"Community Members Have More Impact on Their Neighbors than Celebrities": Leveraging Community Partnerships to Build COVID-19 Vaccine Confidence

"Engaging trusted community leaders to better understand community needs related to the COVID-19 vaccine can help prioritize and inform initiatives which increase vaccination rates in marginalized communities, such as Black and Latino communities, and work towards advancing health equity."

Several studies have found that inequities in COVID-19 mortality and vaccine uptake are directly associated with measures of structural racism present in communities of colour. Further, challenges faced by immigrant communities, such as language barriers, impact inequities in COVID-19 vaccination rates. In recognition of these challenges, medical centres caring for diverse communities developed culturally and linguistically inclusive approaches to engage their communities during the pandemic. Such approaches sought to overcome mistrust and motivate health behaviour change among traditionally marginalised communities. This paper presents Boston Medical Center (BMC)'s approach of using a series of community-engaged conversations to elicit and address concerns regarding the COVID-19 vaccine in Boston, Massachusettes, United States (US). It describes the themes that emerged during these conversations and proposes next steps for healthcare leaders.

BMC provides care to patients regardless of their ability to pay or their immigration status. Of patients treated at BMC for COVID-19 between March and May 2020, 44.6% were Black, 30.1% were Hispanic, and 16.4% were experiencing homelessness. From March 2021 to September 2021, BMC organised a series conversations that were led by trusted community leaders, such as faith leaders, leaders of local community organisations, local sports celebrities, and healthcare professionals from respective communities, as well as healthcare professionals employed by BMC. The community conversations provided space to address community concerns, answer questions regarding the COVID-19 pandemic, and encourage COVID-19 vaccination. All 9 conversations were held via the Zoom audio-video platform; 6 were simultaneously shared on Facebook Live; and 2 were broadcast on local radio stations. Each of these conversations garnered attendance of between 8 and 122 participants.

Five main themes emerged from these community-engaged conversations:

1. Structural factors are important barriers to COVID-19 vaccination - For example, language differences impacted individuals' ability to understand messaging, schedule appointments, and communicate with healthcare providers.
2. Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government - Participants expressed deep race-related medical mistrust stemming from historical experiences of medical oppression and exploitation of communities of colour. Another component of mistrust was grounded in government involvement in the COVID-19 vaccine development and distribution processes. People expressed a lack of familiarity with vaccine licensing and approval processes.
3. There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine, as well as the practical implications of being vaccinated - One community leader recalled a common question within their (Cape Verdean) community: "Why get a vaccine if we have to wear a mask and why to wear a mask if we are vaccinated?"
4. Community leaders emphasise community engagement for delivering COVID-19 information and education -  Community leaders underscored two methods to effectively engage their communities in conversations about the COVID-19 vaccine: (i) They believed that public health officials could leverage existing social networks to become an effective vehicle for disseminating COVID-19 vaccine-related information and education. However, community leaders believed these networks are underutilised. (ii) They suggested engaging trusted community leaders and established community and/or religious organisations to deliver credible information to their communities.
5. Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic - Community leaders framed their responses to participants' concerns about the COVID-19 vaccine by addressing both the social and the health benefits of receiving the COVID-19 vaccine. For instance, they expressed that receiving the vaccine would allow communities to gather and engage in social activities as they did prior to the start of the pandemic.

Reflecting on the findings and mapping out a way forward, the researchers note that: "Leveraging a community-engaged approach to develop messaging campaigns that appreciate the nuances of the pandemic in lay language, adapt to the shifting landscape of the pandemic, and provide COVID-19 related care to communities of color can help to refocus community expectations of the COVID-19 vaccine and provide protection guidance without oversimplifying the solution. Community leaders hold trusted positions within communities, and can help to tailor messaging focused on continued protection against severe disease, hospitalization, and death as well as quality of life within the community. Such community-engaged initiatives in urban settings have been successful in the past and can serve as models for future initiatives; key elements of these community partnerships include building trust, centering the voices of community members and trusted community leaders, and focusing on the role of systemic racism in health outcomes and experiences..."

In conclusion: "Ultimately, community engagement must occur alongside efforts to address systemic barriers to healthcare; it is necessary to build trust in the medical community in addition to removing the root causes of systemic inequities."