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Promoting community and belonging to support vaccination in older adults

By Adriana Diaz | October 25, 2023

A Michigan nonprofit serving older LGBTQ+ adults shares lessons learned.

Photographs featuring diverse older adults in beachwear as part of the 2023 Hottest Bodies campaign are displayed on a gallery wall.
Photo courtesy of MiGen Michigan LGBTQ+ Elders Network.

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Older adults still make up the majority of COVID-19 hospitalizations in the U.S., according to an October 6 report from the CDC. However, data also shows a large majority of older adults have not received a recommended updated COVID-19 vaccine.

To gain a deeper understanding of the distinct challenges that older adults encounter while accessing vaccines, especially those who live at the intersection of marginalized identities, Public Good News reached out to Kat Mehrer, program director at MiGen Michigan LGBTQ+ Elders Network. Mehrer shared insights into the organization’s adult vaccination program and efforts to connect people to updated COVID-19 vaccines while also helping them navigate barriers. Here’s what they said:

[Editor’s note: The contents of this interview have been edited for length and clarity.]

PGN: MiGen has been connecting adults 45 and older in your region to vaccines since COVID-19 vaccines first became available. When it comes to getting older adults up to date on their vaccines, what has changed?

Kat Mehrer: About a year ago, we were hearing a lot more of the kind of vaccine fatigue of people going, “Okay, well, these vaccines aren’t working if we have to keep getting them” or, “I already got a vaccine, why do I have to get vaccinated again?” Or people just being confused, quite frankly, about what they’re supposed to do, how often they’re supposed to get vaccinated—and the confusion often leads to inaction.

Now, people are starting to have more clarity or, at the very least, have a better understanding of who to ask and where to go to get information. Also, I feel that the perception has started—emphasis on “started”—to change from this idea of getting this one vaccine and it’ll solve everything to understanding it more like a flu shot, where it is a routine aspect of preventative health care. And that change of perspective starting to happen is really, really beneficial in terms of uptake.

PGN: What are the primary obstacles that the older adults you work with face when attempting to obtain vaccinations?

K.M.: There are a lot of different barriers for the LGBTQ+ community, specifically, of course. There’s a history of mistrust and discrimination that, at a base level, exists for health care provisions in general. And that is a challenge that we’re always going to have to work toward overcoming until we get to a point as a society where these issues don’t exist.

However, more acutely, we see issues of, for instance, transportation, especially for older adults. I can go drive out to CVS, no problem. But people who maybe have challenges in mobility, people who live in a second-floor apartment and use a walker, and there’s no elevator and they’re on oxygen. These people are not necessarily going to schedule an appointment. They need assistance.

They might not realize that they could have someone come out to their house and give them a vaccine, for instance. So, that’s one example that MiGen can help mitigate.

Another one is being uninsured. As we know, up until May, vaccinations were available for free, whether or not you had insurance. However, research has shown that people who were uninsured were still less likely to go out and get the COVID-19 vaccine.

It’s partially because of fear of being turned away, of being charged unexpectedly, you know, mistrust of when people say, “This is free.” People don’t always necessarily believe that because of historical instances or just a general mistrust.

And I don’t know that people realize that there’s the Bridge Access Program. So people can still receive a free vaccine, even if they are uninsured. But a lot of folks don’t necessarily realize that. 

And that’s something that we can also help with: Getting you connected with providers who are part of this bridge program who can still provide vaccines for free even if you are uninsured. Because that is really one of the biggest hang-ups: People who don’t have insurance, which is only going to be increasing now that the changes with Medicaid are occurring, in terms of people having to reapply and reestablish their Medicaid.

PGN: How does the lack of trust in the medical system present itself within the community?

K.M.: There has been a history of abuse or discrimination from health care providers. This can be in very explicit ways: People who literally have been turned away by medical providers because of their identities, where doctors may have made discriminatory remarks about them. It could also be in much larger ways, like how research has been done, whether this was done ethically and with people’s consent or knowledge, or what has been ignored. Like when we think about HIV or the AIDS epidemic, people have been left to float in the wind or been actively discriminated against because of certain health statuses they may have.

What is interesting is that folks who have HIV are more likely to get COVID-19 vaccines, which is probably for multitudes of reasons. They are at higher risk in general if they do get sick. But also, we see that people’s experience, especially older adults, who experienced the HIV and AIDS epidemic firsthand, have a very different perspective on public health. They understand that their duty to get vaccinated is a public health duty. That it’s not just a personal choice. But on the other hand, they may have had a personal experience being rejected by a physician. And then, of course, these things get compounded when you bring in other identities.

PGN: How has this history informed your work to spread accurate information and connect older adults to vaccines?

K.M.: In our design of our vaccination promotional materials, we took a lot of inspiration from past public health messaging, like from the AIDS epidemic. We had these fun, cheeky taglines and slogans, like “Get poked,” or “The hottest bodies on the beach are vaccinated.”

These taglines and slogans were really inspired by public health messaging from that era, of having these cheeky positive messages that were focused on community and belonging, rather than fear. Ours were really about getting back to each other.

PGN: As a community, older LGBTQ+ people have witnessed and survived many struggles. What can be learned from their resilience?

K.M.: At the end of the day, vaccinations, especially for LGBTQ+ folks, are so vastly important, because we have a disproportionately high likelihood of having a bunch of comorbidities, so we’re at a high risk. You know, when people talk about COVID-19, a lot of times they say, “Oh, only high-risk people. It only matters for them, right?” As if those aren’t real people who have hopes and dreams and families and lives that matter to them.

It’s important that we help people get vaccinated so that they can maintain their health as long as possible and so they don’t feel like they have to be as isolated.

People in the LGBTQ+ community were much more likely to be willing to socially isolate, which I think is partially because we were more isolated to begin with. But also because we understood it more as a public health concern, and we were doing our part because we want to be in community. 

Ironically, the isolation was partially out of our urge to help others, you know, to maintain our connections and maintain our safety for everyone.

COVID-19 vaccines, in addition to representing health protection, also provide so much more for LGBTQ+ older adults. It gives them their ability to interact with others again, in a meaningful way. And that’s so important.

Read the original article on Public Good News.