While canvassing for a COVID-19 vaccination clinic on Baltimore’s Pennsylvania Avenue, James Green met a woman who chastised him for wasting his time.
“That’s the white man’s vaccine,” she told him this summer. “They’re trying to wipe us off the face of the Earth.”
It wasn’t the first time Green, 23, heard that sentiment in his role as a vaccine ambassador for the city health department. The West Baltimore resident said he understands where it’s coming from.
“A lot of the hesitation is ingrained, even in my generation,” Green said.
After the coronavirus vaccines became available, demand was initially strong, while supplies ran scarce. Health officials knew that demand would ease and many people still would need convincing to get inoculated and help stop the pandemic. They launched a messaging campaign, including prominent Marylanders such as sports figures, celebrities, community leaders and politicians rolling up their sleeves and spreading the word that the vaccines were safe and effective for all.
Yet the number of people getting the shots now has dropped off. About 32% of the U.S. population hasn’t been vaccinated, according to national data. And several studies found that those who remain hesitant, reluctant or dismissive about getting vaccinated were more likely to distrust institutions such as hospitals, government officials and the news media. That meant that they wouldn’t necessarily respond well to messaging campaigns pushed out by recognized figures.
At the same time, disinformation and misinformation about the vaccines continued to circulate largely unchecked across the country, targeting individuals who remain unvaccinated or on the fence.
The Baltimore City Health Department and others are attempting to remedy the disparate views by deploying an army of “vaccine ambassadors” like Green into neighborhoods and communities, redefining what a “trusted messenger” looks like and who qualifies as one.
These messengers — ranging from full-time students to retired adults — are tasked with communicating the benefits of COVID-19 vaccinations to those they meet and sharing the information people need to make informed decisions.
The process is slow and time-consuming, but more one-on-one engagement will help dispel some of the myths and misunderstanding standing in the way of eligible populations and the vaccines, said Dr. Kendra McDow, chief medical officer for the health department.
McDow said ambassadors answer any questions people have about the safety, development and efficacy of the vaccines. They don’t, however, push the shots with anyone expressing reluctance.
She acknowledged that some of the distrust that exists in Baltimore and elsewhere is valid and stems from personal or historical examples of abuse in the medical system.
Since the city hired ambassadors, the percentage of vaccinated individuals has risen each week, she said. Ambassadors have logged more than 12,000 unique conversations with people since the program started over the summer, according to the latest figures from the department. That includes canvassing, setting up information tables, staffing events, and having conversations over the phone and text messages.
The city health department employs 88 ambassadors, who work 15 hours a week at a rate of $20 an hour. They are employed through a contract the department has with Johns Hopkins’ International Vaccine Access Center and Morgan State University that’s expected to be covered by funds from the Federal Emergency Management Agency.
“We know this is a marathon,” McDow said. “It’s slow and steady.”
James Green, Baltimore City Health Department
Green is a University of Maryland School of Nursing student who coordinates outreach to young men in Baltimore as part of the health department’s VALUE ambassador program.
VALUE ambassadors — shorthand for Vaccine Acceptance and Access Lives in Unity, Education and Engagement — target a range of potential vaccine recipients, including young adults; pregnant and lactating individuals; older adults; members of Black, Latino and Orthodox Jewish communities; people experiencing homelessness; people with disabilities; and immigrants.
Green said vaccine hesitation among young men of color often correlates with age.
“The scary part about young people in that age range is that they don’t do their research, and a lot of times it becomes, ‘What did I hear on the street?’” Green said.
Young men who are a bit older, he said, tend to think they’re invincible against the virus — a misconception fueled by the fallacy that COVID-19 affects only older adults. Even as the delta variant increasingly sickens younger patients and sends more children to the hospital, many of the young men Green interacts with remain ambivalent about protecting themselves, he said.
“I think we’re still stuck in that egocentric, ‘Well, it won’t happen to me,’ attitude,” said Green, a Morgan State University graduate.
While Green acknowledged that many young Black men have rejected his efforts, he has scored some wins. He said it helps that the ambassadors appear at the same time and same locations each week, which helps establish trust. For recurring clinics at Coppin State University and the Druid Hill Farmers Market, the ambassadors spread out on foot into the surrounding neighborhoods.
Green likened his group of vaccine ambassadors to “party promoters.” But they can’t each rely on a script to “promote” the clinics, he said. The conversations have to be personal, genuine and authentic.
“It’s tricky, right? Because if you try to talk to someone about changing their behavior, even if they have a maladaptive thought process behind the change, it’s not good for you to outright directly challenge that,” he said. “Because once you [invalidate] someone’s belief ... they’re going to stop listening to everything you say.
“So, I meet them in the middle. I say, ‘Hey, I thought the same thing. I still have those reservations sometimes. But let me tell you something: This is not designed to hurt you. This is designed to help you.’”
Dr. Kathleen Page, Maryland Department of Health
When Dr. Kathleen Page left Latin America in the 1990s to study medicine in the U.S., she figured she’d return south with her medical degree someday. But instead of going home, she settled in Baltimore and focused on serving the Latino community as an infectious disease physician.
The associate professor of medicine at the Johns Hopkins University School of Medicine is one of more than a dozen ambassadors promoted by the state health department’s GoVAX program. She spends two days a week visiting clinics throughout the Baltimore area, urging fellow Spanish speakers to get vaccinated. On a recent Sunday, Page brought her knowledge to Fiesta Baltimore, an annual celebration of Latino culture, in Patterson Park.
Page said most people she encounters through the state’s outreach program eventually agree to get vaccinated. Many people have ill-informed perceptions about side effects they could experience after getting the shots, she said. Also, she has convinced pregnant people that the data overwhelmingly supports them getting vaccinated.
“Having a doctor that speaks Spanish is very, very reassuring to some people,” said Page, whose family is from Uruguay. She distilled her philosophy to three pillars: “Right place, right time, right language.”
Page estimates that about 10% of the people who refuse to get vaccinated do so because of religious beliefs. She doesn’t try to talk them out of their convictions, she said. But she does answer questions and offers people the number for the COVID-19 hotline (667-600-2314) of the Esperanza Center, an immigrant resource center, so they can talk it over further.
The more contagious COVID-19 delta variant, along with vaccine mandates in workplaces, have been motivating more people to seek out vaccinations, Page said. As the numbers continue to rise, she thinks more people will let their guard down and get the shots.
“The most influential thing is seeing others get vaccinated,” Page said. “They saw their neighbors and friends get it, and they were fine.”
Willietta Gombeh-Fonjungo, Baltimore Health Corps
Willietta Gombeh-Fonjungo has heard all the myths since joining Baltimore health officials in city neighborhoods through a program called Baltimore Health Corps: “The COVID-19 vaccine makes you more sick than the disease.” “It alters your DNA.” “It tracks your whereabouts.”
She spends her days delivering real information, and some reassurance, to people who remain hesitant to be vaccinated. The program is a ready force of some two dozen community health workers and supervisors. It’s been trained with the assistance of Johns Hopkins University’s Jhpiego, an international nonprofit health care organization, and other groups.
The 24-year-old joined the effort not long after moving to Baltimore from New Jersey with her new husband and her new degree in public health. She was from a family of nurses and eager to get on the front lines — in this case outside, on sidewalks, in neighborhoods.
Now a site supervisor, she leads canvassing teams that hand out flyers about vaccination clinics, answer questions and debunk the persistent misinformation that keeps people from getting shots.
“The number one thing I do is dispel all of the things people hear,” she said at a recent clinic at a city high school, where the inaccurate refrains were that COVID-19 doesn’t infect kids or their cases are never that bad.
Gombeh-Fonjungo said she often visits the same places multiple times, approaching the same people, and she hopes, making them trust her. She feels fulfilled each time it works, like when a security guard at a grocery store finally agreed to a shot.
She once approached a half-dozen men outside a library with a big smile and an offer to answer questions about the vaccine. All refused, though one said his mother wouldn’t let him visit until he got a shot. Gombeh-Fonjungo asked whether he understood that his vaccination would protect her, too.
After some follow-up questions answered by a nurse, and Gombeh-Fonjungo offering to hold his hand through the process, the man not only got the shot, but talked another friend into doing it, too.
“It’s become personal,” she said. “We clap when people get vaccinated.”