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CME / ABIM MOC / CE

Decreasing Disparities: Bridging Gaps in Immunization to Decrease the Burden of Vaccine-Preventable Diseases

  • Authors: Elena Rios, MD, MSPH, MACP; Lakesha M. Butler, PharmD; Zeke J. McKinney, MD, MHI, MPH, FACOEM
  • CME / ABIM MOC / CE Released: 4/19/2022
  • Valid for credit through: 4/19/2023
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  • Credits Available

    Physicians - maximum of 0.50 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.50 ABIM MOC points

    Nurses - 0.50 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

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    IPCE - 0.50 Interprofessional Continuing Education (IPCE) credit

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    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, pediatricians, infectious disease specialists, nurses and any clinicians in a position to discuss vaccinations with patients or caregivers.

The goal of this activity is to motivate healthcare providers from different specialties and professions with a call to action to increase immunization rates among adolescents through older adults.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Causes underlying disparities in immunization rates
  • Have greater competence related to
    • Immunization advocacy
  • Demonstrate greater confidence in their ability to
    • Collaborate with members of the interprofessional healthcare team to address immunization disparities


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Disclosures for additional planners can be found here.


Faculty

  • Elena Rios, MD, MSPH, MACP

    President and CEO
    National Hispanic Medical Association
    Washington, DC

    Disclosures

    Disclosure: Elena Rios, MD, MSPH, MACP, has no relevant financial relationships.

  • Lakesha M. Butler, PharmD

    Clinical Professor
    Department of Pharmacy Practice
    Director, Diversity, Equity, and Inclusion
    Southern Illinois University Edwardsville
    Edwardsville, Illinois

    Disclosures

    Disclosure: Lakesha M. Butler, PharmD, has no relevant financial relationships.

  • Zeke J. McKinney, MD, MHI, MPH, FACOEM

    Affiliate Assistant Professor
    University of Minnesota School of Public Health
    Director, HealthPartners Occupational and Environmental Medicine Residency Program
    Research Investigator, HealthPartners Institute
    President, Twin Cities Medical Society
    President, Central States Occupational and Environmental Medicine Association
    Saint Paul, Minnesota

    Disclosures

    Disclosure: Zeke J. McKinney, MD, MHI, MPH, FACOEM, has no relevant financial relationships.

Editor

  • Cheryl L. Perkins, MD, RPh

    Medical Education Director, Medscape, LLC

    Disclosures

    Disclosure: Cheryl Leigh Perkins, MD, RPh, has no relevant financial relationships.

Compliance Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Content Reviewers

  • Amy Groom, MPH

    Director of Immunization Initiatives, ECHO Institute

    Disclosures

    Disclosure: Amy Groom, MPH, has no relevant financial relationships

  • Joanna Colbourne, CAE

    Deputy Executive Director, National Foundation for Infectious Diseases

    Disclosures

    Disclosure: Joanna Colbourne, CAE, has no relevant financial relationships

  • Litjen (L.J.) Tan, MS, PhD

    Chief Strategy Officer, Immunize.org

    Disclosures

    Disclosure: Litjen (L.J.) Tan, MS, PhD, has no relevant financial relationships

  • Tierra Dillenburg, BS

    Project Manager, Association of Black Cardiologists, Inc.

    Disclosures

    Disclosure: Tierra Dillenburg, BS, has no relevant financial relationships

  • Elena Rios, MD, MSPH, MACP

    President and CEO, National Hispanic Medical Association

    Disclosures

    Disclosure: Elena Rios, MD, MSPH, MACP, has no relevant financial relationships


Accreditation Statements

Developed through a partnership between Medscape Education, the Association of Black Cardiologists (ABC), Immunize.org, the National Foundation for Infectious Diseases (NFID), the National Hispanic Medical Association (NHMA), and the University of New Mexico Project ECHO.



In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

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  • Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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CME / ABIM MOC / CE

Decreasing Disparities: Bridging Gaps in Immunization to Decrease the Burden of Vaccine-Preventable Diseases

Authors: Elena Rios, MD, MSPH, MACP; Lakesha M. Butler, PharmD; Zeke J. McKinney, MD, MHI, MPH, FACOEMFaculty and Disclosures

CME / ABIM MOC / CE Released: 4/19/2022

Valid for credit through: 4/19/2023

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Activity Transcript

Elena Rios, MD, MSPH, MACP: Hi, I'm Dr Elena Rios, I'm President and CEO of the National Hispanic Medical Association, and today we're here to discuss Decreasing Disparities: Bridging Gaps in Immunization to Decrease the Burden of Vaccine-Preventable Diseases.

Here with me today are Dr Lakesha Butler, Clinical Professor of Pharmacy Practice and Director of the Diversity, Equity, and Inclusion office of Southern Illinois University at Edwardsville, and Dr Zeke McKinney, Program Director at HealthPartners Occupational Medicine Residency and Assistant Professor of the University of Minnesota School of Public Health.

Let's get started. We have a few major comments to talk about to lay the groundwork here on disparities in the vaccine arena. The first one, we all know that there's been a lot of disparities in our vaccination rates, not only healthcare disparities, lack of health care, limited access to health care, limited access to minority health professionals, both doctors and pharmacists, but also, we've had a huge disparity, exacerbated by the COVID-19 pandemic, on our communities. Just the health of our communities has been increasingly toxic, with toxic stress and anxiety, dealing with death and morbidity, and just major disparities.

One of the issues is about the importance of the dosing and getting doses of vaccines. And we've seen that minority people in this country, Latinos, African Americans, Native Americans have had poor access and problems related to everything from transportation to communication to getting vaccines. And we see that the one dose of vaccine and initiation of vaccinations has actually increased among our communities, so we're happy about that. But again, we see disparities.

We also see disparities in geography from rural to urban areas, and just the regions of the country, every region, every state, has different levels of disparities. And I think that we're now going to have a conversation about this.

Dr McKinney, or let me call you Zeke. Zeke, do you want to comment on the vaccine rates by age and race and ethnicity?

Zeke J. McKinney, MD, MHI, MPH, FACOEM: Yeah. As far as COVID-19 is concerned, there's certainly divergences across all those dimensions. We know that for older populations, in general, we've gotten to a point where most people above age 65, even across race and ethnicities, generally speaking, are actually pretty well-vaccinated.

But as you go into the lower age groups, those disparities get a lot bigger, and especially as you get into the much younger age groups, people under 18. To some degree, that may be because younger people think they're invincible or aren't going to get sick, but also to some degree, young people also may have a greater fear of needles.

But similarly, these issues of access to health care, despite the introduction of the Affordable Care Act (ACA) several years ago, which provides free health insurance, essentially, or guaranteed coverage of health insurance to all children in the United States, still people have hesitation. And as it pertains to COVID-19, actually, the vaccines don't cost anything. And so that's been a big point of misinformation for people all along the way. And I think a lot of that misinformation has been spreading, particularly on social media, which again, I think, to some degree, has a tendency towards younger populations as well.

Dr Rios: Can you comment specifically on the adolescent vaccination coverage by race and ethnicity? We know we have to have children vaccinated in this country to go to school, but do you still see disparities within an adolescent population?

Dr McKinney: Yeah, absolutely. Influenza rates of vaccination in adolescents are quite low, and certainly that also exists for other diseases such as hepatitis A/hepatitis B. Ultimately, we're talking lower than 30% for some, lower than even 20% for some. It's really disparate. And again, in communities of color, when you're talking about your Black, your Latino/Latina communities, your indigenous communities, these rates are much, much lower, and a lot of that's just because there's been so much hesitancy for health care and healthcare research over the history of time, as well as the misinformation that's been spread, a lot of which has gotten worse with COVID-19. But even when you're talking about your standard vaccine-preventable disease, the numbers are not great. We're talking lower than 50% for sure, but sometimes as low as 20% or 30%, depending on specific diseases.

Dr Rios: Lakesha, can you comment on the vaccine rates by age and race and ethnicity for some of the other more common and infectious diseases that we've had to deal with for years, like the flu and pneumococcal pneumonia and even herpes zoster?

Lakesha M. Butler, PharmD: Absolutely. Certainly, we've set up the foundation of these disparities, that they are pretty persistent throughout all of the vaccines. We, of course, have our most recent disparities that are pretty evident with COVID-19 vaccine.

But as you've mentioned, these longstanding diseases or conditions that have been preventable by vaccines for so many years, we're still seeing these same types of rates, specifically for the flu, there's disparities amongst our Black, Hispanic, and Asian populations, and we definitely see more of a disparity in those that are older; specifically, there are significant differences in those that are 65 and older. We know that in this particular age group, the risk associated with other comorbidities will be a problem. It will increase their risk of developing flu and specifically death, mortality, and morbidity associated with the flu and the older patients.

We see those same disparities with the pneumococcal, also with the herpes zoster. And, as it was mentioned by Dr McKinney, it's a number of factors that we're going to get into.

Definitely, it's the lack of really understanding the way these vaccines work, the misinformation that's out there. Certainly, the internet is our friend, but it has been our foe as it relates to vaccine information. And so really, as healthcare providers, we play an important role in helping to dispel and increase these rates.

Dr Rios: I just wanted to point out the rates are also very different by insurance status and what we call socioeconomic status. In our community, the Latino community, despite having the ACA, there's so many people that don't trust the government or don't want to apply because they're not citizens. And we've seen how the Hispanic community still has 20% or more uninsured, and the people that are uninsured in our country have even less rates of uptake of vaccine.

Let me turn the dialogue here to talking about barriers. Zeke, do you want to tell us about barriers that you've seen in your practice and in your community related to vaccine uptake?

Dr McKinney: Yeah. Thank you so much. And to be honest, you brought up a really good one. People saying, "I don't trust doctors." We know that that hesitation in health care exists across race and ethnicities, but it seems to be worse in your Black and Latino/Latina and indigenous communities.

In part, a lot of people refer back to the Tuskegee Syphilis Study. Again, that was a research study, not a clinical outcome, but of course, for your average person on the street, research and doctors kind of go hand in hand, and so it's not easy to separate those out for folks.

I think telling some of the stories about what happened after that, I think is a good way to help reduce some of those barriers. A lot of people don't realize that the Tuskegee Syphilis Study led to national outrage and led to the development of legislation, the National Research Act, that established a lot of research protections and making sure that research is voluntary, and making sure that people aren't coerced, and making sure that research is reviewed by independent institutional review boards, and so that we're really putting safety first and minimizing the harm that we're doing to others. And so, I think telling some of those narratives about what's changing in medicine and how the face of medicine and research are changing, can really help with that. There were Black doctors who helped develop COVID-19 vaccine technology.

There were definitely Black doctors involved on the ground during the pandemic and in the hospitals. And that's contemporary stuff. But even historically, there was certainly people from a variety of different communities that contributed to this all the way along. And so, I think we need to tell the stories about what we're changing.

Right now, race-based medicine is a big topic with estimated glomerular filtration rate or kidney function that, thankfully, healthcare systems are doing away with, which was purporting some of the biological disparities in race, which, by the way, do not exist, and rather, race is very much a social construct. And so, again, as people see these positive changes, trying to reduce the barriers to appropriate care for different races and different ethnicities in health care, I think that can help.

Dr Rios: Lakesha, what other barriers do you think have hindered our communities from really becoming vaccinated just as much as the Caucasian community?

Dr Butler: Yep. I just wanted to also comment on a couple of things that Dr McKinney mentioned. So, definitely it's the historical perspective that is really playing a part in the hesitancy. I'd have to say, I was just talking to a patient yesterday and she just said, "Well, my grandmother told me that I shouldn't get it." These stories are being passed down from generation to generation. I can even say personally within my family that just the idea of not trusting the healthcare providers and the government, those are stories that are generational. And so, we have to address that, we have to understand that.

And I definitely agree, combating that with the ways that medicine has improved and evolved, the policies that have improved and evolved. But also, I think it might be important to just share our own personal stories. I like to share how I first had some hesitancy just because of those generational stories that were passed down, and it took me personally taking the time to research and understanding it for myself and really sharing that I've done the research and I can share with you what is what's factual and what's a myth.

And so that leads me to this idea of, there's a lot of misinformation regarding the vaccines. There's this thought of, "Well, is it really going to do anything?” I'm still seeing patients actually being tested positive for COVID-19 or catching the flu, even though they've received the vaccine. And so, understanding the purpose of the vaccines and explaining that to our patients, that it's not necessarily to say that you won't be exposed to these particular conditions, but the most important thing is that you won't be hospitalized, you won't die from them. That's really the two main goals of vaccines. And so, I think that's really important, so they understand that it's not supposed to prevent you from actually getting the condition.

Dr Rios: I'd just like to comment on what Lakesha is saying and Zeke is saying about how important it is that our community leaders in health care, whether they're doctors or pharmacists, get engaged in the design of our program, such as the rollout of the vaccine for our communities. It started with the military, Federal Emergency Management Agency (FEMA), and big mega-sites, but it took our community to say, "Well, wait a minute, we should have mobile vans that actually reach our people and our community." And so, I just want to turn it back to Zeke and ask you, what are some other ways that we can solve these issues of disparities because of the barriers? What can we do in the healthcare system?

Dr McKinney: Well, the points that you and Lakesha brought up are really, really great. For one, what you were saying about communities bringing the stuff to the community. I say this all the time. You got to show up where people are. So, the Biden Administration partnered with University of Maryland to develop the "Shots at the Shop" program, and I was fortunate enough to get some help from the Minnesota Department of Health, and we had, actually, a longitudinal vaccine clinic in our primarily African American community where I grew up in North Minneapolis at a barber shop. We've had a bus outside there and also giving them in the shop, and we've given over a thousand shots in a 6-month period, which is really amazing. That's not breaking the pandemic, but I think it's definitely lowered the barrier for a lot of people to get their first shot or to get their booster doses.

So really, just showing up where people are, and as you both pointed out, making sure that there are doctors and nurses and health professionals from the community who look like the people there or who can speak to the experience of the people there makes a huge difference in reducing that barrier.

But, as Lakeisha pointed out, it's about how we tell these stories too and maybe tempering expectations. If people are expecting, "Oh, I'll get a vaccine and I'll never get sick again," that's not exactly what it is. And similarly, I would tell people, "Well, I don't expect a seatbelt to a hundred percent protect me from getting hurt in a car accident, neither do vaccines 100% protect you from catching an illness." And so, it's about how we tell these stories and what people's expectations are in terms of how we can combat that misinformation. But showing up is key.

Now, one thing a lot of people say, and I swear I hear this from young people all the time is they say, "Oh, my body can heal itself," or "I don't want to take medicine or pills." And I think that's great. That's a wonderful message of self-empowerment that people have. Of course, I'm concerned in the middle of this pandemic or in terms of other vaccine-preventable diseases that people will take that to mean that they're invincible.

I think the prevention aspect is really, really important and vaccines are a really important part of that strategy, and that's where we have to be able to let people know, "Yes, you have control of your body." That's a huge thing that people don't know about medicine. I can't force you to do anything as a doctor and I don't want to, but even more importantly you can do a lot in terms of your diet, your exercise, all the ways in which you live your life to try to not only reduce your exposure to diseases, but also reduce the likelihood that they're going to have an impact on you. And again, making sure that people aren't caught up in all lot of this historical and peripheral trauma, like Lakesha was talking about, and feeling like there isn't anything we can do, that there's a system out there stopping us from being able to have power to control our own health in our own bodies. That's the message I think we need to keep sharing.

Dr Rios: In the Latino community, most Latin Americans who come from Mexico or Latin America, they actually use the pharmacy and the pharmacist as their teachers and healers. And Lakesha, I'd like you to comment on the importance of interprofessional communication and that we all talk with the same message to get more vaccinations in our community, maybe make it a campaign effort. We have a campaign called VaccinateForAll. It's not just one person we want to vaccinate or one adult or children, we want to vaccinate everybody. But Lakesha, do you want to comment on that?

Dr Butler: Absolutely. You mentioned that the Latin community will utilize pharmacy and pharmacists. It's clear that pharmacies are very accessible, there's one that's very closer within five miles usually of individuals, and so the accessibility is definitely significant and capitalizing on that is so important. You're right, that all healthcare providers should definitely provide the same type of message, definitely making sure that we are capitalizing on each opportunity. So, when patients are coming to the pharmacy, they're presenting to our offices, primary care clinics, utilizing that time to be able to provide them with the information and get them vaccinated. So, don't wait until the next time, but really saying, "This is the time for your shot."

And so, there have been a number of campaigns, especially within the pharmacy world, of really advocating for vaccines, just because we are able to provide them. Anytime a patient comes in, we are we're accessible. And so definitely utilizing the interprofessional care team. I also work in a clinic where I work with other healthcare providers, so having those vaccines available and making sure that everyone speaks about the vaccine, the importance of it. So, the more that the patients here about the vaccine from multiple people, I think, the greater the influence will be. You mentioned earlier, making sure that you have individuals that look like your patient population that can be the messenger, and so really utilizing our minority healthcare providers.

Dr Rios: So Zeke, where are we with vaccine equity? What can we do this year?

Dr McKinney: Well, certainly with COVID-19, we've seen these barriers and those disparities grow, I think, over time, which is unfortunate, because we're seeing a divergence. It's not coming together as far as people reaching the same rates, but things are slowing down quite a bit, especially now where we have a lull in the numbers and everyone's feeling a little bit safer. We're seeing a lot less of those first doses coming in the door, and that's unfortunate. But I think also reiterating the importance of all the vaccine-preventable diseases that aren't COVID-19.

I talked to people, especially people younger than me about the fact that look, "I had chicken pox as a kid." By the time I was a teenager, a chicken pox vaccine existed, and now everybody past me being age 18 has never seen chicken pox in the world. We've seen President Roosevelt in a wheelchair because of the long-term consequences following polio, and yet how many people do we see like that in the modern era? And for most people, I imagine, we've never seen that. And it's because we are taking for granted all the benefits of prevention that these vaccines have provided. And so, that's a huge thing again about this narrative.

But I can't emphasize enough Lakesha's point about a lot of times it's just a matter of talking about it. So, I see people who have injuries at work and are coming in completely for things usually not to have anything to do with the vaccine, but I have recently tried to end every visit to talk a little bit about COVID-19 vaccines or vaccines in general. And I'm shocked at the number of people who, first of all, aren't vaccinated, but second of all, say, "Oh, no doctor has brought this up to me about a COVID-19 vaccine before." And I'm like, "What, how could that be?" This is maybe one of the hottest issues we have right now on the table, so making sure we take all those opportunities.

This has been shown throughout the literature that the more we bring things up, whether it's about vaccines or about smoking or about diet, people listen to us as those trusted messengers as you yourself said. And so, we just have to really take those opportunities, and as Lakesha pointed out, rely on all of our colleagues, whether they're doctors, nurses, pharmacists, whoever, to be able to share those same messages.

Dr Butler: And I just wanted to interject as well and say, it's so important that we don't give up on our patients. When they say no, don't take that as, "Okay, I shouldn't go back and say something to them about it." I believe in being very persistent and most often it's so important to use open-ended questions. So those are things that we already know, certainly asking, what barriers do you have or what concerns do you have regarding the vaccine, so that we can clearly open up the lines of communication with the patient. But don't give up. Utilize each opportunity that you're speaking with them to provide a little bit more information. And I believe that we are planting seeds each time we share information that will eventually grow into uptaking of the vaccine.

Dr Rios: I've also heard about the importance of educating all levels of our community, and especially children, who can tell their parents and their grandparents what they've learned in simple language, but reinforcing the importance of being more healthy of, like you said, not having a disease that can be preventable with a vaccine, and that vaccines need to be understood by all of us in our communities. And I think we all know that the elderly gets sick the worst because of underlying diseases, especially in our communities, and how important it is for their grandchildren to tell grandparents to go get vaccinated, I think is something that we don't we take for granted that everybody feels the same way about a communication. But in fact, when you're talking to somebody, a family member can be really convinced by their own families, and I think that's something we have to realize.

The other thing I was going to mention, we didn't talk about the barrier of communication, but as doctors and pharmacists, we have to be able to communicate with patients. And one of the hardest things to learn is that not everybody can read or not everybody can understand simple things like reading labels on your medications. And so, health literacy is a big problem in our communities, that we really do need to teach the next generation of students, medical students, pharmacy students about the importance of health literacy. And I think that's another lesson learned through this COVID-19 epidemic about the essential workers that have been the ones really sick because they've had to face so much of the COVID-19 disease, and many of them are unskilled laborers or working in supermarkets or meat packing plants and farm workers that haven't really been as educated as others, and we need to help everybody in our country to get vaccinated. Zeke or Lakesha, any other items for the vaccine confidence that you're all talking about and the importance of vaccine messaging?

Dr Butler: Well, I just wanted to piggyback on what you were just saying that building trust is so vital in especially in our minority communities. There's already this idea of mistrust, and the way that we build trust is the way that we communicate. And so being very mindful of both our verbal and nonverbal communication. If we are thinking, "Well, why isn't this patient vaccinated?" That can come across in our nonverbal. And so being very aware of certain biases that we may have regarding the different patient populations that we interact with. I think that's so important.

The other thing, when we're communicating, is, are we actively listening? Actively listening is, I'm looking at you with good eye contact. I can personally say that I've been in a situation where my healthcare provider was just so engaged in their computer, that they didn't even look at me. And so that's not that active listening and it's not building trust, and so we do want to be mindful of those verbal and nonverbal communication skills that we learn about in school, but it's all about implementing them and acting on them in practice and being very aware of them.

Dr Rios: And Zeke, any more comments on the importance of vaccine confidence and positive messaging?

Dr McKinney: Yeah, very much so. I want to piggyback on everything that both of you said. Look, we would love it in a world where people who look like us could be our doctors, could be our nurses, could be our pharmacist, but we know there's a discordance there, and that doesn't exist. And so, for when our non-Black or non-Latino Latina colleagues ask us, "Hey, how do I talk to these communities and how do I get out there?" Again, emphasizing, look, just showing up and being present goes a long way. If people know you're at least accessible, that's a huge thing. To Lakesha's point, you have to actively listen, and very importantly, understand what our biases are. And if you don't even know that, well, just assume that you're making assumptions about people and try to not assume anything about anybody.

We've talked a lot about race and ethnicity here, but the concerns of all Black people or all Latino people or all indigenous people are not the same. You'd be so surprised at how differently everybody approaches this. And so, really taking that time, as Lakesha pointed out, to actively listen to a person and let them know that. That hugely builds trust, and again, being there and being present goes such a long way. And so, the more that we can provide good information for people and focus on things that people care about, as you pointed out Elena, people's family, the people they love. Part of vaccine preventable disease is that transmitting diseases to those who are most vulnerable is something that's really serious. And so, "Hey, you want to protect the babies in your family or the elders in your family. Getting vaccinated goes a long way to really make that huge difference."

And so, it's really going to take all of us, not just people who look like me, not just people who look like you two, but to actually everybody in health care to do their best to try to continue to build and rebuild trust in all the different communities that need it. But again, understanding that not every community is the same and not every individual is the same, and everybody's concerns are very real and are coming from a place of people wanting to try to take care of themselves.

Dr Rios: Let's just give a last message to the providers listening in today on what you think is a major takeaway message. Lakesha?

Dr Butler: Well, I think adaptability is one thing that really resonates when I think about increasing vaccine confidence. That includes the message that we share, the way that we share it, the amount of times that we share it, the how. So, are we getting out and actually going to the individuals to share the information? One thing that I think we may not have mentioned is, when we're building vaccine confidence, it's important for us to make sure that our message is accurate. And so, we as healthcare providers, we have to stay up to date on all the information. And if we don't know the answer, saying that we'll get back with them on the information. But definitely making sure that our information is accurate, and the messages are adaptable.

Dr Rios: And Zeke, your last message on what we've learned today?

Dr McKinney: Yeah. Just to distill it down to something simple, show up, listen, as Lakesha said, be adaptable, and be prepared to have uncomfortable conversations. Don't give up on people, but similarly, don't be so pushy that you're trying to force somebody to do something they don't want. Just remember that our job is to give people great information so that they can make health choices consistent with their goals.

Dr Rios: Thank you. And I'll just say that health disparities have been with us a long time, and it's all of our jobs, especially our health providers, again, who are not Hispanic or Black or Native American, to help us and help our communities by doing what you can to impart information, encouraging everybody to get vaccinated.

I want to thank the organizers and thank all the audience today for being with us and thank you Zeke and thank you Lakesha. I think this has been a great panel. Thank you very much.

This is a verbatim transcript and has not been copyedited.

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