Community-based Strategies to Engage Pastors Can Help Address Vaccine Hesitancy and Health Disparities in Black Communities

"Further evidence to document the effectiveness of faith-based approaches to building vaccine acceptance and reducing health disparities may support expanding investments to address a growing problem of vaccine hesitancy."

Despite the promise of COVID-19 vaccines to curb the pandemic, many members of the African American community distrust them and the system that touts them, given a history of structural racism and mistreatment and many other current concerns. In light of the need to protect this community, which faces a disproportionate amount of disease, this paper presents a framework to build trust and acceptance, including: understanding history and context; listening and empathising; engaging Black pastors as trusted messengers; creating partnerships with shared responsibility and power; and co-creating solutions with faith leaders and their community, governments, and institutions to create sustainable, long-term change.

As outlined here, the factors influencing immunisation decision-making among the African American community are complex and may include limited access to care, lower health literacy, systems issues including unequal treatment, attitudes and beliefs, racial awareness or discrimination, and failure of the health system to implement community-based models to address disparities in the health system prior to COVID-19.

Given that religion plays an important role in the Black community, partnering with pastors and religious institutions can help in initiating discussions and can act as a bridge to government or institutions that are experts but not necessarily trusted by the community. Trusted messengers such as pastors recognise there is a wide spectrum of vaccine-hesitant people and vaccine deniers, and all for different reasons. This trust has been earned based on years of service.

In light of these factors, the authors urge that listening to the concerns of the community occur prior to launching a campaign to implement messaging intended to increase vaccine acceptance. Their experience in Baltimore City, Maryland, United States (US) to engage Black pastors alongside public health professionals to empathise with how COVID-19 has impacted the community and listen to the concerns about vaccines was an important first step in building trust and understanding.

They explain that pastors are accustomed to encountering people with different beliefs, but they are able to provide a framework that enables people to see the bigger picture and hold onto their core beliefs and practices consistent with the learnings of their faith. Likewise, in the case of COVID-19 vaccines, they can acknowledge past and present mistreatment and yet reframe this experience to focus on achieving a shared vision that aims to protect the community. "People in congregations do not always agree with messages delivered by their pastor, but because the church can be considered a 'safe' space, it is one where people will listen - an important consideration when starting with a level of distrust."

Specifically: "Trusted messengers are most effective when their input helps devise strategies that are targeted to the needs of their community versus providing a rubber stamp for campaigns that have already been developed. Community-based interventions are successful because of shared engagement and shared power. Pastors have the potential to set the tone and design the message based on what is best in their community. It is crucial that they are co-creators of messaging that tell a story based on what they know will work with their community."

In conclusion: "The time of COVID-19 presents an important opportunity to better understand the social determinants of health and engage with the community to take a more person-centered approach....There is an evidence base of what is needed to address health inequities, build empathy and political will to address racial disparities, and ensure access to health in places that are trusted..., but clearly more is needed. Changing social norms and building trust around vaccination takes time, but is an important part of the process in building vaccine confidence and acceptance in high-risk communities....Sustainable efforts are needed now to establish relationships with communities and to lay the foundation for both COVID-19 vaccines and future interventions."