How Trusted Messengers Increase Vaccine Uptake

ADRIANA DÍAZ originally published the article under a Creative Commons license on PGN.

Photo: PGN.

Vaccine uptake remains a challenge for community health workers as COVID-19 continues to spread. People’s reasons for not staying up to date on vaccines can vary, including a lack of awareness about eligibility, medical mistrust due to systemic racism, or believing persistent vaccine myths.

As of March 23, only 23 percent of U.S. adults and 14 percent of U.S. children have received the updated COVID-19 vaccine, according to CDC data. 

To better understand how community-based organizations have adapted their vaccine outreach after the public health emergency ended, Public Good News spoke to Sarah Jane Knoy, executive director, and Iliana Barreto, Latino community coordinator, of Granite State Organizing Project in New Hampshire. 

Here’s what they said. 

[Editor’s note: This content has been edited for clarity and length.]

PGN: Can you tell us more about the communities your organization serves?

Sarah Jane Knoy: Granite State Organizing Project was founded in 2002. We’re New Hampshire’s largest faith-based grassroots organization. 

We work primarily in the largest cities, Manchester and Nashua. We have active groups in the Saligan Valley and [in] the Upper Valley. And we work all across the state on state legislative issues. 

New Hampshire itself is majority white, but Manchester and Nashua are the most diverse communities in this state. Manchester is Latino, with a lot of African refugees that have resettled here. Nashua’s Latinx population is more Brazilian. So, we work a lot with communities of all denominations and faiths as well as low-income communities, immigrant communities, and people who live in public housing. 

PGN: We’ve now entered the fifth year of living with COVID-19. How has your vaccine outreach work evolved? 

Iliana Barreto: We started by doing two COVID-19 test clinics. We tested over 400 people, including Latinos, documented and undocumented children, adults, the elderly, and other community members. From there, we moved forward to COVID-19 vaccination clinics. For the last three or four years, we’ve vaccinated over 500 people in our community, some of them fully. And this includes ages 2 all the way to seniors. 

We also did massive outreach to educate and provide knowledge about COVID-19, misinformation, and how to access vaccinations. 

Now, we’re also doing trusted messenger leadership training in which we’re developing leaders in the community to share their knowledge with others. 

PGN: What goes into training someone to become a trusted messenger?

S.J.K.: We do a lot of leadership training at the Granite State Organizing Project, but the trusted messenger program is a little different because some of the traditional community organizing leadership training we’ve done is designed for people who are already active in civic life. 

And the trusted messenger training starts without any presumptions. It helps prepare young single moms, young families, and people who are, for the most part, not already active in their community.

It takes them through a very intentional process of learning how to set personal goals, how to build relationships, how to speak in public, and then moves up into how the systems works in this country: how the medical system works, how the governmental system works, and includes homework assignments along the way where participants are asked to interview family and friends. 

And then, either on the penultimate or ultimate week, the training brings in a person to speak to the group and answer their questions. The group identifies who they want to have come to speak. In the height of the COVID-19 pandemic, it might have been a doctor. Other times it’s been a health navigator to speak to them about how to get health insurance. Sometimes they want to have a local elected official come and speak to them about how the government system does or does not work for them. 

I.B.: All these training sessions have happened in Spanish. We know it is a lot easier for our people and more comfortable for them to actually be able to reach out in their language.

PGN: What have you learned about training trusted messengers? What’s worked or not worked about this approach?

S.J.K: We are a community organizing organization that works to build power and capacity for people to have the ability to influence decisions that affect their own communities in their own lives. We believe that the people who are experiencing problems are also the same people most qualified to identify the problems, propose and design solutions, and then implement those solutions. 

It’s clear that just having vaccinations available during a pandemic won’t mean that people who are in marginalized communities are going to take advantage of those resources. 

They have to hear from people they trust that it’s safe and that it’s effective and worthwhile. Particularly now that the emergency is over, the only way to get people to take these issues seriously is to have them hear from their neighbors and friends that it’s important.

I.B.: Before, it was very clear that you had to get vaccinated; there was a push. But ever since vaccine mandates [ended], people’s awareness has also come down. So, the only way people really trust and feel the need to be like, “Oh my god, this is really important. I should really do this” is if they hear it from somebody that they care about and that they love. 

It can’t be more clear that we really need some kind of free health care in this country. Also, I’ve learned that what builds people’s trust is these one-on-one, face-to-face relationships with people. No amount of paperwork, no doctor or professional can give somebody the confidence that they should get vaccinated than somebody from their own community who shares the same language and who can understand them at their level.

This article is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the CDC Foundation totaling $69,392,486 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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