Nursing home staff are working tirelessly to protect our most vulnerable population against COVID-19, but many remain wary about getting vaccinated. The issue is particularly acute among minority groups, consistent with data and polls among the general population.
Herd immunity depends on reaching high vaccination rates across the nation, so vaccine hesitancy is of growing concern. One thing is clear from our experience: Effective communication and peer encouragement are the keys to boosting vaccination rates.
Recent data on COVID-19 vaccinations by race/ethnicity released by the Kaiser Family Foundation suggests vaccine access is creating racial disparities in COVID-19 vaccinations. Yet, in nursing homes, where access is 100% guaranteed, the bigger hurdle is actually vaccine acceptance, particularly among people of color and frontline staff.
As of Feb. 16, data collected across Genesis’ nearly 300 nursing homes show that overall, more than 63% of its nursing home staff have been vaccinated – well above the 37.5% national average for the first month of vaccinations, as recently announced by the Centers for Disease Control and Prevention. However, our Black and Hispanic staff have been 35% less likely to accept vaccination than White staff.
By contrast, approximately 85% of skilled nursing residents in our centers have been vaccinated, with similar patterns of lower acceptance rates among people of color.
According to the KFF report, 37% of Hispanics and 43% of Blacks plan to wait and see how the vaccination affects their peers before making the decision to take it themselves.
Many cultural, societal and historical reasons drive vaccine hesitancy among minority groups, including:
The historical medical mistreatment of minority groups, including Blacks, Hispanics and Native Americans in the U.S. We saw this first-hand during the 30-year Tuskegee experiment where Black men with syphilis were denied treatments so researchers could study the effects of the disease.
Infringements on minority women’s reproductive rights, including sterilization programs without consent, particularly among Hispanics and Native Americans.
Chronically underfunded federal health programming for Native Americans and Alaska Natives leading to government distrust and inadequate access to medical care.
Compounding this is a common lack of understanding of how the COVID-19 vaccines work and an absence of studies on long-term side effects, paving the way for mass misinformation and fear.
As healthcare professionals, we understand the skepticism surrounding COVID-19 vaccination. But as a nation, we can – and we must – overcome this by listening to the concerns of those who are hesitant and taking steps to minimize their distrust.
If we do not, more people will contract the virus, and the nation will see more suffering and death. In nursing homes, it’s particularly important that frontline workers get vaccinated to protect both themselves and nursing home residents.
To get there, we must focus on reaching every community in a focused and empathetic way. As American Medical Association Chief Health Equity Officer Aletha Maybank, M.D., has said, messaging needs to be deliberate to surmount mistrust because of “well-documented harms both in stories that have been passed down across generations and in the present lived experience.”
Last September, Genesis started educating patients, residents, staff and families about the importance of being vaccinated, months before the first vaccines were approved or available.
As trends demonstrated vaccine hesitancy among Black, Hispanic and Native Americans, we met with our Diversity, Equity and Inclusion Committee to better understand the nuances of vaccine hesitancy and educate committee members about the vaccine. We created opportunities to hear and answer every point of hesitancy or concern with a combination of compassion and factual information. Members of the committee also participated in “Ask The Doc” sessions to encourage open discussion of culturally sensitive questions with frontline staff.
Another impactful method for people in doubt involves testimonials from trusted co-workers and community leaders. We used social media to highlight vaccine experiences and the journey to acceptance of Black, Hispanic and other minorities.
The Belvedere Center, located in Chester, PA, hosted Chester Mayor Thaddeus Kirkland and Darrell Jones, president of the Chester NAACP, who were vaccinated onsite at the center’s first vaccine clinic. Both spoke to employees about the importance of vaccine acceptance. Initially, 52% of staff received dose one of the vaccine, but acceptance jumped to 69% by clinic 2 among this predominantly Black workforce.
A personal, encouraging word-of-mouth moment from a trusted voice can help overcome vaccine hesitancy. Plainly stated, we urgently need to spread the word about the importance of vaccination to save lives. We believe this can be accomplished by partnering with leaders within minority communities to help build trust and share truthful information about the vaccine in a way that is patient and empathetic to people’s concerns and experiences.
Richard Feifer, M.D., MPH is chief medical officer of Genesis HealthCare and president of Genesis Physician Services. LaShuan Bethea, J.D., M.Ed., BSN, RN is chair of the Diversity, Equity and Inclusion Committee and vice president for Reimbursement & Legislative Affairs at Genesis HealthCare, which is the nation’s largest skilled nursing and long-term care provider, caring for patients across more than 325 skilled nursing facilities and assisted/senior living communities in 24 states.