Vaccine equity — not hesitancy

Hogg Foundation for Mental Health · Episode 113: Vaccine Equity and Trust

Although the term “vaccine hesitancy” has gained momentum in recent months, the term fails to capture the systemic nature of the greater problem of vaccine access and lack of trust in public health institutions, especially among groups and communities that have been historically underserved and mistreated or even abused by the public health and medical care systems. We should call it “vaccine equity” to reframe the issue in a critical way.

The COVID-19 pandemic undeniably hit communities of color the hardest. Disparities in testing, infection rates, rates of hospitalization and death in communities of color have been well-documented since the onset of the pandemic. And yet, according to the latest data available, the rate of vaccination within these groups lags well behind white people nationally; Texas is no exception.

The initial rush for the vaccine is over. Americans who remain unvaccinated weren’t eager to stand in hours-long lines to get the first shots, of weren’t in places where shots were so available that they could show up for any appointment time. The populations we must now reach may be on the wrong side of the digital divide, vulnerable to misinformation, with limited transportation access, or whose trust in public health institutions has eroded after centuries of structural racism.

By opting for the phrase “vaccine equity,” we reframe the issue in a critical way.

As tempting as it is to focus on stubborn or ignorant individuals; the real problem is twofold. First, we have a health care system that fails to engender trust. Second, the frenzied circumstances of the pandemic have led many to the unfortunate (and wrong) conclusion that listening to people is a luxury they can’t afford.

Another way is possible. We have an opportunity to design solutions that meet people where they are. Solutions that work recognize the disparities that exist and innovate ways to break down those barriers. Mobile vaccination sites, outreach through local churches and other grass-roots, community-based efforts are among the most effective ways we have seen of helping people overcome issues of access and trust.

Mount Pleasant, in the northeast part of our state, illustrates what we can do once we make mobilizing community resources the main focus. As reported by The Texas Tribune, residents of this town of 16,000 weren’t the most receptive to vaccination; at more than 40 percent Hispanic, with many undocumented people, fear and mistrust of government was a barrier to vaccine acceptance.

Their experience holds many lessons. The town had a critical mass of community members — faith leaders, health care workers and local organizations — who knew better than to write off their own community or treat hesitancy as an inalterable trait. By relying on trusted messengers, word-of-mouth and a willingness to meet people where they were, Mount Pleasant doubled its vaccination rate by early May, achieving this turnaround even as vaccination rates slowed for the state as a whole.

That could work across Texas, particularly in rural communities. It can only happen if public health experts are guided by more generous assumptions about those many have written off as “hesitant.” If vaccines are ubiquitous, convenient, accessible and promoted by trusted voices in the community, it won’t be a question of if those Texans they get vaccinated, but when and how.

Systemic change is never simple, but we can start by calling things as they are. Not only is it inaccurate to talk about vaccine hesitancy at this stage in the pandemic — it sidesteps and ignores reality. Vaccine access and trust are issues of equity, not hesitancy. The next chapter in America’s efforts to vaccinate its population depends on us understanding that distinction.