2020 was an unprecedented year of innovation in healthcare. The Covid-19 pandemic led to numerous scientific advances in diagnostics, treatments and vaccines to combat the SARS-CoV2 coronavirus. But developing vaccines is just one part of the effort to end the pandemic, encouraging people to take them is another challenge.

Previous widespread vaccination campaigns, such as the drive to protect people against seasonal influenza, have taught us that various communities are often more hesitant about vaccines than others. The reasons underlying this are complex and often specific to factors like language and culture. So, what can we learn from previous flu shot campaigns about how to ensure equitable access to information about Covid-19 vaccines for all Americans?

Understanding the Key Demographics of Vaccine Hesitancy

First, flu vaccination rates are significantly lower in non-English speaking U.S. residents than in English speaking U.S. residents, with a flu shot uptake of 26% vs 37-41%, respectively.

There’s every reason to believe that the cultural and language barriers behind these disparities will be replicated and even amplified with Covid-19 vaccines, with evidence already emerging that Black and Latino Americans are being left behind with access to Covid-19 vaccines. Amid ongoing controversy about the accessibility of vaccine appointment systems, these are likely to represent yet another barrier to Covid-19 vaccination for limited-English proficient Americans Trust is crucial for driving vaccine uptake and November 2020 survey showed that 66% of Latinos would definitely or probably take a coronavirus vaccine if offered to them free of charge. Separately, only 34% of Latinos surveyed trust the safety of coronavirus vaccines and 40% trust that they are effective.

(Data collected by Covid Collaborative)

The speed of the Covid-19 pandemic itself and vaccine development, as well as rampant spread of misinformation on social media platforms means effective communication is more crucial than ever before. Physicians serving primarily Hispanic communities are concerned about the susceptibility of their patients to vaccine misinformation and are calling for more targeted messaging to tackle this. Healthcare companies will also have to adapt quickly as new information about the efficacy of Covid-19 vaccines is released as more people are vaccinated, as well as possible “shuffling” of vaccine targets as new variants of the coronavirus emerge.

Pharmaceutical companies are beginning trials of Covid-19 vaccines in children, with many experts predicting that vaccinating young people is the key to achieving “herd immunity”.  To achieve this, it is critical to understand how family values, culture, and vaccine hesitancy may impact children from minority populations’ engagement in these efforts. Connecting with relevant cultural values to communicate the benefits of the vaccine is integral to driving participation and ultimately reaching herd immunity.

Despite widespread vaccine rollouts only beginning mid-December 2020, there is already some evidence that minorities are being left behind. In Florida, Spanish speakers are struggling to access vaccine information, as only the most basic guidance is currently translated on government websites. Hispanic people in the U.S. are more likely to work in industries where they cannot work from home, more likely to contract Covid-19 and more likely to be hospitalized and die from the disease than white Americans, so effective outreach and communication with these communities is vital to gain their trust and ultimately drive vaccine uptake.

Crafting Culturally Relevant, Medically Accurate Messaging 

Bespoke cultural adaptation of messaging about vaccines is also often as important as language translation. For example, English-speaking Asian Americans as a generalized group are just as likely to get the flu shot as white Americans but delving deeper into the data reveals that Korean and Chinese Americans are less likely to have the flu shot, underlining the importance of culturally relevant communication to drive vaccine uptake in minority populations.

Additionally, in cultures which value modesty, removing clothing or revealing private health information in a relatively public area, such as many mass-vaccination sites may contribute to vaccine hesitation disproportionately affecting minority groups. Considering such environmental and cultural incompatibilities and addressing these in communications throughout the early stages of vaccination should not be discounted when assessing an effective messaging strategy.

According to an October 2020 WHO report on behavioral considerations for acceptance and uptake of Covid-19 vaccines, three key strategies can be implemented to increase these metrics. Firstly, an enabling environment must be created to make vaccination quick, easy and crucially, affordable, with affordability being a key consideration for many minority Americans. For example, almost a third of Hispanics in the U.S. don’t have health insurance, adding financial considerations to their decision-making about Covid-19 vaccines.

The second strategy is consideration of social influences, which requires an understanding of culturally specific barriers to design effective interventions. For example, if Spanish-speaking Americans are accessing misinformation via online channels in their primary language, is messaging designed to counter that also being presented in Spanish in the same places? The third key WHO strategy is increasing motivation through open and transparent dialogue, including communication about uncertainty and risks. To match Covid-19 prevention messaging, tailored and culturally relevant messaging must be prioritized to drive vaccine uptake.

At CQ fluency, we specialize in empowering people to make the best decisions about their health by making sure that information is accessible, relatable, and adapted to language, values and culture. In this unprecedented era of innovation and healthcare advances, we can help you connect with the people you work to serve, to ensure nobody gets left behind.