Since the onset of the COVID-19 pandemic, community-based organizations (CBOs) have sought to increase vaccine uptake in underserved communities, including immigrants, Black communities, Latinx communities, and those living in rural areas. Through the Partnering for Vaccine Equity (P4VE) program, launched in 2021, many CBOs have identified barriers to vaccine uptake, both common (such as institutional mistrust and misinformation) and structural (such as limited transportation access, lack of child care, and housing instability).
These barriers, which fall under the five domains of the social determinants of health, disproportionately affect people of low socioeconomic status and people of color because of systemic racism and oppression. As a result, there are fewer financial, social, and emotional resources available to these communities, creating conditions of scarcity. In turn, people must make trade-offs that affect vaccine uptake, such as not visiting a vaccine clinic because it would mean taking time off work. Constant sacrifices because of scarcity perpetuate a negative cycle of traumatic effects for people, households, and communities that can lead to disparate health outcomes.
Despite growing evidence on scarcity’s traumatizing effects, many CBOs in the health equity and social response sectors do not fully understand the many forms of trauma experienced by the people they serve. This lack of understanding could limit their work’s impact. To overcome deeply rooted barriers and improve vaccine confidence and uptake, we draw insights from the P4VE program on the connection between scarcity and trauma and offer CBOs trauma-responsive strategies that can better promote health equity.
Understanding trauma is critical to increasing vaccine confidence
Trauma results from an event, series of events, or set of circumstances that causes physical or emotional harm and has lasting adverse effects on a person’s functioning and mental, physical, social, emotional, or spiritual well-being. Trauma can take many forms: individual, community, generational, and environmental.
Communities served through P4VE have disproportionately experienced multiple forms of trauma, which was exacerbated by the COVID-19 pandemic (environmental trauma). Historical trauma, such as the Tuskegee Syphilis Study, can corrode trust in health care systems across generations, contributing to a lasting lack of vaccine confidence. However, while a community as a whole may experience generational trauma, personal responses to that trauma can vary. Structural racism in health care may cause some people to mistrust vaccines, but others with the same identity may not share this response.
Trauma-responsive principles for vaccine confidence
Throughout the course of P4VE, CBOs pursued strategies such as leveraging trusted messengers and culturally appropriate messaging to improve vaccine confidence and uptake.
These strategies integrated the “Four R’s” (PDF) of being trauma informed and responsive:
- Realize the widespread impact of trauma.
- Recognize the signs and symptoms of trauma in clients, families, staff, and communities.
- Respond by integrating knowledge about trauma into policies, procedures, and practices.
- Resist re-traumatization.
By offering a safe, trusted connection for community members, CBOs can integrate the Four R’s approach into their activities. An invitational approach that empowers people to make their own decisions about their health can build and maintain safety and trust. Additionally, communicating information more than once and in multiple formats, like visuals and audio, can improve message retention and provide ample opportunities for questions. Practicing cultural sensitivity that respects the unique perspectives community members bring to vaccine conversations can also build and maintain safety and trust.
Cultural factors can influence how people respond to trauma and other experiences. When planning an organizational trauma response, CBOs must consider cultural norms that could either limit or encourage certain responses. Trusted messengers and community health promoters from the affected community often have a better understanding of the cultural factors at play and can respond with more sensitivity during conversations about vaccine and health equity because of shared identities and languages.
Implementing trauma-responsive approaches
As CBOs implement or refine trauma-responsive approaches, they should continuously examine their thinking around service provision and community engagement.
- Think about the communities and community members served. What cultural factors may limit their response to service provision? What steps has the organization taken to acknowledge this limitation, and how can the organization continue to build cultural sensitivity?
- Reflecting on the Four R’s in the organization’s work, what resonates? What is the organization currently doing well to support community members? What are areas for improvement?
- What is an action the organization might try or expand on?
Responding to these questions can amplify successes while providing space to discuss growth. As CBOs continue to address structural barriers to improve vaccine confidence and uptake, it’s crucial that they integrate trauma-responsive strategies in service to their health equity goals.
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