Build trust in vaccines by investing in community workers

When the workers at a pistachio packing plant in California’s Central Valley started falling ill last spring, they turned to Veronica Perez with questions. Ms. Perez is not a doctor or public health official — she’s a trained outreach volunteer from the nonprofit Líderes Campesinas. In the past, her neighbors and coworkers might have asked her for help locating a food pantry, applying for social services, or understanding where they could get affordable medical care. This time, their questions were about COVID-19.

“Where can I get tested? How can I buy food if I miss work?” they asked Ms. Perez as the virus struck more than 150 of the plant’s workers. Now, with a COVID-19 vaccine on the horizon, she’s starting to hear: “Where can I get the vaccine? Am I going to have to pay for it?” and most importantly, “Is it safe?” When the time comes, Ms. Perez is the person they will need to hear say, “Yes.”

Many people across the country are asking the same question. A new national study commissioned by UnidosUS and NAACP found that just one in three Latinx Americans — and only one in seven Black Americans — mostly or completely trusts that a COVID-19 vaccine will be safe. This distrust stems in large part from experiences with institutionalized racism, unethical medical experimentation, and other vaccination campaigns that have prioritized expediency over equity.

As federal officials work to roll out lifesaving COVID-19 vaccines, the success of vaccination efforts will hinge on equity — and on whether we can make the impact Ms. Perez has had with her coworkers possible on a national scale, especially among communities hardest hit by the virus.

One strategy now before Congress — the Health Force and Resilience Force Act of 2020 — has the potential to do just that, as well as create jobs, strengthen local health departments and restore our communities. By including it in the next coronavirus relief package, Congress has an opportunity to tap the power of thousands of trusted community-based workers like Ms. Perez to help bring this pandemic under control — equitably and effectively. 

First introduced in April by Sens. Kirsten Gillibrand (D-N.Y.) and Michael Bennet (D-Colo.), the “Health Force” bill would provide flexible funding to state, local, territorial and tribal governments to create a public health workforce representative of and tailored to each community’s specific needs. Comprised of thousands of trusted workers like Ms. Perez, this workforce would be deployed to support a range of key activities: contact tracing, health education campaigns, coronavirus testing, medicine, food deliveries and assistance for those who are sick or in quarantine, and, of course vaccine administration.

Our local health departments desperately need this support. With a tsunami of COVID-19 cases spreading across the U.S., policymakers and scientists are grappling with how we will get relief and vaccines to communities and people who need it the most — and how we can help them learn to trust these vaccines. The answer to both challenges is to activate a community-based workforce, and we cannot wait a moment longer to do so.

Public health moves at the speed of trust

For months, Americans have been turning to trusted voices for information, advice, and support during the pandemic. These voices include local doctors and public figures like Dr. Anthony Fauci. But many Americans have also been relying on others, heroes seldom discussed in the media. We define these other trusted voices as the “community-based workforce,” a term which covers a diverse range of trained individuals, including community health workers, promotores de salud, outreach workers, local nonprofit staff, social workers, doulas, and other trusted professionals.

While skills and roles vary, members of this workforce share common traits. Like Ms. Perez, they share culture, language, and life experiences with the members of the communities they serve. As skilled health workers and neighbors, they support people of color and lower-income families who have been historically excluded or ignored by health care. Through good times and bad, they’ve earned a deep level of trust.

That trust has been proven effective in the fight against many outbreaks and pandemics, including this one. As one example, a COVID-19 program in San Diego showed that community health workers (CHWs) effectively improved contact tracing and quarantine efforts among at-risk members of the Latinx community. And studies have shown that for every $1 invested, this workforce generates anywhere from $2.47 to $15 in health, economic and social returns. This track record led federal and state officials to formally recognize them as essential workers early in the pandemic.

Invest in community-based workers

But recognizing the community-based workforce is not enough. We need to fund and build it. Congress now has a chance to get COVID-19 vaccines and immediate relief to those who need it most, while creating jobs and laying the groundwork for a stronger, more equitable public health system and economy. How?

First, passing the Health Force bill can help us improve equitable access to testing, vaccines, care and support. The COVID-19 age-adjusted death rate among Black, Indigenous and Latino Americans is now triple or more the rate among white Americans. And in ZIP codes where median household income is less than $35,000, the overall infection rate is more than twice as high as in neighborhoods with household income of more than $75,000. To bring this pandemic under control and heal as a nation, we need to address deep racial and economic inequities that have created such deep disparities in who gets infected and who dies from COVID-19. A diverse, community-based workforce is an important part of the solution. Evidence shows they increase health care access, reduce economic and racial disparities, and improve outcomes for communities of color who have been disproportionately impacted.

Second, at a time when so many Americans are out of a job, the Health Force bill is also an economic investment. By passing the bill, Congress could help create thousands of jobs in economically gutted communities by recruiting individuals who reflect the neighborhoods they serve. The bill could also pave the way for a U.S. Public Health Jobs Corps. Proposed by the incoming administration, this program would train and mobilize 100,000 Americans to help communities fight the pandemic. It would also position them to take on jobs that would help build longer term health infrastructure and fast-track local economic recovery.

As we head into a brutal winter, the news of COVID-19 vaccines gives many a glimmer of hope. But we can’t be complacent. If we hope to reopen schools, revive the economy, and enable families to reconnect without fear, we must all take greater responsibility to protect our nation’s health and promote equity. Congress must act too by including the Health Force bill in the coronavirus relief package.

As federal officials work to build trust in the vaccine and the broader public health response, it’s time we invest in community-based workers like Ms. Perez who’ve already earned it.

Dr. Rishi Manchanda is CEO of HealthBegins. Claire Qureshi leads U.S. initiatives for the Community Health Acceleration Partnership. Both organizations are founding members of the national Community-Based Workforce Alliance.