Since the onset of the COVID-19 pandemic, community-based organizations (CBOs) have sought to increase vaccine uptake in underserved communities, including immigrants, Black communities, Latinx communities, and those living in rural areas. Through the Partnering for Vaccine Equity (P4VE) program, launched in 2021, many CBOs have identified barriers to vaccine uptake, both common (such as institutional mistrust and misinformation) and structural (such as limited transportation access, lack of child care, and housing instability).

These barriers, which fall under the five domains of the social determinants of health, disproportionately affect people of low socioeconomic status and people of color because of systemic racism and oppression. As a result, there are fewer financial, social, and emotional resources available to these communities, creating conditions of scarcity. In turn, people must make trade-offs that affect vaccine uptake, such as not visiting a vaccine clinic because it would mean taking time off work. Constant sacrifices because of scarcity perpetuate a negative cycle of traumatic effects for people, households, and communities that can lead to disparate health outcomes.

Despite growing evidence on scarcity’s traumatizing effects, many CBOs in the health equity and social response sectors do not fully understand the many forms of trauma experienced by the people they serve. This lack of understanding could limit their work’s impact. To overcome deeply rooted barriers and improve vaccine confidence and uptake, we draw insights from the P4VE program on the connection between scarcity and trauma and offer CBOs trauma-responsive strategies that can better promote health equity.

Communities served through P4VE have disproportionately experienced multiple forms of trauma, which was exacerbated by the COVID-19 pandemic (environmental trauma). Historical trauma, such as the Tuskegee Syphilis Study, can corrode trust in health care systems across generations, contributing to a lasting lack of vaccine confidence. However, while a community as a whole may experience generational trauma, personal responses to that trauma can vary. Structural racism in health care may cause some people to mistrust vaccines, but others with the same identity may not share this response.

Read the full article about trauma response for vaccine equity by Alexis Weaver and Leandra Lacy at Urban Institute.