Naw Mu Chaw had questions about possible side effects of the Covid-19 vaccine.
Chao, a recent refugee from Myanmar, received medical care at a community health center near her home in Clarkston, Georgia, a town of about 14,000 people. Her English is limited, but the center has an interpreter to translate health information into her native language, Burmese.
Her questions began to fade when a health worker texted her about the vaccine in Burmese. He received the shots and then urged other refugees to get vaccinated as well.
“Some people have underlying diseases, such as diabetes, and if they are [the virus], they may die,” he said. “If they have diabetes or high blood pressure, they should get more vaccinations than other people.”
Public health officials and resettlement groups across the United States have used such community strategies to encourage newly arrived refugees and other vulnerable people to get vaccinated against Covid. And in places like Clarkston, health officials say these kinds of grassroots efforts are working. The city of metro Atlanta — the center of refugee resettlement in Georgia — has higher vaccination rates than its county or state.
Refugees in general have been disproportionately affected by Covid.
Those newly resettled may experience living or employment conditions that increase their risk of contracting the virus. According to the Centers for Disease Control and Prevention, some refugees enter the country with underlying medical conditions that increase their risk of serious illness. And in multigenerational households, it can be difficult to protect older family members in cramped housing.
Some refugees face other significant barriers to vaccination, including language barriers, lack of transportation, and irregular work schedules.
“We want to make sure these epidemics are not disproportionately affecting people of color, immigrants, refugees and other vulnerable people,” said Kat Kelly, senior director of migration and refugee services at Virginia-based Catholic Charities USA. “If your communities are historically underdeveloped, they will be underserved in any kind of crisis. You have to build a sustainable infrastructure that addresses those obstacles.”
To build that infrastructure, CDC developed a toolkit for local health departments and community organizations that includes Covid-related messages about the disease and vaccines in more than 30 languages. It also provides guidelines for data collection and work policies for public health professionals, rehabilitation agencies, and employers. And grassroots groups have recruited bilingual, community-based workers to increase vaccination rates among refugees.
Unlike those who choose to move to the United States from other countries, U.S.-bound refugees are not required to receive vaccinations prior to travel. Once in the country, all refugees receive a medical exam within 90 days of their arrival, during which time providers discuss vaccinations.
Groups supporting the Covid vaccine effort include the International Rescue Committee, a global nonprofit that provides emergency aid to refugees and has resettled more than 28,000 refugees in the Clarkston area over the past 40 years.
Clarkston is known for its diversity, with large populations of refugees from Myanmar, the Democratic Republic of Congo, and Syria. Community health workers and grassroots organizations have been instrumental in educating people there about the Covid vaccine, and organizers say their efforts have been largely successful.
According to data compiled by Georgia State University’s Prevention Research Center, 70% of Clarkston residents were fully vaccinated as of July. In DeKalb County, where Clarkston is located, that number was 62%. Georgia’s share, at 57%, is the lowest in the country.
The Georgia State Center said Clarkston’s vaccination rate is estimated to be more than 20 percentage points higher than other DeKalb County areas with similar Social Vulnerability Index scores, which evaluate communities on factors such as socioeconomic status; density of housing; availability of transportation and household; and race, ethnicity and language. Mary Helen O’Connor, the center’s deputy director, said outreach efforts in Clarkston are behind high vaccine rates there.
GSU’s Prevention Research Center has hired five community health workers, each fluent in a different language, to promote the benefits of getting the Covid vaccine. Two activists working in the Clarkston area are Kaden Tun from Myanmar and Thomas Rodger from the Democratic Republic of Congo.
Rogers said vaccine misinformation is a major challenge among the Swahili-speaking community, particularly among refugees from the Democratic Republic of Congo. Before resettling in Clarkston, Roger lived in a camp in Tanzania and said that the president of that country, John Magufuli, who died in March 2021, denied the existence of Covid and many people were exposed to this misinformation on Facebook. Some people watched YouTube videos in Swahili that linked the vaccine to satanic practices, Roger said.
He wasn’t surprised when the people of Clarkston wouldn’t let him into their home at first. At first people saw him as an outsider. His friends connected him to the vaccine and wondered why he was paying to promote it. He developed strategies that worked best for the people he was trying to reach. To demonstrate that the shots were safe, he used his phone to record vaccinations of well-known members of the community.
Tun, who sent tea vaccine information, said he knew a family of Rohingya refugees — who have historically faced repression — had recently attended a health fair and received vaccinations that allowed him to enter inaccessible communities.
“What surprised me the most was how receptive everyone was to our work,” Toon said. “Because I can’t imagine, with everything that’s been said since the start of Covid, how confusing it can be for the community, especially with the language barrier.”
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