Vaccine Hesitancy Among Direct Care Workers: Addressing Accessibility and Answering Valid Questions

Just over half of all front-line health care workers have received at least the first dose of the COVID-19 vaccine. Of these workers, home health professionals are the least vaccinated. Expanding vaccinations is critical, but how can we address skepticism and concern among caregivers?

While many conceptualize this problem as vaccine hesitancy, recognized infectious disease expert and physician Dr. Mati Hlatshwayo Davis offers a different understanding: skepticism and hesitancy are actually better conceptualized as a deliberative process wherein valid questions need to be answered, particularly for communities of color.

CareAcademy CEO Helen Adeosun recently led a conversation with Dr. Davis and David Rosales, EVP and Chief Strategy at VNSNY, to explore actionable strategies to engage your caregiver workforce in this important initiative.

Get the highlights below, or watch the full webinar replay here.

Question: We hear the term “vaccine hesitancy” in the media today. Is that the right way to understand the moment we are in?

Dr. Mati Hlatshwayo Davis,
MD, MPH

It has been a tough year. Let’s start there—let’s all acknowledge that we are a year-plus into an unprecedented situation that has turned all of our lives upside down and has affected all of our mental health. I think about Dr. Fauci, who I respect, as a leader around infectious diseases and the COVID-19 pandemic. Some of the criticism he has received is “three months ago you said this, and now you’re saying this.”

In addressing that concern the first thing we need to understand is that the very definition of a pandemic means we are learning as we go. The data evolves, the response evolves, the outcomes have evolved, and what we have in our toolbox has evolved. So what we may have asked of you in March of last year certainly, and must, by definition, look different than the summer, than the end of the year, and now. And I’ll say the same has to be true of the term vaccine hesitancy. 

I jumped on to that term: I found myself a pregnant, Black, female, immigrant, infectious disease doctor at the beginning of a pandemic, seven months pregnant, scared for myself and my unborn baby. And then there is the acute and chronic trauma of seeing communities like mine disproportionately affected: We saw Black and Brown communities experience higher levels of disparity. We saw older people were impacted worse, we saw people with pre-existing medical conditions impacted, and then we saw people from Black and Brown communities experience higher cases, being hospitalized at higher numbers, and dying at much higher numbers—we’re talking two or three times higher than their white counterparts. This was not unique. It’s not about my specific gene makeup. It’s not about the virus. COVID joined the long list: It is about the combination of systemic and institutional racism—both historic and current. It’s about disparities, social determinants of health, and barriers that get in the way.

So I jumped onto the term vaccine hesitancy because it was important for me to make people understand that it is valid for people from my community to not want to take this vaccine. Early polls all had Black communities across the board saying that they would take the vaccine at much lower rates than any other group. So I got on TV and was in the community and was doing town halls about vaccine hesitancy. So what did we do then? We learned, we listened, and we evolved. And I believe that term should be retired. In its place, we should see "vaccine deliberating," or "appropriately questioning." Because that’s what it is. Consider coming from a community where the hands of the very government and scientific and health institutions which are supposed to serve you, that are supposed to protect you, have had abhorrent issues.

Question: In light of what Dr. Davis shared about listening, learning, and evolving, how can you employ this perspective in practice as a home care agency?

David Rosales,
Executive Vice President and Chief Strategy Officer, VNSNY

VNSNY, is a home health and long term care provider in NYC, with a large field-based work force. We were on the front lines of the pandemic back in the spring, and have cared for thousands of COVID-positive patients in their homes. Since December we have been all hands on deck in improving access and answering questions around the vaccine.

The first thing I’d say is that we should think about the vaccine, especially in the direct care workforce, as one of many tools in our toolkit to keep our workforce and our patients safe. It is not the be all and end all, it is one of many tools we have available.

The second thing is that we have done a lot of listening. The messages we have sought to convey and the questions we have worked to answer are along a wide spectrum. For some people, it is the logical argument: it’s facts and data around safety and effectiveness that’s most important. Other people are really concerned about the side effects, at the first dose, at the second, and about whether it will impact their ability to do their jobs and live their lives. For others, it’s about time. They’re not ready now: they need more people they know to get it, for more data to come out, and as Dr. Davis said, they need time to continue to deliberate.

And then there's the aspect of access. What we did at VNSNY, because we are large enough and able to make this investment, we set up a vaccination site in our offices. We’re proud to say we have vaccinated 6,000 of our workers in our clinic. We sought to make access to the vaccine as convenient and simple as possible. We didn’t ask people to go through any complicated online scheduling process. We reached out by phone to every one of our field based staff and offered to answer their questions or questions their family members may have. Then, we walked them through the process of making an appointment with us if and when they decided to. If they weren’t ready yet and they wanted to wait, that clinic was there waiting for them.

Get more insight on addressing vaccine deliberation and accessibility: 

Dr. Davis and David Rosales addressed many other questions during our webinar. Watch the full recording to hear their take on the following topics:

• How to address common concerns about vaccine access and deliberation including:
  • How did this get made so fast? Wasn’t it rushed?
  • What is mRNA?
  • Side effects? Differences in side effects between types of vaccines?
  • Are there live materials in the virus?
  • Are there chemicals in the virus?
  • Can you die from the vaccine? What about adverse effects?
  • Why should African Americans trust this vaccine?
• What are the most effective ways home care agencies can communicate answers to these common questions?
• What considerations are important for home care agencies when thinking about mandatory vaccinations?

Get answers to these questions and more in the full webinar. For a list of the most commonly asked questions that we were not able to get to during the webinar, click here.