Vaccine Hesitancy in San Diego Asylum Seekers

Nick Rice and one of the health screening teams in the shelter’s vaccine clinic

Beginning my undergraduate medical education in the midst of the global COVID-19 pandemic made much of what I was learning about the practice of medicine seem abstract. Unlike other years where first-year medical students began their ambulatory care apprenticeships (ACAs) in the fall, I did the majority of my simulated clinical experiences via Zoom and had few opportunities to interact face-to-face with patients. Even my clinical encounters with UCSD’s free clinic were telemedicine visits, where I often felt I was missing out on crucial opportunities to develop what many call the ‘art of medicine’ – building a trusting rapport with our patients, reading their body language, and using the power of laughter and touch to alleviate anxiety and suffering. 

After the first COVID-19 vaccines received emergency use authorization from the FDA, things began to look up. My ACA experience was finally allowed to begin and I began to get excited about my summer plans for my global health academic concentration (GHAC) research project in Brazil. I planned on doing bench research on a neglected tropical disease called leishmaniasis, a disease that disproportionately affects those living in poverty, with the added opportunity to visit leishmaniasis clinics in the Amazon. However, low COVID-19 vaccination rates in Brazil, coupled with the emergence of new variants meant that many of these clinics remained closed, and I felt it might not be ethical to divert time and energy away from clinician mentors in the country who may be needed elsewhere to treat the local community during a time when medical systems were operating at or over capacity. Thanks to the extensive network of mentors that the GHAC program has developed over the years, I was able to quickly pivot to a local project here in San Diego. 

I began working under the mentorship of Dr. Linda Hill in two shelters that temporarily house asylum seekers in San Diego, mostly from Russia, Central America, Haiti, and Brazil, who have been released from detention by the Department of Homeland Security and are en-route to their final destinations where they meet their sponsor families and await their hearing. Within these shelters, families receive COVID-19 testing and vaccination, travel assistance, nutrition services, medical screenings, and legal assistance through a number of nonprofits including the San Diego Rapid Response Network, Jewish Family Services, and Catholic Charities. 

My research centers around understanding vaccine hesitancy in these populations, a complex issue that not only derives from the dissemination of misinformation about vaccine efficacy and safety, but also from legacies of past criminal justice disparities, lack of access to regular sources of care and reliable medical information, unequal disease burden, forced sterilization campaigns, and medical abuses/mistreatment that shape their perception of government and medical institutions. Many also arrive after long and uncomfortable stays in overcrowded DHS detention centers where they often receive inadequate food and water, and experience sub-standard sanitation facilities and living conditions. Many children arrive at the shelters with vaccine-preventable communicable diseases such as chicken pox and medical conditions associated with overcrowding and sub-standard unhygienic living conditions (such as upper respiratory infections, fungal skin infections, scabies and lice). The majority also arrive after having critical medications to treat chronic conditions confiscated at the border or in detention. These experiences all culminate in the erosion of trust in institutions in the United States. 

Understanding the perspectives of these communities that lead to vaccine hesitancy will ultimately equip us with the knowledge needed to address specific concerns and restore trust. This understanding will allow for culturally appropriate communication related to the vaccine technology, efficacy, risks and benefits, and may ultimately increase health literacy and vaccine uptake, not only in these communities but also in local minority communities that suffer similar histories of mistreatment. 

In addition to my research on vaccine hesitancy, I also had the opportunity to see patients 20 hours/week alongside the medical team at these shelters where I gained invaluable clinical experience and physician mentorship while ensuring that families were safe to travel to their final destinations. I was able to hear heartbreaking stories related to the violence and persecution many were fleeing, and was inspired by the resilience I saw in the smiling faces of the families that had overcome so many obstacles in their journeys to the US. My work over the summer on this project has reinforced my commitment to work with refugees and allowed me the opportunity to witness how the provision of dignified, high quality and compassionate care to these populations can help to restore trust in medicine. 

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