I have a philosophy that I often share with the teams I work with. Mistakes are a natural part of life. I make mistakes all the time. But I try to understand the mistakes I make. I try to figure out what I can learn from them. A mistake, repeated, could mean that I haven’t learned from it yet. Instead, if I do make a mistake, I would rather it be a different one. New mistakes provide us new opportunities to learn. New mistakes can mean we’ve learned from past mistakes and moved past them.
A component of my new assignment is to help overcome what is often described as vaccine hesitancy. Some people use it to explain why BIPOC populations lag behind other groups for covid vaccinations. It’s an easy explanation to say that some populations are hesitant or resistant to get vaccinated.
Earlier this week, a colleague suggested we reframe our language. ‘Vaccine hesitancy’ zeroes responsibility on the person who hasn’t gotten vaccinated. To be sure, some people are reluctant to receive a covid vaccine. But for many, it’s not reluctance that’s the problem. It’s ease of access. People in communities of color may not know where to get the vaccine. They may not be able to read the flyer advertising it. They may not be able to drive to the vaccine site. They may not be able to get time off work. They may worry about feeling the vaccine side effects before their next shift. They may dislike, not trust, or not have a healthcare provider. They may not have anyone to care for their children. And they may have general concerns about the side effects of a vaccine that’s only existed for a few months. They may wait to wait and see what happens next. They may have more pressing issues to attend to than a vaccine that will be there later.
What’s easy to forget are the same old mistakes. The people doing the work are often in their roles because of systemic racism. The same problems plaguing communities of color before the pandemic are still here. None of those problems disappeared in our new norm. In the past year, those problems may have gotten worse.
My friend Christina shared with me another issue hindering vaccination rates. Canada relies on community and faith based organizations to help distribute the covid vaccine. Their health agencies work with such groups to improve vaccination rates. One group, Friends of Chinatown Toronto (FOCT), published a letter about their experience. Their letter describes what weakened our efforts to vaccinate as many people as we can. The health system asked the volunteer group to lead the way for outreach. FOTC felt let down by a vaccine response that shared their goals but did not meet their needs.
I recommend reading their letter before relying on my paraphrasing. FOCT describes the broken promises made by the clinic system they partnered with. The clinic promised needed language interpretation they did not deliver. Clinic workers acted in condescending ways to their volunteering partners. Worst of all, the issues led to community members feeling scared, used, or unvaccinated.
In the food bank world, all it takes is one bad experience to keep someone from ever coming back. A person may need to overcome the stigma associated with the charity of food banks. Lots of people can only muster up the courage to go once. If that experience doesn’t go well, a person may decide that this service is not for them. We may never see or hear from them again. I doubt it’s because their food insecurity has gone away.
what do the experts recommend?
The FOCT shared their demands in the letter. It’s important to note that these are not requests of an oppressor, but demands of an equal. Some of my takeaways from their demands:
- Let the community lead
- Pay your experts like experts
- Lead with outreach
- Make the entire system accessible
These are vital and necessary improvements. Program improvements often come after a program’s launch, when it can be too late. Once you’ve spent valuable time, money, and trust to do it wrong, you will have already lost people. It’s frustrating to spend not enough money to try fixing a badly-designed system. What if we designed it better from the beginning?
from the ground up
Establish clear goals. Who do we want to vaccinate? What resources and leverage do we have to do it?
Establish clear outcomes. How can we cut the usual disparities? Who do we need to focus on, over all else, to break the pattern? Who do we usually miss or exclude? Again, we can’t think of these things as accommodations. We are trying to build a distribution and delivery system from the ground up.
Develop a clear strategy. This can happen within a small steering committee or as part of a larger group. Let community groups determine how we distribute a limited supply. Exchange information on how we can best meet the needs of our high-priority groups.
Learn from each other. Learn as equals! Do away with outdated power dynamics from the beginning. People with the health authority have technical and scientific expertise. They hold access to vaccine because of their placement in the health system. Community groups have ties to and awareness of the needs of people in their area. They have connections to elders and respected community members. They have relationships that existed before the pandemic and will endure long after. And when we talk about “community” I mean taking the time to meet with people most affected by the issue we’re trying to change. It can mean finding people who are doing the work as a labor of love and building trust and respect with them. Be sure to compensate them for that labor of love. Nobody can pay the rent with praise from an organization.
Work together from the beginning. Community-driven solutions may look unfamiliar to people in power. They should reject the white-dominant approach to solving problems. They should be careful to avoid a top-down, paternal approach that disrupts so many good intentions. It’s always easy to do what’s been done before. Doing what’s new will take time; your success may not look like success at a pace that you’re used to.
I would codevelop a process that looks like participatory budgeting. Seattle Public Schools used a participatory budgeting toolkit to understand racial disparities. I would use a similar process to create an equitable vaccine distribution system. This process could decide how to spend the money the region can spend. It can also create a vocal coalition to demand a different amount of money to do this right. Either way, this process can help allocate funds based on need and the total sum of money. The FOTC demands paying volunteer community members as much as the public health staff receive. When you are equal partners in a strategy, equal pay feels like the only fair solution.
Bake in accessibility. So many of these ideas came from the FOTC letter. Start—from the beginning—with a goal to make your program 100% accessible. Students attending Seattle Public Schools speak close to 130 different languages. When you start with that number, it feels absurd to me that we’d prioritize English only. Imagine adding Spanish to that list, as many organizations would want to do. You’d have 128 more languages to go. This doesn’t include additional support for people who are visually impaired, Deaf, hard of hearing, dyslexic, or unable to read. Nobody benefits when we underfund translation and interpretation services. Another aspect of accessibility is physical. How can people get to our distribution sites? Where do we locate them? Plan for the reality that some people only have time to be vaccinated after 9-5 business hours. FOTC also demands giving priority in line to people who don’t have a long amount of time off work.
Ensure accountability. I don’t know what I don’t know. I rely on my colleagues to help me with that. I do not operate in a hierarchy. I can’t veto your idea just because I disagree. When we make decisions together, we stand by those decisions. We don’t leave or cut funding before our plans can work. Instead, we share concerns and work to understand before making rash decisions. Split-second decisions often rely on instinct. They can have lasting negative impacts on our populations of focus.
I took meaning from the FOTC’s telling of their experience. There is a sense of disregard for the community coming from the clinic and its staff. This could have been stress, or burnout, or a bad day. But the impact on the community and these volunteers was the same. We enter communities with a sense of being an outsider who knows better. This neoliberal fantasy shows up in our humanitarian and military interventions. But in the real world, we are not the expert. We are an expert in a sea of experts. We all bring something unique to the table. That’s what it means to be in community.
the fire next time
Before we can make new mistakes, we have to learn from the old ones. Back to vaccine hesitancy, I often hear the litany of racialized justifications. The unequal historic distribution of services. The generations of racist doctors, public health workers, and people in power. The community members who can’t focus on a vaccinated future while facing the problems of today. We know these things and we can say them to each other. But we have to start talking about what we’ll do differently to reverse them.
We have to make overtures to community that are meaningful and not tokens. We have to invest in our community relationships now, before we need something. We have to listen first and then act on what we’ve learned. We have to distribute the power we currently hoard.
It’s not enough to close the gap. We have to do better. We have to start now.