Nurse Leader Shares Five Lessons on Breaking Down Barriers to Vaccination
A nurse leader who has been vaccinating a diverse community offers a candid assessment of false starts, wisdom gained, and the best way forward.
Maria S. Gomez is a public health nurse who received a Presidential Citizens Medal in 2012 from President Barack Obama. She along with other colleagues founded Mary’s Center in 1988 an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. Today, it serves over 60,000 people each year. Here, Gomez shares lessons learned through Mary’s Center vaccination program.
Lesson One: No Wrong Door
Mary’s Center’s vaccination program didn’t have an easy start. Like the community we serve, our team was fearful and struggling in the pandemic. Suddenly, there was a vaccine that offered promise to keep us safe, but people were confused and anxious about it. It fell to us to provide information—but first we had to educate ourselves. There was no shortcut and no chance of success unless we did. So we put in the time, even holding Town Hall Meetings with our team of nearly 800, to learn and become effective messengers.
We learned that for some in the Mary’s Center community, a lack of trust stemmed from our country’s history of medical abuse—and not just horrors like the Tuskegee syphilis study but also more recent atrocities including involuntary sterilizations of Puerto Rican women and of women detained at the U.S. border. Many in our community have experienced those abuses well.
Some worried about being a burden on their host country by taking a shot someone else might need more. Some feared that accepting the vaccine could make it harder to get immigration papers. Some were deterred by misinformation about a fee associated with the vaccine or visit to get the vaccine.
We learned to address all of this. We initiated conversations with everyone and tackled worries head-on. There was no wrong door to come through to talk about the vaccine. If you came to Mary’s Center for a child’s check-up, dental care, a pre-natal exam, or to pick up a check to pay the rent, you had a conversation about vaccines. By talking and listening, we learned what strategies made our clients feel safer and more comfortable with being vaccinated.
Lesson Two: No Wrong Messenger
We soon saw everybody as a vaccine messenger. As our staff and their family members were vaccinated, we shared the joy that came with their newfound freedom to move around more freely. When a teen came in for homework help, we suggested she encourage her grandmother to get a vaccine. Sometimes our best messenger was the person focused on mopping the floors, because the client she was chatting with had been doing the same thing at his job a few hours earlier.
People may not trust the medical establishment, but they trust their own doctor or nurse practitioner. It’s powerful when our clients see their doctor on Facebook or YouTube talking about the vaccine! I’m so impressed with what our Black community has been doing with barbershops and hair dressers; it works because there’s so much trust and the vaccinators are right there.
Mary’s Center has partnered with our local utility company, Pepco, in two ways. First, to administer their philanthropy commitment to keep the community connected to their utilities, and second, to vaccinate their line workers so they are safe when they are working in the community. We partnered with local chambers of commerce to reach small businesses that employ our clients. And we’ve learned the power of telehealth; it has saved lives and been especially important for the disability community and those facing mental health problems in the pandemic. Without telehealth, we would have lost many more people to drug overdose and suicide.
Lesson Three: No Wrong Moment
We believe fervently that there should be no wrong moment to get the vaccine. I’m convinced that it was a mistake to have limited vaccines only to seniors and people with certain pre-existing conditions at the beginning of the roll-out. We had to follow these strict rules or we would not have been allowed to continue vaccinating our community.
But I wish we didn’t have to turn away the young woman—and others like her—who struggled to take a day off of work to bring her grandparents in for a vaccine, but could not get vaccinated herself. Being forced to turn away people who wanted shots was painful. And, as we expected, now we are struggling, not always successfully, to get them back.
I hope when we look back at how we handled this pandemic, we will acknowledge that not doing so was a mistake we need to fix.
Lesson Four: Take Care of Your Staff
I’ve learned a lot about how to be an effective administrator during crisis. I learned that administrators need to stay out of the way, create a MASH unit, and give your team the tools and resources they need.
Being transparent has been essential. I cried many times with my staff. I admitted when I didn’t have answers. I stressed that we were in this together. I told them when we had enough money to stay afloat for the next week or month, and when nothing was guaranteed after that. I was in the trenches with them and made sure they saw me.
There were practical considerations. We had to feed our staff because nothing was open. And there was psychological stress. The social determinants of health were very real for our team. They have partners who are in construction, child care, sanitation and grocery workers who had to show up for work; some of them got sick and some died.
Never forget that your community is your staff—and you are nothing without them. Stay out of their way and they will deliver miracles.
Lesson Five: Time Is On Your Side
We’ve been rushing a lot over the last year. We rush to meet an established timeline, a goal set by the President, or a city directive. But sometimes people need time. Taking a vaccine can be a big decision. People need time to process it. In time, they will convince themselves to get the shot. When your grandpa has gotten the shot, you see that it’s safe. The 16-year-olds now getting their shots are the best voices for their parents. But parents also have a responsibility. We’re telling parents: You don’t give your child a choice to take showers, drink or smoke. Why give them a choice about whether to take a shot that can save their life?
As health care providers, scientists and leaders, we need to give our community time. I believe we will get there, to 80 or 90 percent of people being vaccinated, if we keep using social media, holding meetings, talking one on one, enlisting influencers like religious leaders and teachers, and doing all the things we know how to do best. It works. We just need to keep doing it and give people some time to normalize this activity, as we have with our childhood immunizations.
Dr. Rich Besser and Dr. Julie Morita shared why equity must be front and center in the distribution of vaccines. Read their op-ed.
About the Author
Maria S. Gomez is president and CEO of Mary’s Center, and an RWJF Award for Health Equity 2019 winner.