Summer brings many observances: In June, we celebrate LGBTQIA Pride, Juneteenth, and World Refugee Day; July is Disability Pride Month and Black, Indigenous, and people of color (BIPOC) Mental Health Month. These observances are about addressing fundamental rights and the health and well-being of marginalized people. It seems timely that in August, we round out the summer with National Immunization Awareness Month. Vaccines have been one of the most important and impactful achievements of public health, but marginalization and inequity put a damper on our ability to fully realize their potential benefit to our communities.

Marginalization

A recent review in PLoS One defined marginalization as “systemic processes through which certain populations are excluded or relegated to the periphery of political and socioeconomic resources. The systemic structural and social inequalities produced by marginalization (e.g., residential segregation, disparities in employment and income, lack of access to affordable healthcare, barriers to mobility) are perpetuated by ideologies such as racism, sexism, heterosexism, ableism, and xenophobia, and increase vulnerability to poor health outcomes.” 

Throughout the COVID-19 pandemic, Black, Latinx, American Indian, Alaska Native, Native Hawaiian or Other Pacific Islanders, and other minorities disproportionately experienced higher infection rates, higher death rates, and were more severely affected by economic impacts than other racial and ethnic groups. This marginalization carried over to COVID-19 vaccination, evidenced by the Centers for Disease Control and Prevention’s COVID Data Tracker which reports disparities in COVID-19 vaccination status among racial/ethnic minorities, as well as people with disabilities, people who experience homelessness, those involved with the justice system, and more. The COVID-19 pandemic has shed light on, and in some cases worsened, health disparities that already existed.

Marginalization Leads to Health Inequity

A 2020 article in The Global Citizen captures how marginalization affects equity in healthcare: “People living in poverty cannot afford health care; people with health conditions that are stigmatized become marginalized; when women are not seen as equal to men, their health becomes less important; when racism marginalizes people of color, their needs go unmet. From financial barriers to stigma to gender to race — marginalization makes fully accessing good health impossible for marginalized groups.” We can look to Maslow’s Hierarchy of Needs which shows that basic foundational needs must be met before growth and learning can occur.  Likewise, health is foundational to all other pillars of well-being – educational, social, emotional, and economic. And vaccines are foundational to health. 

Quality healthcare and equitable healthcare access concern all citizens of a community. We should all be working to support greater access to and accurate information about preventive care, including life-saving vaccines, for everyone. Vaccines have the power to benefit us all on a community-wide scale. When one person in a community is vaccinated, they protect not only their individual health, but the health of those around them. Ensuring affordable and easy access to vaccines for everyone is how we can start to chip away at marginalization and inequity.

The Road to Vaccine Equity

Vaccines have lowered incidence of or even eliminated many infectious diseases. But while we benefit from their efficacy, it can be easy to overlook that many of the viruses and bacteria that cause these diseases still exist. In a letter to the editor from the Spring/Summer 2000 issue of NEEDLE TIPS from immunize.org, E.J. Gangarosa, MD, MS notes, “Imagine losing not one, two, three, or four, but five babies! It was common in the pre-vaccine era. Like our family, many families lost several children to these diseases. We forget. Time blurs our memories of these common tragedies of yesteryear. I remember well, during the winter and spring of each year, hearing the whoop of pertussis in movie theaters, school assemblies, and assorted gatherings. Today, few have ever heard this, and those who have, forget.” 

Individuals who are un- or under-vaccinated can spread these infections, and in communities where there are large gaps in vaccinations, we run the risk not only of backtracking and losing hundreds of years of progress toward eradicating terrible diseases, but also losing lives. What’s more, the people most at risk for adverse complications from vaccine-preventable diseases are those who have been marginalized and may not have affordable or easy access to health care treatment. We’ve seen this play out during the COVID-19 pandemic. Ensuring equitable access to vaccination is one of the best ways to prevent illness and complications like hospitalization or death. 

The National Vaccine Advisory Committee addressed vaccine equity gaps in their recommendations in 2021. Along with data reporting deficiencies, they cited access, affordability, knowledge and awareness, attitudes, beliefs, and vaccine acceptance as barriers. Acknowledging these barriers is critical to understanding how to address them on the long road to vaccine equity.

Widening the Circle: A Cooperative Effort

Efforts to widen the circle to include marginalized communities must be dynamic. We must meet people where they are at times convenient for them, and connect to them in ways that are culturally relevant. This will allow us to develop relationships, build trust, and ensure people have accurate information to make informed decisions about vaccination. This is how we can make people feel truly welcomed and turn marginalization into inclusion to pave the way for equity. 

The work of Julissa Soto, the recipient of Immunize Colorado’s highest honor, the 2022 Big Shot of the Year award, demonstrates this. Her work has resulted in the vaccination of more than 14,000 Latinx adults, teens, and children. Recently, Julissa co-hosted a Community Conversation in Spanish on the COVID-19 vaccine with Dr. Aimee Bernard, Assistant Professor at CU. After the event, she reflected:

“It was a conversation we all actually participated in. It was like we were all sitting around the kitchen table as a family. Everyone there, even the quiet ones, were part of the community family and wanted to know more. With a feeling of equity because it included everyone. Unlike most webinars, it was not talking down to but talking with the people.”

These are the types of connections we must strive to make; harnessing the full benefit of vaccines is going to take all of us working together. We cannot truly be a healthy community when marginalization and inequity are allowed to exist. This sentiment is echoed by Lilla Watson: “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” We are all bound together.

Since Immunize Colorado was formed over 30 years ago, our work has aimed to widen the circle of vaccine equity and protect all Coloradans from vaccine-preventable diseases. From establishing the Colorado Refugee & Immigrant Immunization Taskforce, launching the Colorado Vaccine Equity Taskforce, launching the Together We Protect Vaccine Equity Fund in partnership with the Caring for Colorado Foundation and 11 other foundations, and offering low-cost vaccine clinics through our Shots for Tots and Teens program, our commitment to this work is steadfast. 

But much work remains to be done! From a simple one-time or recurring donation to becoming a Vaccine Advocate to learning more about the Colorado Vaccine Equity Taskforce, or simply staying informed through our newsletter, you can make a difference to impact vaccine equity in Colorado!