| Washington, DC — Responding to the disturbing reports of vaccine hesitancy and dip in demand for the COVID-19 vaccine, the National League for Nursing has issued a call for research and analysis to assess societal structures that can impede vaccination campaigns, especially in communities of color. Published as the latest entry in the League’s Vision Series, The Equitable Determinants of Access to Vaccine Distribution and Vaccinations for All examines intersecting cultural, economic and social realities that historically have conspired to prevent Black and Hispanic people as well as other people of color from having equitable access to quality health care. The statement then asks what must be done to effectively implement widespread immunization of them and all vulnerable populations traditionally overlooked or neglected by the nation’s health care system.
In addition to racial and ethnic minorities, these sectors include people who identify as LBGTQ+; the homebound elderly; homeless individuals and families; victims of PTSD; those living in geographically remote locations without nearby medical facilities or adequate public transportation, as well as impoverished multi-generational crowded households that increase risk of infection spread; and others living with disabling physical and mental health conditions.
“The Board of Governors approved this Vision Statement because nursing’s recent experiences with COVID-19 are likely not to be our last concern related to vaccinations that have the potential to make the entire world safer,” said NLN Chair Dr. Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAONL, FAAN, Professor and Dean Emerita at Texas Tech University Health Sciences Center and president of The Wise Group. “Unfortunately, structural racism, racist policies and the social determinants of health have engendered too much mistrust of the health care professions and institutions responsible for safeguarding everyone’s public health and must be addressed.”
“The implications of the current COVID-19 crisis extend to all communicable diseases, future pandemics, and natural and man-made disasters,” said NLN President and CEO Beverly Malone, PhD, RN, FAAN. “If interventions like vaccine campaigns are to succeed, there must be an understanding and acknowledgement that while all individuals are of equal worth, not all individuals are at equal risk or pose an equal risk to others. Reducing the risk to everyone means reaching those in underserved, marginalized circumstances and gaining their confidence.”
Among the entrenched barriers to vaccine and other health care access the Vision Statement identifies:
• Health insurance: none or underinsured
• Citizenship status: fear of deportation
• Health literacy: lack of access to valid, reliable information
• Technology: No Internet access or a lack of comfort using online tools
• English literacy
• Geography: remote communities, lacking transportation to nearby medical facilities, as well as urban environments where multi-generational, crowded living conditions increase risk of infection
• Psycho-social conditions: homeless or homebound; physical or mental disability; LGBTQ+ identified
In mapping the way forward, the Vision Statement includes a number of vital essentials:
• Community engagement: Building trust through culturally competent messaging and education delivered by familiar community organizers
• Public policy advocacy: Creating collaborations between public policymakers and nursing organizations to engage frontline health care workers in direct health care initiatives, like vaccine distribution
• Public health infrastructure: Increasing federal, state and local funding for improved outreach and expanded resources directed to marginalized population sectors
• Academic and practice partnerships: Preparing a diverse nursing workforce and cultivating a model of nurses as trusted providers and communal leaders
The Vision Statement concludes with an outline of recommendations for key stakeholders, including the League itself; nurse educators, deans and directors; nurses; and public policymakers.
The complete text of this latest entry in the NLN Vision Series may be found at NLN.org.
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