Building Trust and Bridges: Ways to Overcome Vaccine Hesitancy, Access
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Proactive outreach is vital to helping at-risk people in the U.S. get the COVID-19 vaccine, expert witnesses told the Senate Committee on Aging.

“When it comes to mistrust and building trust, we definitely get it,” Anand Iyer, MD, MSPH, assistant professor at the University of Alabama at Birmingham, said during a hearing Thursday.

Alabama is where the Tuskegee syphilis studies took place and Iyer said that, during his training, he treated a relative of a participant in those trials. Since those infamous experiments, the university has worked to build relationships with trusted minority community leaders and that appears to be paying off: The university has delivered vaccines to local minority communities at four times the state and national average, Iyer said.

He explained that trust comes from one-on-one conversations with “pillars in the community” such as religious leaders, barbers, leaders at senior centers, and even “Meals on Wheels” delivery drivers. “If they get on board … [residents] see representation. They see that [vaccination] could be a real way to get out of the pandemic,” Iyer said.

Witness Anthony Jackson, MBA, senior vice president and COO of Roper St. Francis Healthcare in Charleston, South Carolina, agreed, suggesting that one option is to ask church pastors to highlight the important of vaccination in their virtual sermons.

Iyer noted that access, not hesitancy, is the real barrier for many of his patients: “They want it. They just don’t know how to get it.”

He also pointed out that one in five seniors could be in danger of missing their vaccines due to age-related barriers, such as mobility limitations, functional and cognitive impairments, a lack of transportation, digital and social isolation, and a lack of caregiver support.

The COVID-19-related American Rescue Plan Act of 2021 signed into law last week includes investments aimed at reaching these vulnerable populations, and Iyer proposed three ways to overcome vaccine-access obstacles:

  • Create a centralized database through a collaboration with the Areas on Aging agency. Churches and home-based care programs can also partner to identify at-risk individuals, he stated in written testimony.
  • Simplify vaccine registration. Iyer said that online registration systems are often “impractical” for older adults; they may not have email accounts or may have low digital literacy skills. Telephone registration should be expanded. Also, door-to-door outreach programs, such as “Senior Buddies” and the “Vaccine Community Connectors,” should be replicated to aid with scheduling and transportation.
  • Expand mobile vaccination and target the most vulnerable areas.

Jackson highlighted several ways his state has brought vaccination to underserved communities, such as a drive-thru vaccination site at the North Charleston Coliseum and Performing Arts Center, which has the capacity to administer 1,500 vaccines a day, and a pop-up vaccination site in Berkeley County for adults ages ≥55. He noted that three-fourths of the seniors in Berkeley County have yet to be vaccinated.

Healthcare at Home

The committee also heard about healthcare challenges for vulnerable populations, such as the lack of a robust home-and community-based support networks.

Amy Houtrow, MD, PhD, professor and vice chair of the department of physical medicine and rehabilitation for pediatric rehabilitation medicine, at the University of Pittsburgh School of Medicine, reported that she has a rare genetic disorder and must take immunosuppressant medications.

She said she prepared to self-isolate in February 2020 — because “I knew right away that COVID-19 could easily kill me” — and moved her entire practice to telehealth.

Houtrow thanked Committee Chair Bob Casey (D-Pa.) for helping to include $12.7 billion in the American Rescue Plan for home- and community-based services for at-risk populations. But she noted that, even pre-pandemic, there wasn’t a “strong workforce” to provide that care, partly because of inadequate pay.

Houtrow said that in Allegheny County where she lives, direct service workers make $12.41 per hour, but a “living wage” for a single mother raising two children is about $34 an hour. In addition, these care providers need access to adequate personal protective equipment, sick leave, and transportation to and from work.

LTSS: A ‘Mandatory Benefit?’

Sen. Elizabeth Warren (D-Mass.) pointed out that millions of Americans can’t access long-term services and supports (LTSS).

Warren argued that the investments in home and community-based services in the American Rescue Plan are useful, but “Congress must do more,” and called for making home and community-based services a “mandatory benefit” in Medicaid, as well as for expanding Medicare to cover more long-term care services.

She also pressed for Congress to “force” private insurers to commit to investing some of their “billions in profits” to long-term care services that “should be a right, not a privilege.”

Sandra Harris, Volunteer State President of AARP Massachusetts in Boston, noted that Medicaid is currently not required to cover in-home long-term care services and support; only nursing home care is mandated. She explained that Medicare covers some limited part-time skilled nursing services and therapy, but excludes support for “activities of daily living,” such as eating, bathing, or dressing.

Houtrow warned that when people lack access to these kinds of services, their risk for depression and hospitalization increases, and their families come under emotional and financial strain.

Last Updated March 22, 2021

  • Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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