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1 in 10 Americans is 'unvaccinated but willing.' Here's how to reach them.

Nearly half of unvaccinated Americans say they may be willing to get vaccinated but have not because of different challenges, Meryl Kornfield reports for the Washington Post. And while providers and volunteers have made efforts to reach this population, they remain hindered by a lack of funding.

'Unvaccinated but willing'

Around 44% of unvaccinated Americans say they may be willing to get vaccinated, but different reasons have prevented them from doing so, Kornfield reports. According to a report from HHS last month, this group of "unvaccinated but willing" people make up approximately 10% of the U.S. population.

According to Kornfield, vaccinating this population could be crucial in helping the United States reach herd immunity and protecting groups who have been disproportionately affected by the pandemic. However, public health officials have struggled to reach this population, which includes young adults, Black and Hispanic Americans, and those who are uninsured.

Several barriers may hinder these individuals from getting vaccinated, Kornfield reports, including difficulty accessing vaccine sites, a lack of information about how to get the vaccine, or uncertainty about the effects of the vaccine.

For example, Yolanda Orosco-Arellano, a hotel housekeeper and mother of four, wanted to get vaccinated but had difficulties securing an appointment. She lacked transportation to get to the vaccine clinic and needed an appointment that could be scheduled around her work shifts.

Cody Grier, a pre-med student and volunteer at Medical Outreach Ministries, a clinic in Montgomery, Ala., said many of the clinic's patients were overwhelmed by the amount of information available online about the vaccines. In addition, some patients were worried about the cost of the vaccine, unaware that they could receive it for free.

And many undocumented immigrants are concerned about needing official identification to receive the vaccine, Kornfield reports, although showing a driver's license, social security number, or health insurance card is not required.

According to Jovany Ochoa, a volunteer at HealthNet, a clinic in Rock County, Wis., it's unfair to perceive everyone who is unvaccinated as just being against the vaccine. "[T]here's a lot more to it than that," he said. "I just don't want them to be categorized for being selfish or anything like that because that's not the reason they're not getting it. They're not getting it because sometimes they literally can't or they don't know how to."

Clinics increase outreach but remain limited by lack of funding

Currently, nearly 100 free and charitable clinics across the country have joined an initiative called "Project Finish Line," which aims to vaccinate one million people in underserved communities, Kornfield reports.

Several clinics are offering rides to patients without transportation and expanding their hours to accommodate patients' work schedules. Some health workers spend their lunch breaks or time outside of work vaccinating patients who can't reach the clinic when it is open.

Many health clinics are also providing educational outreach for their patients through phone calls or in-person visits, Kornfield reports. For example, Ochoa, one of HealthNet's educational "ambassadors," visits supermarkets, farms, and factories where he knows many workers are still unvaccinated to answer any questions they may have about the vaccine.

According to Joe Agoada, CEO of Sostento, a nonprofit supporting frontline health workers in underserved communities, clinics that are part of "Project Finish Line" have vaccinated more than 112,000 people since June. HHS data has also shown that the number of people who are willing but unable to get vaccinated has declined recently, suggesting outreach efforts have had some success.

However, Agoada said the "safety-net" clinics spearheading these vaccination efforts do not receive federal funding and instead largely rely on grants and donations, which can make it difficult for them to keep up with their patients' needs.

Separately, Ericka Sinclair, CEO of Health Connections clinic, said a lack of critical funding to support these clinics can lead to further distrust from patients as providers try to answer questions they may not yet be prepared for. "If you leave too much of a gap between when the question is asked and when there's an answer, that creates distrust every moment that exists," she said. "People need to feel addressed, not dismissed."

So far, Sostento has raised $500,000 for its vaccination efforts, just half of what the nonprofit has said it needs, Kornfield reports.

"Free and charitable clinics are vaccinating populations nobody else can, despite a lack of resources," Agoada said. "To defeat this pandemic, we cannot afford to overlook and underinvest in this group, and yet so far this is exactly what has happened." (Kornfield, Washington Post, 9/23)

Advisory Board's take

Many stakeholders (including you…probably) can help reach the 'unvaccinated, but willing' population. Here's how.

By Pamela Divack and Regina Lohr

If vaccine uptake feels like a continually challenging feat, take these findings as an opportunity to act. Whether you are a health care leader, an employer, an individual clinician, or a leader at a community clinic, there is an 'unvaccinated, but willing' population that you can help move toward vaccination. Here are some of our thoughts:

What health care leaders can do

Governments, health systems, and pharmacies have been at the front lines of offering vaccines since December 2020, and their work successfully got shots to millions of people. But as has been noted, those who are not yet vaccinated probably missed out on those mass vaccination clinics for a reason, and they aren't showing up at their local pharmacies either.

Health care leaders now need to expand access by going into the community, either themselves or by leveraging a team of outreach workers. They need to expand who they consider "partners"—religious groups, cultural organizations, local community organizations, small grocery stores and corner stores—in other words, places where people routinely visit.

And approaching community leaders should involve cultural humility. Health care leaders need to do more asking and listening with community leaders to understand how to overcome the vaccination barriers their communities face. Approaches to vaccine uptake are not one-size-fits-all. There are a myriad of challenges, considerations, and preferences among different community and cultural groups. Health care leaders must let go of what they think is good for a certain community and instead compassionately ask what that community needs. When we embrace this empathetic framework, we can build trust while eliminating the hierarchies that often push away individuals at the margins.

What individual clinicians can do

Taking the time to understand and listen to individual patients' concerns—and respond with empathy and understanding—can establish trust with patients that's necessary to move them toward vaccination.

Trust-building takes time, and while it can be difficult these days, taking that time is exactly what some individuals may need. Allowing time for someone's personal narrative to be told may expose unique hesitancies that clinicians can address.

And trust-building doesn't always have to be related to vaccines—by establishing transparency and honesty with patients in routine visits or visits for non-Covid related means, individual clinicians can build relationships and credibility which may eventually lead to vaccination.

Additionally, clinicians might consider reframing the conversation about Covid-19 vaccination to be one of overall health care access and wellbeing. With upcoming booster shot rollouts, plus a continuous lack of evidence about long Covid-19 and long-term complications of the disease, patients need an ongoing relationship with their clinician and not just a one-time shot. Clinicians can build trust by framing the conversation to focus on the persons health overall and not just Covid-19 vaccination.

Finally, it's important to remember that these efforts really do make a difference, even if it takes many conversations to move to vaccination itself, as Dr. Malebranche recently shared in an encouraging article.

What employers can do

Employers—both inside and outside of health care—can play a large role in encouraging and enabling their employees to get vaccinated, even outside of the question of mandates.

First, employers need to make sure that their employees have the time and space to get vaccinated. The most vaccine-supportive approach involves providing vaccine access for all shifts and all locations, while employees are on the clock, and offering a paid sick day the next day for recovery. While employers may balk at how much this approach costs, this up-front investment can do double duty in minimizing call-outs due to illness later on—all while improving employee loyalty and satisfaction.

Second, employers can normalize conversations about vaccination. It's important that leaders model an openness to discussing vaccination in a way that gives space for individuals to voice vaccine-related questions or barriers. This gives leaders an opportunity to walk alongside their employees on the journey toward vaccination, whether it's helping them process their concerns or identifying logistical barriers that the employer can help overcome.   

What community clinics can do

As many mass vaccination sites start to shut down, community clinics and local health care organizations will continue to play a critical role in reaching unvaccinated patients. They must leverage some of the early keys to success—such as holding appointments at convenient hours or offering transportation to the site or other support services—to continue to promote vaccine access. These clinics can also help build trust within their communities by collaborating with local organizations that patients routinely visit—like grocery stores, religious sites, public transportation stops, or others—to find new ways to reach patients and expand vaccine access. Many leading organizations have held pop-up sites in these locations, increasing accessibility and convenience. 

Community clinics can also find ways to provide resources and support to patients beyond Covid-19 vaccination. They are a critical access point to the health care ecosystem and can offer additional services like routine screenings or overall health support to continue the relationships with patients.

Parting thoughts

Vaccine uptake is a challenging undertaking, but it is precisely what needs to happen if we want to slow this pandemic down. Now that we know how many unvaccinated individuals are willing to get the shot, it's time to act with a new perspective—it may be what actually moves the needle, quite literally.

Listen to Radio Advisory's episode on the unanswered vaccine questions you should be tracking. And if you are curious about booster shots, here's the update from the FDA and our thoughts on what to look for moving forward.

Advisory Board's Andrew Mohama contributed to this article







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