This article for developing awareness surrounding racial and ethnic disparities in care was funded by GSK.
Drs DeLawnia Comer-HaGans and Karen Krueger are contracted by GSK and are compensated for the development of this article.

Adults in historically under-resourced and minoritized communities face multiple barriers to receiving all recommended vaccinations. Grounded in a deep engagement with the impacted communities, a spectrum of solutions ranging from communication strategies to hiring and recruiting practices can offer tools to address this critical public health imperative.

One structural barrier to adult vaccine uptake in minoritized communities is a history of poor and insufficient treatment by the very healthcare system we are asking such patients to engage with. Black and Latinx patients routinely receive care at lower-quality hospitals that report more negative clinical outcomes, and may receive fewer evidence-based treatments, as one study demonstrated is true of patients receiving cardiovascular disease and stroke care. Similarly, flu vaccine uptake among people of color is negatively impacted by lower rates of provider recommendation and experiences of racial consciousness and stereotyping. This pattern of underinvestment in minoritized communities was made apparent during the early days of the COVID-19 pandemic in New York City, where vaccination resources were mostly funneled to White and middle-to-upper class areas. The resulting vaccination access deserts left poorer people struggling to schedule appointments, receive their second dose, or even travel to the closest vaccination site.

These issues suggest some clear policy-level solutions. Before we can expect patients in underserved or marginalized communities to make and keep the appointments required for all indicated vaccinations, we must ensure they have a reliable and comprehensive healthcare center at which to receive these treatments. But it is not just a matter of building and funding hospitals or health clinics. In order for patients to actually want to visit these centers, we have to also offer them culturally informed communication and care. At the level of the healthcare system, this means being embedded enough in the community to understand how to engage with it. Hiring local community members; funding, educating, and recruiting providers from diverse backgrounds; and doing community outreach are all strategies that can improve outcomes.

On the topic of communications and outreach, another point of contention between health systems and the communities they serve is the transitory and opportunistic nature of such engagement strategies. It is laudable for clinical trial centers to make efforts to recruit patients from these populations, but it should not be the only time an individual hears from their local healthcare system or provider. Similarly, while physicians and other healthcare professionals may want to be able to convince patients to protect their health with a vaccination, we cannot expect the few precious minutes these practitioners get with them in an appointment to be enough time to nurture a trusting relationship. After all, if we want patients to visit healthcare institutions or community clinics regularly, our institutions should start by visiting them regularly. Instead of simply telling people, health systems can demonstrate that they are a sincere and trusted partner in the community’s health by nurturing consistent and service-oriented relationships with churches, senior centers, and schools. One study partially demonstrated that medical mistrust can contribute to the higher rate of some Black and Latinx patients avoiding participation in COVID-19 vaccine trials or receiving COVID-19 vaccines. Such mistrust cannot be mollified by communication strategies alone; we must also prove ourselves trustworthy partners.

I share Dr Comer-HaGans’ concerns about building a lasting and meaningful connection between healthcare systems and the patients they serve. There are both big-picture and more immediate reasons for this disconnect, which may contribute to patients not receiving all indicated vaccines. Black, Latinx, and other patients from underserved or marginalized communities may not see themselves represented in the people who are treating them, or in the clinical trials that are used to verify the efficacy and safety of the treatments they may be prescribed. Such exclusion from the medical establishment leads patients to assume that the services recommended were not really designed for them. As far as more immediate causes for not engaging with the healthcare establishment, patients who are routinely unable to keep the appointments necessary to stay up to date on vaccinations may face obstacles such as poor or expensive transportation, long commutes, or inaccessible office hours. Some may also face communication barriers in locating and pursuing appropriate care.

Solutions at the level of healthcare systems could be implemented to address these issues. For example, communication strategies could be tailored to specific communities and distributed through establishments that are important to that group, such as a church or event space. We could go a step further and offer not just the information but the vaccinations themselves at such locations, which could allow patients an opportunity to integrate this important part of their preventive health care into their existing routines.

There are many other ways we can improve the institutions that administer vaccines and other healthcare services to patients that may improve vaccine uptake in our patients. Something as simple as standardized vaccination records and guidelines that are available to nurses and physicians a patient may encounter at each office visit, in addition to the pharmacist they may pick up prescriptions from, allow vaccines to be better integrated into office visits and reduce the need for repeat visits. Institutions can also empower patients with this information as well, sending messages and reminders about vaccines over text and patient portal interfaces. When such technology-driven communication is culturally appropriate, it can have a great impact on utilization of services and health outcomes. Greater integration of a patient’s particular health insurance coverage into provider recommendations would also lower the barrier to vaccination. In my clinical experience, patients are far less likely to receive a vaccine if they first must verify with their insurance on their own that it is covered. By improving the quality of each visit patients pay to their healthcare provider and ensuring their preventive care is well integrated into their daily lives, we can take the first step toward better engagement between providers and patients.