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The flu can kill. In a bad year as many as 52,000 people in the United States die from complications of influenza, according to the Centers for Disease Control and Prevention (CDC).
A vaccine decreases a person’s risk for serious flu complications and the CDC recommends annual vaccination for pretty much everyone, including kids as young as 6 months. But stark racial and ethnic vaccination disparities in the United States are leaving many unprotected.
Fewer than 43 percent of Black, Hispanic or Latinx, and American Indian/Alaska Native (AI/AN) adults were vaccinated during the 2021–2022 flu season, compared with around 54 percent of white and Asian Americans.
Compared with white adults, flu-related hospitalizations are 80 percent higher among Black adults, 30 percent higher among AI/AN adults, and 20 percent higher among Hispanic or Latinx adults, according to the CDC.
The many reasons for these disparities include deep racial inequities in access to healthcare, lack of culturally sensitive information about vaccination, and a history of racism in the American healthcare system (as with the infamous Tuskeegee experiment) that has left many people distrustful.
“This is the mountain we have to climb,” says Bernard Macklin, PhD, a CDC Flu Fighter and community outreach and education coordinator for the CDC-funded Community Alliance for Research and Engagement (CARE) at Southern Connecticut State University in New Haven.
Flu shot warriors like Dr. Macklin are working to promote vaccination from within communities of color: talking to people face to face, listening to their concerns, meeting them where they are (even if they remain unsure about getting a flu shot), and answering their questions.
For many of these flu shot advocates, the choice to take on this challenge comes from personal experiences. In the most tragic instances, the motivation is the death of a loved one.
Some, like Macklin, have made promoting vaccination their career and are leading teams. Others fight the fight more quietly, by sharing their own stories of loss with others in their community and tapping into the power of empathy.
Promoting Vaccination Requires Building Trust
Macklin says his brother’s death from complications of diabetes was a wake-up call for their family, many of whom also have diabetes, to take charge of their health. Shortly after his brother’s death, Macklin (who has a PhD in theology and a passion for ministry) began working with CARE to spread vaccine awareness in inner city communities in New Haven.
Macklin says that strategies for closing racial vaccine inequities must be rooted in building trust. This often starts with people getting information about the flu vaccine from individuals they can identify with and believe have their best interests in mind.
Many people of color have experienced discrimination in medical settings, seeding distrust. A meta-analysis of 95 studies, published in 2022 in the journal Health Equity, found that individuals who experienced racial stereotyping by healthcare professionals were less likely to seek out vaccination, as were those who had general mistrust in the system.
“I’m a Black man and I know that if I wasn’t on the inside, I would have some of those same feelings,” Macklin says. “When it comes to past hurts, we don’t heal too quickly because that hurt hasn’t been resolved. People of multiple ethnicities in this country feel they aren’t being heard, they aren’t being taken care of, and they aren’t being listened to.”
Through CARE, Macklin has spent years partnering with local hospitals in the New Haven area to provide free vaccination and testing and disseminating vaccine information “any way possible,” he says. “We give out flyers and put up posters, yes, but we also have clinics throughout the New Haven area promoting wellness, which includes vaccines.”
Building trust takes years of continued partnership.“Temporary programs are not enough. Longevity is the answer — continuing to provide funding, education, and programming in these areas until people know you are actually serious about vaccine equity,” says Macklin.
The biggest thing is being there for the community, he says: “We put out a constant message that we care about them. We want the community to really know that we are serious about their health and removing disparities.”
Sharing Powerful Person Stories Can Make a Difference
Bethany Drapeau is Ihanktonwan Dakota and enrolled in the Yankton Sioux Tribe. She understands the barriers to vaccination in her primarily Native American community in Wagner, South Dakota, and brings that awareness to her efforts to promote the flu shot.
Influenza vaccination rates among AI/AN people vary greatly between states and tribes. Indian Health Service (IHS) data from the 2020–2021 flu season showed an overall vaccination rate of about 20 percent in California and Oklahoma and 43 percent in the Navajo Nation (for those served by IHS, rather than clinics outside the system).
“Forty seven years ago the government sterilized Native women without their permission. The consequences of these practices continue to harbor concerns about vaccines,” Drapeau says.
Drapeau knows first-hand that the flu can be deadly. By sharing what happened to her daughter Amiah MorningStar Houseman, she works to convince others to protect themselves.
When Amiah was 4 years old, she tested positive for influenza B after a week of being sick and two previous visits to the clinic.
Drapeau remembers the doctor saying, “B is for bad. Watch her closely.”
The following day, Amiah wasn’t able to keep any water down, so Drapeau took her to the emergency room. Tests revealed her kidneys were damaged. After 12 hours of care, Amiah was airlifted to a children’s hospital where she died shortly after Easter in 2017.
Each fall when Drapeau gets a flu vaccine along with her family, she posts a photo on social media, reminding her network of Amiah’s story. She also hangs a Families Fighting Flu poster in the local business she runs. The town is small, and Drapeau says people know what happened to her family — which in and of itself is a powerful tool for vaccine education.
“I think sharing Amiah’s story will help others to understand why getting the flu vaccine is so important to me now,” she says. “It allows people to see beyond statistics or generalizations about vaccines.” Drapeau hopes “it will touch the hearts and minds of others.”
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