Last year, missing doctor’s visits due to fear of catching COVID-19 led to late diagnoses for many. “Problems are more advanced when you wait until the last moment or go to the emergency room for their care,” says Dr. Lakshmi Deepa Yerram, chief medical officer with International Community Health Services (ICHS). The Seattle-based federally qualified health center welcomes all in need of care regardless of health, immigration status, or ability to pay and serves nearly 28,000 patients in 70 languages.

Yerram says seeing the doctor for annual checkups is important to making sure health problems are caught early and treated. When patients aren’t seeing their doctors due to barriers and fear created by the COVID-19 pandemic, health problems end up being “more acute and severe, with more hospitalization and cost of care” Yerram says. Last year saw an uptick of late-diagnosed cancers. Those with hypertension and diabetes often missed the in-person exams critical to maintaining health. 

As we approach fall and winter, vaccination can help lessen future COVID-19 impacts and help with preventive care that improves overall health.

But while over 70% of the U.S. adult population received at least one dose of the vaccine and over 60% are fully vaccinated, increasing gaps in vaccination could badly impact people from several racial and ethnic minority groups as the Delta virus advances. Fewer than half of Black and Hispanic people have received one dose in most states, including Washington state, according to data from the Centers for Disease Control and Prevention

These disparities in vaccination rates result from several factors, including vaccine fear and barriers to accessing vaccination clinics. Immigrant communities, for example, can face language barriers at vaccination sites or may not even hear about vaccine events and information in their own language. Some families and individuals may not have time in their work schedule or easy access to vaccination sites where they live.Vaccination rates are often less about politics and more concerning a variety of factors including history, trust, time, and sometimes, misinformation tied to politics and the legal system. 

Fears and concerns

Vaccine concerns make sense, says Dr. Hieu Pham, a physician and Interim Family Medicine Residency Director at ICHS. New technology of any kind can concern people, he says. COVID-19 rumors, vaccine news and other misinformation can spread from person to person or online. Pham tries to listen closely to what underlies a patient’s concern. 

For example, an older patient may hesitate to take the vaccine because they’re concerned about losing a day of caring for grandchildren. Instead of providing too much information on how vaccines work, Pham gently asks what might happen if COVID-19 interfered with spending time with the grandkids, if ill or in the hospital. “What’s important to you, and how will the vaccine help you do the things you want to do?” Pham asks.

Young people may also feel “invincible,” he says, and consider the vaccine unnecessary. But many young people live in multigenerational households, Pham notes. With COVID-19 variants multiplying, getting immunized protects the individual and the community, including children too young for vaccination and those with a compromised immune system. 

Conflicting information through media or news sources can cause confusion, as can word-of-mouth through communities. Like a game of telephone, context and facts get lost. 

So it’s important to recognize trust as part of the vaccine conversation. Those immigrating from more authoritarian nations may not trust a new vaccine, Yerram says, and past abuses have left many populations wary of the U.S. health care system. For example, researchers of the Tuskegee Study, intended to observe the natural history of untreated syphilis, did not collect informed consent from participants and they did not offer treatment, even after it was widely available. As a result of this abuse, there are now safeguards to avoid history repeating itself. There are now rules and policies such as the Belmont Report that protect participants in research studies.

“As health care providers, we want to create trusting relationships, so patients feel safe in telling me, ‘This is what I’ve read or heard, and am concerned about,’ ” Yerram says. Trust also means that a patient is reassured that they have someone to contact if there is an unexpected issue or side effect. 

Access barriers 

Vaccine access can involve serious barriers to vaccination. Older populations may have a hard time accessing online information on nearby vaccination locations. The national wave of attacks on Asian Americans also discouraged older Asian Americans from leaving home. “Our older patients don’t want to be attacked or mishandled in the streets,” Yerram says. 

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Language can be another barrier. Critical health information is first relayed by government and health authorities in English, then Spanish. But it may take a while — if it’s done at all — for information to be translated into all and less-common languages. Undocumented immigrants may worry they’ll be asked for a social security number or personal information to get a vaccine, although even if asked, this is never required, according to Sharissa Tjok, ICHS’ community health services manager. 

Financial barriers are a considerable challenge, Yerram says. Those with the most risk exposure to COVID-19 often work in industries — construction, restaurant and hospitality — that don’t allow days off for vaccination. Many are concerned that they’ll become ill for a few days after vaccination and miss work. Hispanic adults report finding it more difficult to locate affordable health care at a location that’s easy to get to, according to research from the Kaiser Family Foundation

So organizations such as ICHS offer convenient pop-up clinics that bring the vaccine to employer sites, along with locations like farmers markets and grocery stores such as Viet-Wah Asian Food Market, and partners trusted within the community, such as the Redmond Islamic Center. 

Preparing for fall 

For this fall, Pham recommends visiting your provider when possible. Many patients last year missed mammograms, Pap smears and other preventive care, so it’s a good time to catch up on care that’s been delayed. Telemedicine is fine compared to no interaction at all, but Pham appreciates the opportunity to listen to a patient’s lungs in person.

As well, Pham suggests making sure you’re up to date on your other vaccines, including pneumonia, flu and others which help prevent infectious respiratory disease. Fewer illnesses may mean less coughing — and concern. 

Some adults have had a “wait and see” approach to vaccination, Hieu says. According to the Kaiser Family Foundation research, a portion of these adults have decided to roll up their sleeves, influenced by seeing friends and family members getting the vaccine without serious side effects and conversations with their physician about risks. They’re also motivated by the desire to protect and visit with friends and family members. 

Facts are facts, but they don’t always change decisions, Pham says. If you have family or friends still on the vaccine fence, share your story of vaccination or talk through concerns. Instead of sharing printouts or websites, Pham asks others, “What concerns you? Can you tell me more?” Explore the reasons behind hesitation. 

Often, it’s hearing about others’ vaccination experiences that helps individuals get vaccinated.  “We were the original guinea pigs,” Yerram says of physicians on the front lines. “I tell patients that I got the vaccination in December, and my brain works, and I’m doing fine. Don’t give up on them.” 

Even accompanying a friend to a vaccination appointment, or getting vaccinated together, can help get the job done, Tjok says.

Does Pham feel like a superhero when he saves someone’s life by convincing them to get vaccinated? “Yeah, completely,” Pham says. “If I can get someone to take a vaccine, it’s good for me too. Not only does it lower the patient’s risk of dying, but we’ll be able to continue our good relationship for many years to come.” 

ICHS provides health care for everyone, regardless of income, or insurance or immigration status. Affordable medical, dental, behavioral health, vision and pharmacy services with multilingual doctors, nurses and staff meet the needs of King County’s diverse and multicultural communities. www.ichs.com