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Many Sacramentans don't trust COVID-19 vaccine. Here's how the county can build trust

Sacramento Bee - 1/23/2021

Jan. 23—Nearly a year in, the coronavirus has steadfastly and unevenly devastated communities across Sacramento and beyond. Now, all eyes are on COVID-19 vaccines as the key to ending the pandemic.

In a listening session this month, The Sacramento Bee'sEquity Lab reporters spoke with more than a dozen community health advocates about key concerns they have about how Sacramento will deliver shots in the arms of residents in an equitable and efficient way.

The vaccine rollout in Sacramento and California has lagged considerably. Prioritizing populations in the midst of severe vaccine scarcity is a complicated and fraught challenge. There is percolating hesitance in the vaccine among some.

Though it could be weeks, if not months, before large swathes of Sacramento have access to the vaccine, advocates said now is the time to organize a distribution plan with an equity lens.

Here are the major themes from our listening session:

For equitable distribution, meet people where they're at

In the early days of the pandemic, local health officials had imagined huge vaccine sites at vacant parking lots drawing in thousands of people. But so far, most of the attention on vaccines have been on hospitals and healthcare systems, creating a confusing system for eligible individuals hoping to sign up.

Now's the time to start planning and ramping up vaccine sites, advocates said. Why? Because some health advocates say it's unlikely that major health systems and hospitals will provide the bulk of vaccinations in California.

Every year, people have access to the latest flu vaccine. But just under half of adults got the flu vaccine in 2019-2020, according to the U.S. Centers for Disease Control and Prevention. Of those, only about one in three get their vaccine at a doctor's office — the rest get their flu shots either at a pharmacy or store, at their workplace, or at a health clinic, among other places.

In 2019, nearly 3 million Californians were uninsured, meaning they may not have access to a regular doctor or clinician. Others remain deeply skeptical of the healthcare system.

Drive-thru vaccination clinics must be available in neighborhoods across Sacramento County that span geographic, racial and income demographics, advocates said. Times need to be flexible for workers — after-work hours and weekend availability. Just one mass vaccination site at Cal Expo will not be enough.

The county has already partnered with many community hubs like churches and community resource centers trusted by residents to open COVID-19 test sites. Advocates hope local officials will build on those relationships, and likewise open similar vaccine centers across the county.

Vaccine plans must bridge language, income barriers

About one in three people in Sacramento County live in a house where a language other than English is spoken, according to the U.S. Census Bureau. Some of the non-English languages spoken the most include Spanish, Chinese, Hmong and Vietnamese.

Sacramento County, like many counties in California, was slow to translate critical public health messaging materials into Spanish at the start of the pandemic. It can't happen again when it comes to vaccinating residents, advocates said.

But health advocates say translating paper pamphlets will not be enough; most people are getting information about the vaccine online, on TV or on the radio. Translators must also be hired for community vaccine sites, so non-English speakers — especially elderly residents — feel encouraged to go in and have their questions answered.

Healthcare providers, pharmacies and the county should coordinate mobile vaccination sites at workplaces particularly vulnerable to virus spread, such as manufacturing or farming. Many of these essential workers, often in low-paying jobs, might not otherwise be able to take time off to get vaccinated.

Advocates said creative solutions should be implemented to create as little friction as possible for individuals and families to get inoculated. When vaccinations open up more broadly to the general public, parents and kids might get a shot while picking up school meals on campus, for example.

This week, a state advisory committee floated the idea of simplifying the vaccine rollout urging counties to set aside a portion of vaccines for areas most impacted by COVID-19, based on California's Healthy Places Index, which tracks community conditions that predict life expectancy and influence health.

That could mean more vaccines for low-income communities of color like Oak Park, Meadowview and Del Paso Heights that have seen some of the highest rates of COVID-19 cases in the city.

A lack of information breeds hoaxes and fear

For many, the vaccine seemed to have come out of nowhere. Just after the presidential election and in the midst of accelerating wintertime COVID-19 cases, the FDA approved the Pfizer-BioNTech vaccine. Shortly after, the Moderna vaccine was authorized. Two more vaccines may get similar approval next month.

The name of the federal vaccination plan under the Trump administration, Operation Warp Speed, does it no favors. Though the vaccines have all gone through extensive testing and trials, advocates said the speed of development — and inadequate messaging from federal and state officials — has given some the wrong impression.

California, home to a robust anti-vaccine movement that predates the pandemic, has also already started to see misinformation about the COVID-19 vaccines on social media platforms like Facebook and Instagram.

One post, for example, falsely claims the accompanying photo shows "3 of the 4 volunteers who developed Bells palsy after being vaccinated with the Pfizer covid experimental vaccine." According to the U.S. Food and Drug Administration, Bell's palsy was reported in four vaccine participants out of 44,000 total participants of the late-stage vaccine trial, but that the number "is consistent with the expected background rate in the general population."

It's true that some people may experience mild flu-life symptoms after receiving a COVID-19 vaccine — just like many would after taking a flu shot. In rare cases, the CDC has found some people have had severe allergic reactions to the vaccine.

Community advocates said federal, state and local health officials need to make clear and extensive Q&As (in multiple languages) about the vaccine available online and on social media. Officials shouldn't shy away from uncomfortable questions, like potential adverse reactions, but confront misinformation head-on.

Bring in trusted community leaders to back vaccine efforts

Many communities of color are mistrustful of the medical system. Historical and recent stories of unethical research and medical exploitation — Henrietta Lacks, the Tuskegee experiment, the Havasupai diabetes project — have continued to sow doubt.

Black people are systematically undertreated for pain relative to white patients; doctors are less likely to prescribe opioids to Black people than white people for migraines and back pain. Asian and Hispanic immigrants are more likely to die as a patient in a hospital than white people. Some, uninsured or undocumented or underserved, are afraid or unable to go to medical providers.

In many ways, mistrust in medical institutions is valid, advocates said. Any successful rollout will require health officials be ready to engage in thoughtful conversations that acknowledges those concerns.

One way of building goodwill is getting trusted community leaders to become vaccine ambassadors of sorts, sharing their experience of getting the shot on social media and urging others to do the same.

Community leaders is a loose term, advocates said, but it means more than just mayors and councilmembers. An ex-gang member involved in youth programming might be a good messenger, for example, or pastors and church staff.

The consequences of delayed herd immunity are clear and dire

Eventually, failing to take the vaccine may make returning to pre-pandemic life impossible. Out-of-state travel or attendance to major live events may be restricted without proof of inoculation, for example. Advocates hope that may be an ultimate incentive for "wait and see" folks to finally take the vaccine.

But such restrictions are months away. The longer it takes to reach herd immunity — when about 75% of the population has been vaccinated and virus spread will be under control — the longer we'll continue to see devastating outbreaks and deaths.

The longer some remain vulnerable at work, or jobless all together. The more people fall behind on rent and utility bills and car payments and more. The farther behind students will fall. The longer grandparents have to wait to hug their family members.

It's been said in the last year that the virus has revealed and deepened chasms of disparity. Advocates said the vaccine rollout will be one of the defining tests for how equitable life and recovery post-pandemic will be in Sacramento.


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