Mobile Flu Clinic to Address Vaccine Disparity in African Americans 1

Mobile Flu Clinic to Address Vaccine Disparity in African Americans

Lisa Mayer

Influenza virus (flu) is a seasonal infection that causes symptoms ranging in severity

from discomfort to life-threatening. For most people, a flu infection will result in a few

miserable days of achiness, fever, and congestion, but for some, complications such as

pneumonia, congestive heart failure, or chronic pulmonary obstructive disease could lead to

death (n.a., Estimating Seasonal Influenza-Associated Deaths in the United States, 2018). For

most healthy adults flu complications are unlikely, however, even a milder form of the illness

could have serious implications if it prevents one from taking care of one’s family or going to

work. Receiving the flu vaccine is a relatively easy way people can protect themselves from

catching the illness. The vaccine is cheap or free under most insurance plans and is provided at

a huge variety of locations, but negative perceptions of the vaccine and the healthcare system

keep many individuals from getting the vaccine.

These perceptions were found to be a contributing factor in lower vaccination rates in

African Americans as compared to white Americans. Although mistrust of the medical system is

not solely determined by race, one group of researchers found that African Americans were

more likely to express these sentiments in relation to the flu vaccine than white Americans.

Their survey results indicated that African Americans reported lower levels of trust in the

vaccine’s efficacy, lower levels of trust in the vaccine process, higher levels of concern about

risks from the vaccine, and overall, a more negative outlook on the vaccine (Sandra Crouse

Quinn, 2017). Many factors contribute to these sentiments, but two significant ones are
 Mobile Flu Clinic to Address Vaccine Disparity in African Americans 2

historical abuse of African Americans by the medical community and continuing unfair

treatment of African American patients by medical professionals due to bias.

Medical practitioners have a long history of taking advantage of non-whites to further

their research. Although these unethical practices have since been banned, racism within the

medical system persists. African Americans reported feeling that their race influenced the

quality of their care (Sandra Crouse Quinn, 2017). Personally mediated discrimination between

doctors/nurses and patients could be a component of this feeling (Jones, 2000), however the

historical abuses of African Americans in experiments such as the Tuskegee Syphilis Study

represents institutionalized racism that is only beginning to be addressed (Jones, 2000; Sandra

Crouse Quinn, 2017). This and other forms of racism may contribute to findings that doctors

still demonstrate implicit racial bias with their patients. Some of these discrepancies include

overdiagnosis of African Americans with stereotypical diseases, such as HIV and sickle cell

anemia, and assumptions that African Americans will not comply with their treatment plan

(Zestcott, Blair, & Stone, 2016). These experiences do not go unnoticed by patients even if they

do not lead to significant negative health outcomes. African American patients may be less

inclined to trust a doctor after one of these experiences and could convince friends and family

to feel the same way.

Because race is an influence on the difference in flu vaccine rates between African

Americans and white Americans, it meets the World Health Organization’s definition of a

disparity. The key component in a disparity by this definition is an “’unfair and unjust’” nature

of the health difference, which Herbert, et al. goes further to describe as a difference that
 Mobile Flu Clinic to Address Vaccine Disparity in African Americans 3

arises from conditions individuals did not choose (Hebert, Sisk, & Howell, 2008). Race, and the

historical implications and cultural values that come with it, is clearly not something one can

choose. Lower vaccination rates leave African Americans disproportionately vulnerable to

catching the flu and therefore making them more likely to experience the negative effects of

the illness such as missed days of work, cost of care, and inability to care for family members

while sick.

Although the health of the entire community is important, in order to repair the

disparity created by this situation, an intervention needs to focus on improving health the

group that is at a disadvantage (Robert Wood Johnson Foundation). Using a social

determinants of health approach, this means creating an organization that prioritizes the

healthcare needs of the African American community and the social elements, such as mistrust

of the healthcare system, that affect them. To address the flu, this organization would take the

form of a mobile flu shot clinic that travels to community centers and churches to administer

free or discounted vaccines. Following the model for collective impact, this effort would include

nonprofits like local community organizations that will help ensure the clinic meets their needs.

They could also collaborate with local government that can give credibility to the organization

(Koo, O'Carroll, Harris, & DeSalvo, 2016). This approach may unfortunately struggle to attract

partnership from businesses; providing free or low-cost vaccines gives little opportunity for

profit and may not attract investors. This could mean challenges for finding funding and,

although they would be staffed by volunteers, cost of vaccines, educational materials, and

travel expenses must be considered.

 Mobile Flu Clinic to Address Vaccine Disparity in African Americans 4

In Detroit, a traveling flu clinic has the potential to reduce flu vaccine disparity in the

79.1% of the total population that identified their race as Black or African American in the most

recent census (n.a., Quick Facts Detroit City, Michigan; Michigan, 2017).The clinic could be its

own organization, but would benefit from collaborating with a local public health organization,

such as the Detroit Department of Health, that has already built trust and networks within the

community. Everyone affiliated with the project would need to complete training for cultural

competency and reducing bias so they can better connect with patients. Although in the paper

“Eliminating health disparities in the African American population: the interface of culture,

gender, and power.”, Arihihenbuwa & Liburd argue that the cultural competency at the

personal level is short-sighted, it is the right level for immediately addressing the discomfort

patients may have with the flu shot experience. Additionally, the system-level cultural

competency that authors believe must be developed for long term reduction in disparity could

be achieved by educating policymakers once the clinic is established (Arihihenbuwa & Liburd,

2006).

In addition to the training, volunteers should work closely with their community

partners. Visiting churches or community centers would automatically give credibility as it

represents an endorsement by other members, particularly religious or community leaders.

Bringing vaccines to the patients increases access and both location and community partners

would encourage them to actually receive the vaccine. This is important because, in addition to

making this initial flu shot experience as comfortable as possible, an ideal visit should make

patients more interested in receiving subsequent vaccines. One vaccine is not sufficient to

reduce lifetime impact from the flu, so it is critical that people elect to receive annual vaccines.
 Mobile Flu Clinic to Address Vaccine Disparity in African Americans 5

Ideally, the traveling clinic would be able to make annual trips to each location in order to give

the most recent version of the vaccine.

Making the vaccine as accessible as possible in Detroit is an intervention on the

community level, but larger change could be affected once the clinic is established. Initial

volunteers could train public health workers, medical practitioners, or even policymakers on

how to create a similar group in their own community. They could also share literature and

protocols they have already created. Ultimately, this could reduce vaccine disparities across the

country and could become a foundation for expanding healthcare facilities designed for African

Americans across the United States.

Reducing the disparity in flu vaccination rates may seem minor, but its value lies in

avoiding illness and its negative lifestyle impacts. For someone who earns an hourly wage,

missing several days of work could mean not being able to pay bills or buy food. For a single

parent, this could mean not picking up a child from school or preparing them dinner. Every

demographic should have the same access to a vaccine that would make them less susceptible

to these struggles. Bringing a mobile flu vaccine clinic to African-American communities in

Detroit each year, and using social determinants of health strategies to ensure that the clinic is

well-received, will make a lot of progress toward this goal.

 Mobile Flu Clinic to Address Vaccine Disparity in African Americans 6

Bibliography
Arihihenbuwa, C. O., & Liburd, L. (2006, August). Eliminating Health DIsparities in the African
American Population: The Inerface of Culture, Gender, and Power. Health Education and
Behavior, 33(4), 488-501.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, II, O. (2003, July 1). Article
Metrics Related Articles Cite Share Request Permissions Explore More Download PDF
Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic
Disparities in Health and Health Care. Public Health Reports, 118(4), 293-302.
Hebert, P. L., Sisk, J. E., & Howell, E. A. (2008, March/April). When Does A Difference Become A
Disparity? Conceptualizing Racial And Ethnic Disparities In Health. Health Affairs, 27(2),
374-382.
Heintzelman, C. A. (2003, Fall). The Tuskegee Syphilis Study and Its Implications for the 21st
Century. The New Social Worker, 10(4).
Jones, C. P. (2000, August). Levels of Racism: A Theoretic Framework and a Gardener's Tale.
American Journal of Public Health, 90(8), 1212-1215.
n.a. (2017). Quick Facts Detroit City, Michigan; Michigan. Retrieved from United States Census
Bureau:
https://www.census.gov/quickfacts/fact/table/detroitcitymichigan,mi/PST045217
n.a. (2018, January 29). Estimating Seasonal Influenza-Associated Deaths in the United States.
Retrieved November 2018, from Centers for Disease Control and Prevention:
https://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
Robert Wood Johnson Foundation. (n.d.). What is health equity? And what difference does a
definition make? 1-4.
Sandra Crouse Quinn, P. A. (2017, February 22). Exploring Racial Influences on Flu Vaccine
Attitudes and Behavior: Results of a National Survey of African American and White
Adults. Vaccine, 35(8), 1167-1174.
Zestcott, C. A., Blair, I. V., & Stone, J. (2016, May 8). Examining the Presence, Consequences,
and Reduction of Implicit Bias in Health Care: A Narrative Review. Group Process
Intergroup Relat., 19(4), 528-542.