Addressing the consequences of generation after generation of racial inequities and health disparities might seem like an impossible task. Especially in the middle of a pandemic.
But it starts, really quite simply, with healthcare professionals listening to their patients, finding out what they are facing, and learning what they need.
This was a major theme of the new Gold Human InSight Webinar, “Breaking Down Barriers Brick by Brick: Addressing Vaccine Deliberations,” featuring Dr. Kimberly Manning and Dr. Valeria Cantos in conversation with Barbara Humpton, Siemens Corp. President and CEO. The webinar was sponsored by Siemens Healthineers, a member of the Gold Corporate Council that comprises leading healthcare companies that support humanism in healthcare and the nonprofit Arnold P. Gold Foundation.
The webinar is being released this week to the public. It was featured earlier this year as part of the Humanism & Healing: Structural Racism and Its Impact on Medicine conference, hosted by the Gold Humanism Honor Society.
This webinar “will shed light on historical and current inequities that may contribute to questions about the vaccine, factor into vaccine deliberations and access, and help address issues of social justice and anti-racism,” said Pia Pyne Miller, Senior Director for Strategy and Business Development at the Gold Foundation, in her introduction of the panel.
Dr. Kimberly Manning, a physician at Grady Memorial Hospital in Atlanta and Gold Trustee, said that she is often asked what the “magic words” are to use with Black people to persuade them to get vaccinated.
“The magic words are, ‘Do you wish to be vaccinated?’” said Dr. Manning. “Or, ‘How do you feel about the vaccine?’”
When your patients tell you how they feel, “dig deeper about what is important to them,” said Dr. Manning, who is also Professor and Associate Vice Chair of Diversity, Equity, and Inclusion at Emory University School of Medicine.
“Some of our folks who are being coined as ‘hesitant’ or who don’t trust — it’s really logistics,” Dr. Manning said. Often, they want the vaccine, but it is too difficult to get it. They don’t have the time or internet access to continually refresh an appointment website. Or, they don’t have a car to get to a vaccination site not accessible by public transit. Or, they’re worried the side effects from the vaccine will make them lose time at work they can’t afford to lose. Or, they tried a couple of times to get the vaccine and got frustrated.
“It’s barrier after barrier after barrier, so you really have to not only be motivated, but you really have to have the skills and savvy to go through them,” said Dr. Valeria Cantos, an infectious disease specialist and Assistant Professor at Emory University School of Medicine. She is also a principal investigator in a COVID-19 vaccine study.
Dr. Cantos told the story of one of her HIV patients who is blind and who comes to the clinic using a medical van service. The patient had been unable to get an appointment so Dr. Cantos got online and found one. But then it turned out not to be on the medical van’s route and the transportation service needed at least four days’ notice of a pick-up when the appointment site was only booking two days ahead.
“We need to come to people’s neighborhoods, where they are…and save those vaccines for the people of that community,” Dr. Manning said. “We have to tell those stories of how incredibly difficult it is to get a vaccine.”
“It’s putting patients first,” said Siemens CEO Barbara Humpton. “You’re teaching us that often the real barriers are not in the details of the science and the data, but in the simple logistics that would enable people to overcome barriers that would allow them to get access to the healthcare they so richly deserve and which they need.”
Dr. Cantos’ primary focus is treating HIV patients, particularly those in marginalized Latinx communities in Atlanta. Many of her patients only speak Spanish, which is in and of itself is a barrier to navigating COVID-19 vaccine and information websites written only in English.
“For most of the community, they want to know: Will it work? Will I be safe? How will it impact my life?” said Dr. Cantos, who cautioned healthcare professionals about getting too far into the weeds of data and using inaccessible scientific language.
Dr. Cantos said immigrant communities have an additional barrier to getting vaccinated: fear of deportation if they show up at vaccination sites and then are reported to immigration authorities. If they must choose between risking being infected by COVID-19 or being deported and separated from their children, they will choose the lesser evil of risking infection.
“They feel, and it’s accurate, that they are left by themselves,” Dr. Cantos said. “They feel like they are already so put aside by the society that they are not really eligible for anything, including the COVID vaccine.”
Dr. Cantos said it is important to overcome these barriers, not just for these patients, but to achieve the goal of herd immunity that will keep everybody safe. “The pace of the vaccine is getting better…but we have to reach these communities that are being left behind.”
Once those barriers are overcome in marginalized communities, everybody wins.
“If everything is understood and easy for them, it becomes normalized,” Dr. Cantos said. “If I know my auntie or my cousin and my sister all got the vaccine and they are doing fine. That they all had a good experience and that they didn’t feel afraid, they are more likely to get the vaccine themselves.”
Part of the larger context that makes it difficult for marginalized populations to have access to good care is the striking lack of diversity among doctors after generations of structural racism in medical education.
Both Dr. Manning, who is Black, and Dr. Cantos, who is an immigrant from Ecuador, were inspired by their fathers’ dreams of becoming physicians. Both fathers ultimately chose other professions because access to medical education was cut off to them.
“It is no shock we are in this space when we don’t have enough people to offer racially concordant care,” said Dr. Manning, adding “the pipeline has to go very deep” to finding the new generations of doctors, starting in elementary schools in marginalized communities.
Dr. Cantos said there is another very important thing to remember in beating back the global pandemic.
“We have to think that the United States is not alone on planet Earth,” she said. “As long as we don’t have vaccine equity worldwide, COVID is likely to become an endemic infection and is going to cost many lives and going to cost entire countries’ financial systems to collapse.”
The end of the global pandemic begins with communication with a single patient with a decision to make.
“Remember, we are not used car salesmen,” Dr. Manning said. “With almost every big decision, we need to deliberate on it.”
If clinicians have an honest conversation with a patient who is on the fence about getting the vaccine, the patient is most likely not going to run out and get it right at that moment, she said.
“But it plants an important seed,” Dr. Manning said. “That’s a really important message, particularly with communities of color. You can tell information that plants an important seed. Have faith that that seed will bloom and many people who come along and touch that patient will help water it, too.”
The Gold Human InSight Webinars are virtual innovative sessions that the Gold Foundation has hosted with its wonderful partners in humanism. The 2020-2021 theme is “Care, Compassion, and Collaboration during the Dual Pandemic.” If you are interested in collaborating with the Gold Foundation on a webinar, please contact Host Pia Pyne Miller, MPH, Senior Director for Strategy and Business Development, at pmiller@gold-foundation.org.
