vaccine sites aren’t typically located in accessible areas for communities that have been hit hardest by COVID. Mass sites, like those held in convention centers and stadiums, often require access to a reliable vehicle. As do drive-up sites. The virus also caused public transportation services in many large cities to reduce routes and hours of operation.
The road to vaccinating LEP populations
In order to address these barriers to ensure your LEP patient population has access to the vaccine, Abner recommends these strategies:
1. Collect data
Start collecting race, ethnicity, and language (REL) data. This is fundamental to understanding who your patient population is. Abner suggests checking your electronic health records (EHRs) to see if your organization is already collecting this data. If not, surveying your patients and asking them how they’d like to communicate is a simple yet effective way to gather this information.
2. Research and prepare
Once you’ve collected data on your patient population, you can start the planning phase. While this absolutely includes ensuring culturally appropriate documentation (don’t forget to translate those informed consent forms!) and medical interpretation services are available, it goes beyond that.
If, for example, your vaccination site is staffed with uniformed guards or military personnel, it’s important to communicate that. “Managing expectations for LEP populations is really important, so if you’re going to have security, you need to tell them there will be uniformed security there, but they are not ICE; they cannot be deported,” states Abner. “Tell them upfront. Don’t let them be surprised. Because they will get there, see it, and drive away and never come back.”
3. Think about how your patients communicate
Don’t rely on outdated modes of communication when scheduling your LEP patients for a vaccine appointment. Different cultures communicate in different ways, and this includes modality. So ask people how they want to be contacted.
Abner explained that most Americans, nearly 97%, own a cellphone, and most will say that they prefer text over a call. But this shouldn’t rule out a phone call. “For those who don’t [want a text message] and they want a call, call them.”
It’s all about building trust
In sum, Abner encouraged all to simply engage people in a way that respects their culture, their language, and who they are as a person.
“This is about building trust,” Abner said. “It’s not just about getting through the process and checking the boxes and just getting the vaccine in the arm . . . you want to build a relationship with patients, relationships of trust, so that going forward, they trust you, and part of that is meeting them where they are.”
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