In times of trouble — the ongoing COVID-19 pandemic included — many people turn to their faith communities for support and care. And in many cases, valiant efforts to encourage vaccination against the SARS-CoV-2 virus have become a key component of the work these faith-based organizations have undertaken.
The AAMC is supporting such efforts through its Building Trust and Confidence Through Partnerships grant program. The grant program is funded by a cooperative agreement with the U.S. Centers for Disease Control and Prevention that’s working to build confidence in the COVID-19 vaccines in communities and among health care personnel.
Jennifer Bretsch, director of programs for the AAMC Center for Health Justice, says the program aims to support member organizations in building and strengthening partnerships with underserved communities via community-based organizations.
“As part of the grant application, we asked them what partnerships need to be built upon or expanded and what challenges and opportunities exist within the community related to COVID-19 vaccines,” Bretsch says. Thus, the grantee organizations have the latitude to gather insight from local leaders and use the funding to support the programming that best serves the unique needs of the local community.
Many of the grant applications proposed working with faith-based organizations or focusing on a particular patient population. Here, two grant awardees share how they’re encouraging COVID-19 vaccine acceptance with the help of leaders at churches, mosques, temples, and other faith-based organizations.
Henry Ford Health System, Detroit, Michigan
Denise White Perkins, MD, PhD, director of healthcare equity initiatives, vice chair of academic affairs, and associate residency program director for the Department of Family Medicine with the Henry Ford Health System in Detroit, says the hospital has long supported The Henry Ford Macomb Faith Community Nursing Network (FCNN).
Started in 1994, the FCNN is a conglomeration of about 50 congregations that have encouraged routine health screenings and vaccination against preventable diseases like hepatitis B and now COVID-19.
This effort is important: data from March 2021 showed that Michigan had the fourth-highest COVID-19 mortality rate in the country for Black residents. In Detroit, more than 75% of people diagnosed with COVID-19 and nearly 90% of those who died of the disease were Black.
The FCNN and now its subsidiary project, the Trusted FACE (Faith-based Activation for COVID Elimination), offer parish nurses or lay health ministers in these communities opportunities for training, support, and technical assistance around health promotion in the community during monthly meetings.
This regular face time with the congregations’ leadership helps build trust, which these faith leaders pass on to congregants. Because the FCNN had already been established to address other health needs, when COVID-19 arrived, it was a natural fit to use that network to help parishioners feel more confident in accepting vaccination against the disease.
“When this opportunity came along from the AAMC that focused on building trust and confidence in COVID vaccination, it was perfect because we were already working with FCNN during the pandemic on ways to engage people to provide support to connect them with resources,” White Perkins says. “We had done some surveys among the member congregations to understand how they were safely re-entering into congregating together, so it just fit in perfectly to now say, ‘Let’s partner together to build trust and confidence in this lifesaving vaccine for communities that may not feel we’re trustworthy.’”
White Perkins says the grant is helping to support trainings and workshops with local experts.
“We offer training on how to handle misinformation and how to connect people with social resources in an empathetic manner to help move people toward greater readiness for the vaccine,” she says.
Success, White Perkins says, takes a number of shapes in this program. “First of all, there’s the impact we’re having on the faith community nurses and health ministers themselves,” she says, “building up their knowledge base and their comfort level with talking about these issues.”
The group also tracks the number of encounters with individuals and whether they’ve made progress toward vaccine acceptance. That’s because sometimes it takes several conversations before someone moves from “no” to “yes.”
White Perkins has found that accepting or not accepting COVID-19 vaccination is not always the binary proposition that it’s often portrayed as.
“We really have to come at this from a place of openness, seeking to understand and being respectful of the people who we’re trying to convince to get the vaccine,” she says. “It always bothered me that early on we said, ‘Oh, they’re lacking trust,’ as if they were somehow deficient in something, like a vitamin was missing. Really, the problem is that [many feel] our health systems, our pharmaceutical industries, our governmental institutions have not demonstrated that we are trustworthy. So, it’s really more of a trustworthiness problem.”
This trust-building work is supported by an advisory board of faith-based leaders who help craft the messaging so it fits with the intended recipient’s belief system.
Janet Banks-McElrath, the faith community nurse coordinator working on the Trusted FACE campaign, says that her role is to “bring the congregations to the table and communicate with the faith community, nurses, and health ministers at the congregations.”
Angela Roman, DNP, is a doctor of nursing practice who runs a primary care clinic less than two miles from the Henry Ford Hospital. She works with the Trusted FACE program as a faith community nurse and says her position as a primary health care provider in the local community helps build trust in the academic hospital system nearby.
“A lot of my patient population landed with me because of a lack of trust in large health systems,” she says.
In fact, Roman herself knows the uncertainty of accepting the COVID-19 vaccine. “I didn’t go and run to get the vaccine,” she says. “I was extremely hesitant.”
But through ongoing research, reading, and conversations with other medical professionals, she “finally was able to accept it for myself,” she says.
She took great pains to dig into the research and educate herself to be ready to assist her patients and fellow congregation members so she could respond with facts and compassion no matter what challenges arose.
Getting the word out about the availability of COVID-19 vaccines to faith-based communities around Detroit has also benefitted from the efforts of Michael McElrath, who has been in communications and public relations for public health institutions for about 15 years. He currently serves as the marketing and communications director of the Children’s Center of Wayne County in Detroit and offers his expertise in social media and marketing communications to provide messaging support to Trusted FACE. He’s built a Facebook page that helps get the message out and offers informational resources about COVID-19 and the vaccines. He’s also developing other web-based resources to support the team’s efforts.
The Shekinah Tabernacle Gospel Church in Detroit is a key congregation within the Trusted FACE program. The flock is led by Pastor Risarg “Reggie” Huff and his wife, Linda Huff, who’s referred to by congregants as “First Lady.” The Huffs started the ministry in 1997 and First Lady Huff acts as project assistant for Trusted FACE. She also serves as a COVID-19 investigator and contact tracer for the state of Michigan. She says her husband incorporates a call to get vaccinated into his sermons every week.
Despite the team’s hard work in increasing acceptance of the COVID-19 vaccines, Huff notes that there have been some parishioners who have resisted pro-vaccine messaging. But, she says, “You have to be able to push beyond the naysayers and still share your message of hope.” She adds that some folks will never accept the vaccine, but “we still provide the information and let them know we’re here for them if they ever change their minds.”
Swaying such individuals often takes the form of testimonials. Used widely in churches for people to share their spiritual experiences, in the time of COVID-19, these powerful statements offer insight into how the disease is impacting parishioners. “Testimonials are important. People trust those who they trust with a message. So we use that avenue,” Huff says.
Vaccine fairs at churches have also helped get shots in arms, making public health a community-supported event that feels safe and familiar to individuals who may be hesitant. “I’ve seen a couple people have panic attacks right before or after getting their vaccine,” Roman says. “So having a connection to someone who cares about you, especially if you have high anxiety, that’s something that you want to do.”
Amid the effort to encourage vaccination, Roman notes that it’s also important not to push too hard.
“I was on a mission where I was trying to push everyone to get vaccinated, and that’s still my belief,” she says. “But I have to be hypervigilant and respect people’s space.”
She says sometimes backing off a bit allows the person some time to think over the reasons for vaccinating and can lead to more thoughtful engagement.
“You just keep supporting people and not making them feel isolated when they’ve made a decision not to get vaccinated because that just puts people in silos, and then you’ve lost them,” she says. “Don’t make them feel like they’ve made such a horrible decision or that they’re stupid for not getting it.”
Albert Einstein College of Medicine, the Bronx, New York
In New York City, the AAMC grant supports a well-established program that has built significant connections with the West African community via faith-based organizations in the Bronx, home to approximately 120,000 West Africans — the largest such group in the United States.
In 2017, Samuel Sigal, MD, a gastroenterologist and transplant hepatologist with the Montefiore Medical Center, the clinical arm of the Albert Einstein system, launched the Montefiore Einstein Starfish Program to address high rates of hepatitis B in the West African community. The AAMC grant now supports engagement efforts specific to COVID-19 vaccination via that program.
Anne-Marie Tehn-Addy, a coordinator with the program, says adding engagement efforts related to the COVID-19 vaccines made sense. “It makes it easier for us to come in because it gets folded into the existing programming” and leverages existing trust-based connections. She says many West African churches in the Bronx already have some kind of health team in place and connecting with these leaders is the main goal of the program.
While many adults have mixed thoughts on the impact of sharing their information, certain demographics are more likely to think that sharing their information could have a positive impact on their personal health or the health of others — particularly those with higher incomes, those with liberal political views, and millennials. This is according to new polling by the AAMC Center for Health Justice.
Regardless of the type of data, more than half of adults reported feeling comfortable sharing their information with health care providers other than their doctors, federal health-related agencies, and state and local public health agencies. However, less than a third of adults felt comfortable sharing their information with corporations or businesses.
Monthly meetings with these leaders helps uncover whatever might be holding members of the community back from getting vaccinated. They also give the team insight into the sorts of resources the faith-based community leaders need to make the case for public health initiatives to their congregants.
As in Detroit, testimonials and allowing individuals to speak their truth has been a powerful piece of the puzzle, Tehn-Addy says.
“We open the floor for people and we’ll talk about some of the misconceptions that they’ve heard and their general experience with COVID-19,” she says. “From that discussion, we continue to present and talk about COVID-19 and the vaccines and address concerns.”
At these events, they also often have vaccine doses available on-site, ready to be injected straight away. In other cases, they refer folks to local pharmacies and clinics for vaccination.
Another touchpoint for distributing COVID-19 vaccines occurs via the hepatitis B screening activities the Starfish Program has been conducting for several years now. During those screening sessions, Sigal says he’s been surprised to see that most of the individuals who’ve come in have already been vaccinated against COVID-19.
But this is among the folks who enroll in the screening sessions, and there are still plenty of individuals who have not yet taken part in informational or screening sessions. Reaching them remains the focus of the project.
Tehn-Addy, whose family is from Ghana, says one issue particular to this immigrant community is that not everyone is comfortable signing up for something or having their information added to a database. Some individuals feel “that’s invasive,” she says.
They have been able to work around that by distributing informational materials and offering encouragement via several WhatsApp groups that many members of the community use.
Other hurdles they’ve had to overcome include misconceptions about whether the COVID-19 vaccines can affect fertility. There is no evidence that any of the COVID-19 vaccines can alter fertility in anyone, but the persistent myth has caused many people to hesitate about getting a shot.
Others are worried about the possibility of developing cardiomyopathy or other toxicities they’ve heard could occur with the new vaccines. Again, combating these misconceptions with facts delivered by faith leaders the individuals trust has been helpful.
“Most West Africans are very religious,” Sigal says, and incorporating discussion of COVID-19 vaccines into the health screening efforts already underway at houses of worship has built trust that the Albert Einstein team is there to help, not harm.
Fatima Omarufilo, a patient navigator with the Starfish Program, visits mosques and churches in the community to deliver that education and care.
“Educating the community and fulfilling what we say we’re going to do builds trust,” she says.
“Whatever we promised we would do is being done,” she says, whether that’s providing informational materials, refreshments, or access to a clinic for health screenings and vaccination.
Tapping into the power of the community is the core of the project, Tehn-Addy says, noting that they emphasize the idea that “you’re getting a vaccine not just for yourself but also to help protect others in the community who are more vulnerable or who can’t get vaccinated.”
Still, there are some holdouts, Omarufilo says.
“We have a lot of people in the community who are so reluctant,” she says.
This isn’t confined to just the COVID-19 vaccines; it’s a challenge for any kind of health screening, she says, as those who must work long hours to make a living often can’t make time for annual check-ups and other routine health care.
Efforts to convince these folks to say yes to COVID-19 vaccination, as well as blood pressure and hepatitis B screening and the hepatitis B vaccine, are ongoing, Omarufilo says. The good news is, there’s plenty of hope the team will achieve their goal of a 100% vaccination rate — if one woman’s story can stand as testimony.
“The COVID-19 vaccine was actually her first vaccination in the United States after being here for more than 20 years. She told me that she took the COVID-19 vaccine and nothing has happened to her. So she’s coming to take the hepatitis B vaccine,” Omarufilo says. That woman has already gotten her first hepatitis B vaccine dose and is scheduled to come back for the second shot in the series in the near future.