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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Is Vermont Doing Enough To Address Racial Inequities In Its Vaccine Program?

A man wearing a mask gets a vaccine
Mohamed Abdulahi, Courtesy
/
Community Health Liaison Mohamed Abdulahi receives his first dose of a COVID-19 vaccine. He works to spread vaccine awareness and trust among Somali New Americans in the greater Burlington area.

Ahead of vaccine rollout, the Vermont Department of Health Department is working with members of various communities as health liaisons to make sure they can figure out how to best address the needs of Vermonters.The state's current vaccination schedule prioritizes people by age first, and by certain health conditions second. Neither of those prioritization types are necessarily going to capture broad swaths of the population in Vermont that includes people of color. So what is the state actually doing to ensure Vermonters of color are protected?

State officials have said it’s their priority to ensure that Vermonters of color are treated fairly in the vaccination process, given the fact that people of color – in Vermont and beyond – are at significantly higher risk of contracting COVID-19.

Our guests are:

  • Tracy Dolan, deputy commissioner for the Vermont Department of Health
  • Mohamed Abdullahi, Somali refugee and interpreter who has been working as a community health liaison through Burlington's Trusted Community Voices program

The following conversation has been edited and condensed for clarity. Listen to the full program, which originally aired on Tuesday, Jan. 19, 2021, here.

Will Vermonters of color be prioritized for vaccination?

Vermont Edition Jane Lindholm spoke with Deputy Commissioner of Health Tracy Dolan.

Jane Lindholm: Last week, in discussing how the state was going to live up to its stated priority of ensuring that Vermonters of color are treated fairly in the vaccine process – given the fact that people of color in Vermont and beyond are at significantly higher risk of contracting COVID-19 – the state said its current vaccination schedule will prioritize people by age first and certain health conditions second; neither of which are necessarily going to capture broad swaths of the population in Vermont that includes people of color. And the state said it will be working instead to make sure it gets accurate information out to various communities and populations in Vermont.

You know, it seemed earlier on, Deputy Commissioner, that the state was saying that it wanted to ensure health equity, which would ensure that Vermonters of color were getting, if not priority access, at least [access to] the vaccine in an appropriate time frame. That might mean vaccination clinics in concentrated communities of color in Vermont.

But that's not what we're hearing from the state right now. Can you talk a little bit about what the state is doing to ensure that Vermonters of color are protected?

Tracy Dolan: It's actually similar to what you've just described in your latter statement. We are working to ensure that clinics will be accessible. So even in our age groups, we're going to be reaching out to communities of color and saying, “Let's make sure that people of color in the 75-plus range are able to register. Let's provide some assistance if we need to do that, given that this is a higher risk group.”

So [we’ll be] doing that for the age ranges. But also as we open up the chronic conditions, [we’ll be] recognizing that being a person of color is an additional risk factor for COVID-19, in part because of the cultural issues that we have around white supremacy and a history of racism and the history of mistrust in public health because of some of the things that public health has done in this country in the past.

Do you have questions about Vermont's plan to distribute COVID-19 vaccines? We have answers.

And [we’ll be] making sure that we do locate some clinics in areas that have a higher concentration of people of color.

So we are actually going to proactively do additional things besides just to educate and promote. And we're going to be and we are partnering with folks in those communities to make sure the information gets out there, that trust is built, but also to provide greater access.

We may also, for example, as Dr. Levine mentioned, go in and vaccinate somebody in a particular age group because we know there are more multigenerational housing situations in some communities. We may also look at opportunities to vaccinate, for example, a household if there are risks in that household that we see. And so we are actually adjusting some of our methods and our approaches to ensure that we achieve as much equity we can, recognizing that it is not an even playing field for everyone.

More from Vermont Edition: Racism -- And Anti-Racism -- In Vermont

When would the state be allowing people who are not in the age tier to get vaccinated? How would it identify multigenerational households and when would that be able to start?

Dolan: So, we are doing 75-plus, then 70-plus, then 65-plus. Then we're moving into chronic conditions. And we will also at that time really increase our outreach to the BIPOC community: Black, Indigenous, and people of color. And we will do the work then and throughout to ensure that we get clinic access.

And so, this is really an evolving strategy over time, as we reach out and continue partnerships and develop new partnerships.

So younger people in multigenerational households wouldn't be getting the vaccine until after you've gone through those aged 65 and above?

Dolan: That's what I think at this time. One of the reasons we're thinking slightly differently about this community is that … particularly for people with limited English proficiency, if we need to bring in interpretation, if we need to bring in, for example, mobile services, if people are homebound, that's a lot of resources to bring in. So it might be more efficient in some cases, but likely that would happen after our 65 and above.

And so we may be looking at some differences there in these higher risk communities, in order to get the best efficiency for our effort.

More from VPR: 'This Is America': A Conversation About The Capitol Riot And White Supremacy

What is the State of Vermont doing to acknowledge and address vaccine distrust in communities of color?

Vermont Edition host Jane Lindholm spoke with Mohamed Abdullahi, an interpreter who has been working as a community health liaison through the city of Burlington's Trusted Community Voices program.

Jane Lindholm: Deputy Commissioner Dolan said … the state is planning to make sure that Vermonter's of color and New Americans are getting all the information they need to not only know about the vaccine process, but to answer questions and ensure more trust in the vaccine process. Does that seem like a good approach to you?

Mohamed Abdullahi: Yes, it's a good approach, and I was in a lot of meetings that happened with community members that they were trying to educate about vaccines. To add on that, [many members of] our community are very unfortunate [in] that they don't speak English. And we always get information later than anyone else, because it's going to be … secondhand information that we get.

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A good example: last time when we got rental reimbursement, we exhausted everything that we had and we didn't know that it was going to be reimbursed. So we always get that kind of secondhand information. And it's very difficult when people don't understand English, and they have to wait for, you know, a person like me or other community members [to translate and clarify].

And it's correct, what the commissioner was saying. I had two or three meetings that were only specifically for people who don’t speak English, to educate about the vaccine.

So you are getting information now for those who don't speak English about the vaccination process. Are you already working on translating materials from the state, from the Health Department on the vaccine program?

Yes – they always do that, and we always get through.

You know, [there are] a lot of resources, like the U.S. Committee on Refugees and Immigrants, the Association of Africans Living in Vermont – [the state goes] through them, and we always get the information that's needed and translate it. I’m one of the people who always, you know, helps out and does a lot of stuff with them.

More from VPR: How Vermont’s Multilingual Communities Are Providing Grassroots Translation, Resources For COVID-19

Are there enough translators and interpreters in the state to help all the people who may need to have their information translated into different languages, or who may need an interpreter when they're actually going to interact with people, you know, in a vaccine program or to get the vaccine?

… I can’t know – or I don't know – how they're going to conduct in the future, how it is going to happen with the vaccine. But for right now, we have enough interpreters, which is very efficient right now.

Mohammed, for your community – you're a Somali refugee – is there broad trust in the vaccine program? Do you think the people that you're speaking with are eager to get the vaccine or not?

No. No one is trusting [right] now. As the commissioner was talking about, you can hear that there's not a lot of trust. And most of the time they won’t get behind it because they get a lot of social media which is telling them it's harmful; it's killing.

A good example: when I was getting my vaccine – because I’m an interpreter, working with doctors, and I qualified to get the vaccine – you know, I got a lot of calls and odd information, a lot of videos from social media that people were sending me, trying to stop me from taking the vaccine.

One of the reasons why they are so scared is they don't know what this is made of. And they don't read and go and research because they don't speak English. And what they're getting from social media is: this thing was made of, you know, something like … a product of some animal that we don't eat. Like, a lot of things that are not, you know, religious to them and that culturally, we don't eat. Social media was saying that such a thing was added.

And people are so scared. One thing is: they know that it’s not something [to do], culturally, to get it. Second thing is: they think this is killing them. And you know, everyone's seeing on social media that it's very … bad. So it took me to take my video and send it to community members, so they can see: I'm one of them who took it and I'm OK, and I'm still with the community. So I had to do that video when I was getting it. And I'm hoping next Sunday when I get the second [vaccine], I'm going to do another video.

More from VPR: ‘We Don’t Not Pick Up The Phone’: Working As A Community Liaison In A Pandemic

So have you seen people's attitudes change after seeing your video of you yourself getting the vaccine?

I didn't get a lot of good results, but at least one or two will change [their mind].

And when testing was starting … it was very difficult for us to educate people, that it's OK to know your results. You know, it was kind of something that, in the community, they didn't want anyone to be labeled, that you had the coronavirus. It was very hard. And we had to – with the help of a lot of different agencies in Burlington and Winooski – we had to go through a lot to educate the communities and get them to come and get tested. So I'm expecting the same thing is going to happen now.

We're not going to give up. We'll still keep educating the community and giving them an example, like what I did. And my hope is that a lot of people will accept it at the end.

Why might communities of color in Vermont have a distrust of public health?

Vermont Edition host Jane Lindholm spoke with Deputy Health Commissioner Tracy Dolan about how the state is working to ensure communities of color are not left behind when it comes to vaccination.

Jane Lindholm: It’s a steep hill to climb when there’s a mistrust of public health. And certainly when, you know, depending on what community you come from, there may be a really legitimate mistrust of the public health system, based on how people have been treated in the past. How do you overcome that?

Tracy Dolan: Yeah, you know, it's funny. When you said a steep hill to climb, I was literally picturing, as [Mohamed] was talking, walking up a very, very steep hill. It's a tough one.

Somebody reminded us the other day: We dive in as public health and say, “OK, how do we dismantle this lack of trust and how do we build it up?” But the first thing – someone mentioned – was we actually have to respect and honor that that mistrust is real, and not everyone will change their minds. So I think the first piece is listening and to respect and honor where it's coming from. And then, given all of that, how do we work with people?

"... We actually have to respect and honor that that mistrust is real ... I think the first piece is listening and to respect and honor where it's coming from." - Tracy Dolan, deputy commissioner of health

So I think it's that partnership. You know, my voice might not be very effective, but Mohamed's voice might be much more effective – especially with his posting his videos.

Those aren't always easy to do, either. I mean, Mohamed sounds amazing and enthusiastic, but it’s not always easy to do something that might not be very popular in your own community, and to possibly receive some criticism, you know? So I think it's really important for us to continue the partnership.

And it takes anyone a long time to change behavior and change their minds. I mean, we've learned in public health, generally, that behavior change sometimes requires messages, many times, through many different arenas, through many different sources and through many different methods. And so that's where it's really not a one-approach-fits-all. It's through programs like yours, it's through Mohamed putting this video up. It's through all of the translation we do. We have an organization that we funded and they've translated vaccine safety messages into 12 languages. Those are out on social media now.

Vermont Multilingual Coronavirus Taskforce Videos: Facts About the COVID-19 Vaccine

So it's just doing this and at the same time making sure we make our clinics accessible, so that when someone is ready to take it, we are there ready to have them.

But given what the state has been talking about with inequities in the health care system that disproportionately affect people of color, if the priority or the focus of the state plan is to just try to get appropriate and accurate information out – sometimes through trusted voices like Mohamed’s – to try to answer questions, to try to provide interpreter services, if those strategies don't work and vaccine uptake is lower in communities of color, does the state then get to wash its hands and say, “Well, we tried, we tried to give information and if people don't want to take it, that's not really our fault”?

No, that's not how it works. We don't get to wash our hands, generally, of anything in public health. If something doesn't work, then, you know, in public health, the community is not wrong. You know, the community is the community. And if the community doesn't take something up or the community doesn't change, then it's our job to go back and say, “OK, what's another thing we can do differently? Who's another partner? How do we need to change a message? What else do we need to change?”

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And the reality is, in one given moment, in one six-week period, we're not going to change decades of racism that's occurred. We're not going to change lifetimes of some people feeling that mistrust. That's not going to change overnight.

So there's probably no one measure that will say: we've been successful. I mean, if we got 100% uptake, yeah, we’d probably say we were successful. But we may get 20% more than we would have otherwise, and that will be some success. But there's no washing our hands. And this isn't a one-time relationship.

We have learned – and we learn it again and again – that we have to keep reinvesting in these relationships and approaching them with new ideas – more partners like Mohamed. But we just keep working at it and we keep figuring out, “OK, that didn't work. Let's try something else. OK, part of that worked. What part didn't?” And we keep going back to it, talking to the community, finding out what they've experienced as well.

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