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Vaccinating Vulnerable Populations & The Myth Of Widespread Hesitancy

Vaccinating Vulnerable Populations & The Myth Of Widespread Hesitancy

How often have you heard that our most vulnerable populations are desperately seeking access to the COVID vaccine? Almost never? Instead, the prevailing narrative is that people who are Black or impoverished or isolated or elderly or homeless or who use various drugs and so forth are suspicious of, and resistant to, the vaccine.
There is, of course, some truth to this narrative. For a variety of reasons, many people in these groups and others are not yet ready to get a vaccine. Many will require discussion and outreach from trusted sources to make a well-informed decision. They deserve that and should receive these services and much more.
However, hesitancy in these groups has been overstated and repeatedly held up as a barrier in the vaccine rollout. It is imperative that our city, our state, and our nation devote substantial resources to breaking down the current significant barriers that deprive our neighbors of the vaccines.
We are not witnessing vaccine hesitancy — or at least not insurmountable hesitancy. Most of our clients are eager to receive the vaccine and those who are not frequently tell us they would be if it were easier or if their trusted friends get it first. What are the biggest factors keeping some of our most marginalized neighbors from accessing the vaccine? It’s not available where they are and in ways that honor some of their needs. Many cannot produce state ID, stand for hours while waiting in long lines or navigate complex online and/or phone-based systems. These barriers are surmountable.
The organizations where we work, Behavioral Health Leadership Institute (BHLI) and Baltimore Harm Reduction Coalition, prioritize flexibility and service provision where and when it is desired. Among other ventures, both of our organizations operate “pop up” street based services, including substance use treatment with medication, syringe services, and overdose prevention for people who want to increase their health and safety but often find services otherwise difficult to access.
The people we serve frequently have underlying health conditions and tend to be detached from traditional health care systems including public clinics. The majority are homeless or unstably housed, and a significant percentage have had a recent incarceration. Despite what health care professionals are often taught, none of these experiences equates with an attitude of disregard for their wellness or the health of their families. Whether we work from home or are an essential worker serving the public, whether we are out of work or unable to work, we all want to be able to hug our friends and family.
BHLI recently added two survey questions to our clinical intake form. Staff asked clients whether they would be interested in a COVID vaccine if it was offered at the BHLI van or a similarly trusted site. Having asked 152 clients in the past 2.5 weeks or so, 62% responded that they want to receive the vaccine (94 people), while 27% responded “maybe” (33 respondents). For them, and others similarly situated, we need to offer services in places nearby, with providers and community advocates they trust.
The mayor and Baltimore Health Department are working on increasing mobile vaccine availability. However, many barriers remain, and the vaccine is not yet reaching the neighborhoods hardest hit by the pandemic, many of which we serve. Much more can and must be done. Though it is a herculean task, it is one that needs not just a mega approach but an approach that offers a variety of access points including churches and pop-up sites on the street, and strategies that honor the anxiety many people feel in crowds. Many in the communities we serve are uneasy leaving their comfort zones and traveling to new areas of the city. They need individualized and trusted options. To reach everyone, we must reach each one.
The greatest thing we can do to combat hesitancy is to vaccinate. Those who are vaccinated will be able to speak honestly about their experience and will likely convince others, creating a snowball effect. This is the time to speedily vaccinate those who are most vulnerable and who are begging to be seen. To excuse ourselves by saying that they are resistant is dishonest and dangerous to our city’s health.
(Deborah Agus is the executive director of Behavioral Health Leadership Institute. Harriet Smith is the director of education at Baltimore Harm Reduction Coalition, she can be reached at admin@baltimoreharmreduction.org.)

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