Health experts and community members discuss the concept of community-based participatory research in Rochester on March 17, 2018. Credit: Photo used with permission from Rochester Healthy Community Partnership

With the first round of COVID-19 vaccines arriving today in Minnesota, the eventual end of the pandemic is more than just a theoretical possibility. But two steep challenges lie ahead: distributing the vaccines, and convincing people to take them. 

Public health experts anticipate that overcoming vaccine hesitancy will be a major challenge next year, especially in immigrant and refugee communities. Experts and community leaders already are deep into discussions about how to do so. 

“It’s going to be a tough fight,“ said Ahmed Osman, a Rochester-based community advocate. “But I’m also hoping that the damage that COVID has caused in the last 10 months will help people accept this.”

Public health experts aren’t yet close to unanimity about how to effectively message COVID-19 vaccines to immigrant communities throughout Minnesota. But it’s fair to expect them to at least try out the following strategies in the coming weeks:

—Using trusted community leaders and faith leaders like imams in East African communities to make the case.

—Allowing community members to take a lead role in the discussions. 

—Giving people in these communities incentives to take the vaccine. 

In general, COVID-19 vaccine skepticism is fairly high in all communities across the country. Currently, two-thirds of the general population in the country is willing to get a COVID-19 vaccine, according to a Gallup poll. But less than half of Black adults say the same thing, according to the Pew Research Center, even though they’ve been infected with the virus at higher rates than the general population. 

In immigrant populations like East African communities across Minnesota, vaccine skepticism exists for a variety of reasons, according to Ahmed, including the belief that vaccines are used to experiment on the Black community.

This view is fueled by racist medical history like the Tuskegee Syphilis Study, where medical professionals deceived Black participants and experimented on them instead of giving them proper treatment. It’s also rooted in misinformation, like the belief that vaccines can cause autism. While such misinformation is spread online and in social media, Ahmed said, perhaps more spreads during discussions between friends and family members.

“Because we are a word-of-mouth society, it’s not about what we read about, it’s what we hear,” said Ahmed, who is Somali. 

Ahmed, who works to bridge gaps between immigrant and broader communities at the Intercultural Mutual Assistance Association, is hoping the approach of the Rochester Healthy Community Partnership, of which he’s a part, will pay off. The partnership between community leaders and medical professionals at the Mayo Clinic has been producing effective results through community participatory research projects for the past 15 years. 

Changing perspectives on tuberculosis

The project began in the mid-2000s, when Mayo Clinic researchers wanted to study and act on the high rates of tuberculosis existing in the local immigrant community. At the time, several immigrants infected with tuberculosis were skipping voluntary screening and treatment, even though many had free and easy access to it. 

So Mayo Clinic researchers launched a study at Rochester’s Hawthorne Education Center, where several East African immigrants were taking adult and family literacy classes, to gauge the population’s perceptions on tuberculosis. They formed focus groups. One, targeting Somalis, for example, used a trained moderator who spoke Somali to lead the group. 

They got people to participate by trying to be as transparent as they could about the purpose of the study. Then, they encouraged participants to talk and give their perspectives on tuberculosis. 

Researchers learned that many East Africans who had latent tuberculosis didn’t think the disease was a problem once they got to the U.S. because it’s not widespread here. Some spoke of shame and social isolation they would feel if the public found out they had the disease. Others simply didn’t want to get tested in the first place. 

“In that case, it was fear,” said Mark Wieland, an internal medicine doctor at the Mayo Clinic who worked on the project. “TB was often thought of as a death sentence.”

Participation by people in the community in the focus groups led to a greater willingness to get tested and treated. Soon enough, the problem was solved. Between 2009 and 2017, 618 people at Hawthorne got tested for TB and 121 were found positive. All were then successfully treated, and a few didn’t need treatment, according to a 2018 research paper led by Wieland.

Wieland attributed the success of the tuberculosis effort to how it put its participants in the center and gave them a leadership role. The effort on COVID-19 must follow a similar pattern in order to succeed, he said.

“A top-down approach is not effective,” Wieland said.

‘The vaccine is recommended by the Mayo Clinic’ is not an answer

To overcome vaccine skepticism, public health officials often cite the common refrain of using “trusted messengers.” An East African imam, for example, may be more effective than a doctor. 

But Ahmed warned that the process is not as easy as having members of the community simply repeat a public health message again and again. Too often, community leaders who are asked to spread a public health message don’t have enough information. “For example, when a community member says, ‘I think it’s good for you to take the vaccine,’ then someone asks how safe it is, what are you going to say?” asked Ahmed. “‘Oh, this has been recommended by the Mayo Clinic?’ That is not an answer.” 

Such community leaders must be deeply familiar with what they’re messaging, so medical professionals will have to work directly in constantly educating and updating them. 

That challenge is compounded by the fact that the COVID-19 vaccines are new and being used widely for the first time. 

Health experts and community members may also find themselves divided over vaccine messaging strategies. Ahmed, for example, said he is opposed to giving people an incentive such as money or gift cards, an idea that many are already discussing.

“Why do I have to compensate you for taking something that is going to save your life?” he said. “If you don’t believe that this is saving your life, then something is not right; we have to come up with a better message. And it’s not fair. Why incentivize for the immigrant and refugee communities and not the mainstream?” 

Others, like Wynfred Russell, executive director of African Career, Education and Resource (ACER), and a Brooklyn Park city council member, view providing an incentive favorably. In the mid-2010s, Russell managed a polio vaccination drive in Nigeria funded by the Bill and Melinda Gates Foundation in which more than three million people were vaccinated. To encourage people to take the shots, the program offered them free supplies like food, over-the-counter medicine, and even candy for children. 

“I think that was one of the reasons why we were very successful,” Russell said. 

Russell, who sits on a COVID-19 task force for the Minnesota Department of Health that targets messaging for African Americans and African immigrants, is pushing for similar measures now. He knows they’re controversial and has already come across some resistance.

“A lot of my colleagues disapprove of that approach,” he said. “They think it encourages bad behavior.” 

But he hasn’t come across total resistance. So far, he said most members of the MDH task force he sits on seem open to a limited incentive. A bus card or grocery store pass incentive, for example, may be acceptable.

Joey Peters is a reporter for Sahan Journal. He has been a journalist for 15 years. Before joining Sahan Journal, he worked for close to a decade in New Mexico, where his reporting prompted the resignation...