Refugee, immigrant, and migrant communities in the United States include over 40 million people, representing hundreds of cultures. They are integral to the social, cultural, and economic vitality of our country. Many of these communities are disproportionately impacted by the Covid-19 pandemic because they are more likely to:
- Work in essential industries like health care, agriculture, and food processing;
- Have tenuous social and economic positions that make prevention and mitigation activities such as isolation and quarantine difficult;
- Experience barriers to health care.
As vaccine availability grows, we have an opportunity to reduce or eliminate this disparity, but only by ensuring that all who migrate to the US, regardless of legal status, have equitable access to vaccines.
While the importance of vaccine equity is recognized by the Framework for Equitable Allocation of Covid-19 and the Biden administration, vaccination rates remain disproportionately high among white people compared to communities of color. Inclusion of all immigrant communities in vaccine allocation must be improved and barriers to complete vaccination (including required second doses) simultaneously addressed. While immigrant communities vary in their specific vaccine experiences, general barriers include:
- Difficulty navigating the health care system;
- Different perceptions and knowledge of diseases;
- Concerns about vaccine efficacy and safety;
- Limited trust of government and the health care system;
- Lack of or poor language translation services;
- Cultural differences.
In addition to these barriers, concern specific to the Covid-19 vaccine may stem from its novelty, even among communities that are historically vaccine-accepting. Questions or misinformation about vaccine contents (for example, whether the vaccine contains pork products) may also make them less acceptable in certain communities.
Concern specific to the Covid-19 vaccine may stem from its novelty, even among communities that are historically vaccine-accepting.
Engagement Is Key
Overcoming barriers to vaccination requires direct engagement with communities. Historically there has been a lack of investment by government agencies and health systems in developing and maintaining community partnerships. Increasingly, public health is engaging communities in efforts to control Covid-19. We are learning that community engagement works best through both partnerships with organizations that have trusted relationships with their community and by employing community members. A formal way to include community representation in decision-making is by utilizing a community advisory board composed of trusted leaders and groups who can advise on community priorities and logistics.
Culturally and Linguistically Appropriate Communications
In providing vaccines to immigrant communities, communications strategy for vaccination logistics should be carefully considered and implemented. Information must be provided in the community’s primary language and in a culturally appropriate manner by a trusted source. The ideal method of communication may differ by community, again highlighting the need to include community voices in planning the vaccine response. For example, the preferred method and effectiveness of communication may vary based on the format (oral vs. written), distribution (radio, television, social media), and perceived trustworthiness of the source. If this is well done, it can improve vaccination efforts. Done carelessly, it can exacerbate existing problems such as distrust.
Convenient Vaccine Access
Well-organized logistics maximize convenience by bringing vaccines to people, rather than people to vaccines. Bringing vaccines directly to a community overcomes multiple barriers including fear or mistrust of authorities, transportation challenges, navigation of an unfamiliar health care system, and competing priorities such as arranging time away from work.
We can facilitate equitable vaccine provision by prioritizing community engagement, communication strategies, and convenient vaccination opportunities. In order to protect these communities from further pandemic impacts, vaccination efforts must overcome community-specific barriers. The National Resource Center for Refugees, Immigrants and Migrants offers tools and resources to meet this need. If done well, vaccine provision can reduce the disproportionate impact of Covid-19 on immigrant communities, representing a tremendous step towards health equity and social justice.
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