Trust in Action: Reaching the last mile in COVID vaccinations for vulnerable and historically disenfranchised populations
By: Dr. Ashwin Vasan, Dr. Josh Seidman, Nicole Pickett
As the COVID-19 Delta variant surges and vaccine rates stagnate, new approaches are quickly being employed to reach the hardest-to-serve or vaccine hesitant, including dollar stores, door-to-door models and surge task forces. But what about partnering with the trust brokers already existing within these communities?
When the COVID-19 vaccine became available earlier this year, Mike immediately knew where to go: Fountain House, a community-based program for people living with serious mental illness (SMI). Instead of long lines, confusing online portals and traveling to mass vaccination sites in parts unknown, Mike was able to go to a place that had welcomed him hundreds of times before, and where he felt safe and comfortable.
Mike is one of the 280,000 New Yorkers and 13 million Americans living with SMI. While there is little data around the uptake of the COVID-19 vaccine in those living with SMI, we do know that this population is known to be less likely to seek out vaccines when they were made available for previous infectious disease outbreaks, such as the flu. This is deeply problematic given that people living with SMI are at an increased risk of contracting COVID-19, and face higher rates of hospitalization, complications, and mortality. To put things in perspective: aside from age, schizophrenia is the highest risk factor for mortality related to COVID-19.
To create an environment where Mike chose to get vaccinated, Fountain House provided open and transparent communication and educational materials about the pandemic from the beginning. By the time vaccines became available, our members knew that getting vaccinated was necessary to protect the health of themselves and countless others. Trust, established with members over decades, lay the foundation for success. Members feel at home and respected when they enter through the green doors of Fountain House.
Our data speaks for itself: 61% of Fountain House members (a term we use to convey agency and inclusion and who are largely BIPOC) have been fully vaccinated, and 86% of our members in our congregate care residential settings are vaccinated (many within the first 1–2 weeks of eligibility, even during vaccine shortages). Early on, when vaccine shortages were staggering, we successfully orchestrated and administered the first dose of the vaccine to more than half of our eligible population.
But this is not just a story about how we can successfully vaccinate people living with SMI: across the country, vulnerable and historically disenfranchised populations are lagging behind in vaccine uptake. Black and Brown communities have lower vaccination rates on average, in part due to access barriers, such as internet disparities, transportation challenges, and inadequate information. The same is true for immigrant communities, who are also fearful that getting vaccinated will compromise their immigration status.
Efforts are underway to reach the most vulnerable and historically disenfranchised, whether it be via barbershops, libraries, or places of worship. The link among all of these? Trust. With the Delta variant threatening progress against COVID-19, the time to act is now. We know that US-approved COVID-19 vaccines protect against the variant, but vaccination rates continue to slow and a large swath of the country is left unprotected.
To successfully reach the last mile, we need to get a full picture of the unvaccinated populations by taking a deep dive into the data and physically going into the communities with the lowest vaccine uptake, identifying the trust brokers in those communities, and injecting significant resources into those systems to administer the vaccine. But these efforts must also be in service of a larger goal: to be prepared for the next pandemic. We must rebuild our public health infrastructure by focusing on the people, programs and social infrastructure that build trust, creating a public health workforce and network of trust-brokers that keep people connected so they can quickly be deployed in emergencies to easily assist the most vulnerable.
We know what works — now is the time to make the investments.
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Dr. Ashwin Vasan is the President and CEO of Fountain House and an assistant professor in public health and medicine at Columbia University in New York
Nicole Pickett is the Director of Managed Care Relations at Fountain House
Dr. Joshua Seidman is the Chief Research and Knowledge Officer at Fountain House
