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Allie Gross

First in Line? No, Thank You

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Why Your Vaccination Communications Must Attune to Justified Reluctance of Black Populations

Nine months into the pandemic, it’s clear that Black people are suffering disproportionately from COVID-19. Now, on the verge of emergency use authorization for Pfizer’s vaccine, providers and government agencies are working urgently to determine who will receive it first. As plans are laid to prioritize and execute vaccine distribution, healthcare providers are well-served to step back and consider how they will address the reluctance of their own staff and their patients of color to get the vaccine.

Assuming Black healthcare workers and patients will want to be first in line for the vaccine is a flawed approach, according to Rick Smith, president and CEO of United Way of Ross County in Ohio, vice president of Advancement and Engagement at the Northern Pennsylvania Regional College, Warren, PA, and a seasoned communications strategist who’s served in senior roles at several prominent health systems.

Smith maintains that when it comes to being first in line for a vaccine, some African-Americans hear this: “You’re going to be the first because, once again, we want to experiment and see how it works. Once we’ve seen the results and tweaked it, then the rest of the population will get their vaccine.”

To that, their reaction is “No, thank you,” Smith said.

“That’s what society has engrained in that segment: We’re your guinea pig,” he added.

As healthcare provider organizations begin to develop their vaccination communication strategies, they need targeted and particular outreach – internally and externally – to reach and better serve Black populations who have been harmed by health researchers and providers in the past.

Jarrard Inc.’s national consumer survey revealed striking disparities in who is likely to get a COVID-19 vaccine, once available.  The results showed that 36 percent of Black respondents reported being extremely or very likely to get a vaccine compared to 57 percent of white respondents. Black respondents also reported lower levels of trust in hospitals, nurses and doctors.

Those results didn’t surprise Smith or Dr. Pam Oliver, Novant Health’s executive vice president and physician network president in Winston-Salem, N.C. and a practicing OB-GYN.

“Our African-American and Latinx communities are extremely vulnerable to disinformation campaigns because they don’t trust who we would say they should go to,” Oliver said. “They may not trust physicians. They may not even trust us, as African-American physicians, because now we’re part of ‘the system.’”

Smith said these disparities are driven by “a history of mistrust,” – alluding to decades of appalling mistreatment and atrocities the medical community has inflicted upon Black people in the U.S., particularly with experimental treatments.

Henrietta Lacks. The Tuskegee Syphilis Study. Cincinnati radiation experiments. These outrages are contemporary, modern tragedies, Smith said.

“A lot of people want to put their heads in the sand, saying that was so long ago and it doesn’t mean anything now. But these are real issues, and we’ve got to start to combat them head-on,” he said.

Further, these infamous examples don’t even account for everyday experiences Black men and women encounter within our health care system. For example, studies have demonstrated that Black women are often not listened to when reporting signs of complications and one-quarter of Black women reported disrespect and abuse from medical professionals in the hospital.

As healthcare provider organizations enjoy overwhelming trust among the public and a politicized battle over the COVID-19 vaccine looms, there’s work to do to overcome barriers to trust among minority groups. To do so, healthcare organizations should bear in mind:

Educate yourselves first to repair trust

Smith and Oliver agree that deeply educating leaders and internal teams is a crucial first step. “A public, open acknowledgement of where the opportunities are and the history is important,” Oliver said. Smith agreed: “There has to be a coming together to first be educated on the history of mistrust and abuse that one body of people have had most often at the hands of others. There is a mistrust, and here’s why.”

Communicate internally first

Doctors aren’t the only ones who interact with patients. Front desk staff, nurse aides and lab techs also need to be consistently prepared with your organization’s message on COVID-19 safety and vaccines – as they also interact with patients. To gain the trust of all patients related to vaccines, “a thought-out, thorough internal communications process needs to happen with these folks first,” Smith said. Oliver added that people should feel empowered to openly ask questions.

Don’t go it alone

While doctors do enjoy the highest level of trust among the general population (53 percent) and among the Black population (45 percent), provider organizations need to push beyond their own spokespeople – meeting people where they are through partnerships with community organizations and groups like historically black fraternities and sororities, Smith said. For instance, one of Jarrard Inc.’s large health system clients works with a network of 80 churches to reach underserved populations. People who are already trusted in the community should be visible and vocal, Smith said. As we say at our firm, “The messenger is just as important as the message.”

Start communicating early and transparently

While it’s true that no one knows when a vaccine will be safely and widely available, health systems need to start building trust and credibility on this issue now. For Oliver, that means being open and candid with internal teams about how vaccines were evaluated and identified and about any potential risks. Even if you don’t have all the answers – no one does! –transparency and openness are key. “If we wait to start communicating when we have a vaccine, it’s too late,” Smith said, adding that systems must proactively devote extra effort to reaching underrepresented communities.

Make a real commitment to meaningful action

To foster trust, Smith said, “People need to see themselves reflected in the organization.” “When African-American patients come into the room and see no one who looks like them telling them the benefits of the vaccine – there’s going to be a hesitancy,” Smith said. All organizations will benefit from a concentrated effort to diversify their workforces at all levels of the system. When it comes to regaining the trust of marginalized communities, “We can’t just tell people they should trust us because we have their best interests at heart,” Oliver said. “We have to find ways to show it.

About the national consumer survey

In partnership with Public Opinion Strategies, we conducted a national consumer online poll of 1,101 adults between July 31 through August 3. The demographics of the respondents included a representative sample of our nation in terms of gender, region, urban/suburban/rural. This was the second survey conducted in response to COVID-19 with the first occurring in April of this year. Both surveys were designed to assess the lay of the land for providers by measuring public sentiment on topics including telemedicine, federal funding, mask wearing, vaccines and provider trust.

About Kaleidoscope

At Jarrard Phillips, Cate & Hancock, we recognize the power of diversity in shaping perspective, generating awareness and leading to long-term sustainable change. This pertains to our own culture, as well as the work we do on behalf of our clients, most of whom serve diverse communities. Through Kaleidoscope, we hope to use our gifts to do good to drive toward action, broaden perspectives and be more inclusive. We acknowledge that as communicators we are better and our work is stronger when we consider all backgrounds and perspectives. We deeply value diverse viewpoints reflective of our communities and believe that only by seeking out and learning from these diverse voices are we able to perceive the world through the eyes of others. We will use our words, wisdom and resources to help our clients build a better healthcare community for the populations they serve and the teams delivering care, all while striving to eliminate racial disparities and being inclusive of all.

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Vaccines: Show AND Tell

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”Do as I do, AND as I say.”

That might as well be the motto of healthcare’s efforts to guide the U.S. population towards rapid adoption of a COVID-19 vaccine.

With doses about to arrive, common sense would suggest that hospitals and health systems prioritize vaccinating frontline workers in direct patient care roles before healthcare industry leaders and administrators working from their guestrooms or offices.

Or does it?

Though many Americans are anxious to be inoculated, many are skeptical – including healthcare workers. We’ve heard this firsthand from our clients, and a recent survey found that 67 percent of healthcare workers intend to delay vaccination. Asked if they would volunteer for a COVID-19 vaccine, two out of three nurses polled by the American Nurses Association poll said “no” or “unsure.” So, it’s a tough sell. Allowing someone to move to the front of the line does no good if they don’t accept the invitation.

The solution might just be to find someone else to go first.

Last week, three former U.S. presidents announced they would take the coronavirus vaccine on live television to inspire public confidence in the immunization. Healthcare system presidents should consider doing the same for their people. If health systems are encouraging caregivers to take the vaccine, there’s no better way for their leaders to communicate confidence in the science and reassure their team of vaccine safety and efficacy than by taking a vaccine themselves.

Otherwise, the risk is caregivers asking their executives: “Well, if you won’t get it, why should I?”

As doses are shipped, health systems grappling with a reluctant workforce should weigh the potential benefits of a similar gesture. How to go about this?

  • Identify your organization’s most trusted leaders related to the pandemic. Is it your CEO? Your chief medical officer? Your chief nursing officer? Your infectious disease experts? Would trusted leaders receiving the vaccine inspire confidence in your clinical workers?
  • Develop an effective communication strategy. How might you communicate this step? Perhaps a memo or a video message from leadership would be effective.
  • Weigh the implications. If you receive severely limited doses of the vaccine and are seeing high demand among your clinical workforce, would it send the wrong message to allot any of these to non-clinical roles?
  • Continue to set an example in other ways. Even if your system decides not to provide the vaccine for key leaders, leaders should serve as role models for how your team should behave in other ways, like continuing to wear a mask, wash hands and practice physical distancing.

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