By Amy Harris

Welcome to Amjambo Africa’s new Health & Wellness feature, devoted to important health-related topics that impact Black and brown people heavily. In addition to COVID-19, these include cancer, diabetes, mental health illnesses, heart disease, addiction, and HIV. Each month our reporting will focus on understanding a different health topic. September’s focus is COVID-19 and the delta variant. October’s focus will be addiction and substance abuse (October is National Substance Abuse Prevention Month). Thanks to funding from the Sam L. Cohen Foundation and private donations, all content will be fully translated.

Cases of COVID-19 are surging in Maine again because of the dangerous and highly contagious delta variant. Hospitalizations are also rising, and deaths from COVID are climbing. Unvaccinated Mainers remain unprotected and highly vulnerable.

But in clinical trials, the Pfizer, Moderna, and Johnson and Johnson vaccines against COVID-19 have been proven again and again to protect against severe illness and death, and the state’s vaccination rate is among the highest in the nation.

Many people are reassured to learn that scientists and doctors did not rush any of the steps involved in developing the COVID-19 vaccines.

The Maine Department of Health and Human Services (DHHS) partnered with 30 different community agencies to create Maine’s innovative COVID-19 Community Support Program, which is funded by the state. Through the program, local community partners and subgrantees offer pop-up vaccination clinics, provide transportation to vaccination sites, meet with community leaders and members to raise awareness about the benefits of getting vaccinated against COVID-19, provide masks, hand sanitizer, and culturally appropriate food to those who need to quarantine or isolate if they test positive, and find hotels and alternative housing for those needing to safely isolate themselves away from family members.

Charles Mugabe, a health outreach worker at Catholic Charities of Maine, is a key figure working with the COVID-19 Community Care Social Support Program. Since Catholic Charities hired Mugabe as their COVID-19 Project Coordinator at the start of the pandemic, he has earned a reputation for knowing how to get unvaccinated community members who mistrust the vaccines to consider getting vaccinated, which many have. He agreed to share with Amjambo Africa what he says to community members who are vaccine-hesitant.

While not formally trained in public health, Mugabe’s own life experiences as an immigrant from the Democratic Republic of Congo, his multilingualism, and information he has learned from the nursing classes in which he is currently enrolled, guide his work. In May 2021 alone, the Social Support Program received 84 referrals for its culturally and linguistically appropriate services. While DHHS can’t legally collect data on the immigration status of the referrals, more than one quarter of the people accessing the team’s services reported speaking a language other than English as a primary language.

Talking about science to boost vaccine acceptance
Mugabe emphasized that all people want to make informed decisions about their health, regardless of education level. He said that sharing the research behind vaccination is effective. Breaking down science and data into portions understandable to the layperson also works, he said. In his conversations with people, Mugabe discusses a number of common vaccine concerns.

These concerns include the vaccine development process. He says that many people are reassured to learn that scientists and doctors did not rush any of the steps involved in developing the COVID-19 vaccines. To confirm that the vaccines are safe, the U.S. government required vaccine manufacturers to run three phases of clinical trials. More than 10,000 people, ages 18 and older, from different races, backgrounds, and health conditions, volunteered to be a part of these safety trials. There were no increased rates of dangerous side effects or deaths observed in the safety trials. Also, while based on gene technology, mRNA vaccines do not change the DNA or genetic makeup of vaccine recipients.

Scientists used the data from the safety trials to determine how well the vaccines work. This is called vaccine efficacy. Some of the clinical trial participants received placebos or blank shots without any vaccine. Scientists then compared the number of people who got sick in the vaccinated group to the number who got ill in the placebo group to determine vaccine efficacy. For example, if a vaccine is 80% effective, it does not mean that it only works 80% of the time. Instead, it means that in a group of vaccinated people, 80% fewer people will get COVID-19 when they come in contact with the virus.

The U.S. Food and Drug Administration (FDA) approves new medications and vaccines after evaluating the data from multiple, three-phase clinical safety trials. Because COVID-19 created a national public health emergency, the U.S. government authorized the use of the Pfizer, Moderna, and Johnson and Johnson vaccines for emergency use. An independent board of scientists and public health experts (not government employees or employees of the vaccine manufacturers) reviewed all clinical safety data before approving the vaccines’ use. The FDA is now monitoring the millions of people who have received the vaccine for any vaccine side effects or problems, and is expected to issue approval soon.

Over 351 million doses of the COVID-19 vaccine were given in the U.S. between December 14, 2020, and August 9, 2021, with no increased risk of adverse effects or deaths. Mugabe encourages community members to be skeptical of stories on social media about individual people’s experiences with vaccine side effects. Instead, he encourages people to talk with their doctor if they have worries about vaccine safety and personal health conditions.

Cambodian Community of Maine has served over 800 individuals throughout the pandemic.

Despite rising numbers of cases in the last months, the Pfizer, Modern, and Johnson and Johnson vaccines are working to keep infected people from having to be hospitalized and dying. If it weren’t for the vaccines, cases would likely be exploding, completely overwhelming hospital intensive care units, and driving death rates up in much the way we saw last summer and fall, and now are seeing in locations where fewer people are vaccinated than is the case in Maine. The fact that people are getting sick with COVID-19 does not mean that the vaccine is not working. Most people getting sick are not vaccinated.

A breakthrough infection happens if a vaccinated person contracts COVID-19. Like all vaccines, COVID-19 vaccines do not fully protect everyone, and protection can decrease over time. Viruses change over time, and the delta variant of the SARS-CoV-2 virus is different from the strain that the Moderna, Pfizer, and Johnson virus were originally designed to protect against. However, so far the vaccines are doing a good job against the delta variant, and are protecting most people against serious illness and death. Booster shots train the body to recognize new variations of the virus and defend itself. The U.S. Centers for Disease Control and Prevention (CDC) recently recommended that those most at risk of dying from a breakthrough infection should receive a booster shot. At the moment, the CDC has not advised healthy adults to get booster shots. However, in the future, doctors may recommend that everyone get booster shots for the Pfizer, Modern, and Johnson and Johnson vaccines.

Addressing vaccine misinformation
The ocean of contradictory information people see on social media confuses those who are hesitant to be vaccinated, said Mugabe. Confusion can lead to mistrust of scientifically based information and misguided trust in unproven rumors. WhatsApp is a primary vector for spreading misinformation. “I encourage people to go and do research on their own because, in a way, we all are curious, right? And to satisfy our curiosity, it’s important to do research, consult experts,” he said. “But for our people, most of them are already exposed to WhatsApp. … That is not the right [source of information]. I always try to tell people that, and just encourage them to actually do [deeper] research of their own.”

Personal stories can be important data points
Mugabe emphasized the balance between listening and talking when sharing information. “It is important to listen to stories as well. … If data is too scientific and too complicated, listen to stories. Follow what people are saying. And from there you can choose what you want to say because then you know what is actually happening. Nobody is being paid to tell their painful story.”
And Mugabe has his own painful COVID-19 story to share, which he does. Over the past year, he has lost three uncles to the deadly virus. “I find that sharing my personal story – that is difficult. I don’t like to share that. I like to grieve in my own right. But at times, I find it is very helpful. In French, we have a saying that the experience is a great teacher. For some hesitant people, they won’t change their minds until they experience it. But that might be too late.”

New Mainers Public Health Initiative in Lewiston has worked throughout the pandemic to help community members navigate this stressful time. Here, Executive Director Abdulkerim Said and staff stand outside their office on Lisbon Street.

Find cultural cues to boost acceptance
Many community members live in multigenerational homes, and family is very important to them. Parents are often more willing to get vaccinated when they know vaccination will keep respected elders or cherished young children safe and healthy, Mugabe said. With the rise of the delta variant and the lack of an approved COVID-19 vaccine for children under age 12, Mugabe appeals to his culture’s reverence for children and the elderly. The desire to travel back home to see family and friends is also an important motivator. Recently Mugabe has seen an increase in community members traveling home for burials, after rising deaths on the African continent from the delta variant. Those dying in Africa were unvaccinated.

Facing the delta variant
When speaking to community members, Mugabe emphasizes how well the vaccines are working, pointing to Maine’s low hospitalization and death rates, even with rising numbers of cases. Requests to the COVID-19 Community Support program for COVID-19-related social supports have been rising steadily again, week by week since mid-July, reaching 48 referrals in the first week of August after June’s low of just 12. This upward trend worries Mugabe, but his community’s resilience, the successful track record of the COVID-19 Community Support program, and Maine’s high vaccination rates give him hope for the next chapter of the pandemic.