Debunking myths. Improving equity and inclusion in research and care. Gaining trust with vaccines.

They are among top goals for one group fighting COVID-19 health disparities.

From the beginning of the pandemic, the virus hit communities of color hard, with African American and Hispanic people more likely to contract SARS-CoV-2 and getting sicker and dying at significantly higher rates than white individuals.

And now, a federally funded initiative is focused on creating partnerships that strengthen outreach to those communities as COVID-19 studies and vaccinations continue.

"We were alarmed by the disproportionate impact of COVID-19 on racial and ethnic minorities," says Erica Marsh, M.D., faculty director of community engagement at the Michigan Institute for Clinical Health Research (MICHR.)

"When there was an opportunity to get funding to help fight these disparities, we quickly assembled a group of both Michigan experts and community experts that could focus on this mission."

And that University of Michigan team, known as Communities Conquering COVID, or C3, received a $1.4 million grant last fall from the National Institutes of Health Community Engagement Alliance (CEAL) Against COVID-19 Disparities. C3 was launched by Michigan Medicine, MICHR and the University of Michigan School of Public Health.

Marsh heads the project along with Barbara A. Israel, Dr.PH, M.P.H., professor of Health Behavior & Health Education at U-M's SPH and director of the Detroit Community-Academic Urban Research Center. Together, they lead a team of researchers and community leaders devoted to reducing racial and ethnic disparities revealed during the pandemic.

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Marsh, who is also chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women's Hospital, answers more questions about the initiative:

What are C3's main goals?

Marsh: We have seen a significant imbalance in access to testing initially and now access to the vaccine for low income and communities of color across the state. We know that COVID-19 has a more severe impact on these populations.   

Our team is currently focusing on questions around COVID-19 awareness, misinformation, trusted sources of information, and education, especially among African Americans and Hispanics/Latinos.

Initially we wanted to ensure equity in research by promoting inclusion and participation of these groups in vaccine and therapeutic clinical trials to prevent and treat the disease. Diverse participation in trials were essential to developing vaccines and treatments that benefit everyone. The COVID-19 vaccine must be effective for all, regardless of race, ethnicity, socioeconomic background, education level or pre-existing conditions.  Now that we have emergently approved vaccines, we are trying to understand issues around hesitancy and access.

To do this, we rely on trusted relationships that will help us distribute correct information about the disease and vaccine and minimize mixed, confusing and inaccurate messages. We understand that conventional channels of communication may not be where all communities turn to for their trusted information. 

Getting ahead of COVID means increasing vaccination rates among the most at-risk populations. But that means helping everyone feel safe to get vaccinated to protect themselves, their families and their communities.

We are among teams in 11 states that have received initial NIH funding to create these programs.

What will outreach look like?

Marsh: Over the next year, our group will conduct community-engaged research through partnerships between researchers, community organizations - including grassroots and faith-based organizations, and community members. Our goal is to strengthen relationships based on trust, equity, and mutual goals.

Our team is conducting focus groups and interviews across the state to learn about current attitudes about COVID-19 and trusted sources of information for different communities.

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We are also identifying a network of experts to increase awareness, knowledge and trust among the communities involved. We are hosting educational activities and open forums on findings that we can share broadly.

This is part of an effort to help facilitate respect and honor partnerships that bring us the knowledge needed to change hearts and minds of individuals in different communities. We aren't starting with any assumptions. We have to learn from these groups who are the experts on their communities and can guide us. We need to understand and be sensitive to their unique challenges and perspectives.

When we respect the community's expertise and knowledge, we are so much more powerful, informed and set up for success.

The pandemic has magnified and amplified existing health disparities. But it has also reinforced and strengthened our commitment to community partners who play a key role in ensuring an effective COVID-19 response. It is because of the existing and trusted partnerships between MICHR and over 1,000 community organizations that we were able to get support for this grant. 

What communities will be included?

Marsh: We are focusing on Michigan counties most affected by the pandemic, including Wayne, Genesee, Kent and Washtenaw.

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We are particularly interested in reaching African-American and Latino populations in cities like Detroit and Flint with audience-specific, culturally appropriate messages. The intent is to promote healthy choices, encourage community-based participatory research, and develop and share communication materials to address misinformation and mistrust around COVID-19, vaccine trials and the vaccine itself.

We are also building off of existing relationships in cities like Flint where MICHR Community Engagement is very active and where I have a physician role at Hamilton Community Health Network (which we've partnered with to expand access to routine and sub-specialty gynecological services.) Flint has been an incredible partner for us and we feel honored to have the chance to continue to serve and work with communities like these.

Flint is also an example of where community organizations have already been making a difference at the local level through groups like the Healthy Flint Research Coordinating Center. Because of these partnerships and the dedication to reducing barriers to testing and access to care, we are seeing strides in reducing racial disparities in COVID-19 outcomes for people of color.

We want to see these encouraging trends continue.

Why is there distrust about the vaccine among some minority communities?

Marsh: We have to acknowledge the different perspectives and experiences of minorities' interactions with health systems.

Studies show that distrust in medical research is also significantly higher among minority populations and there is frankly good reason for this. We know that systemic racism has long fueled disparities in health and health care. There are many examples of exploitation and dismissiveness of marginalized groups throughout history as well as frankly unethical care. Vaccine hesitancy and mistrust must be viewed in the context of these experiences of unequal and inequitable treatment.

These disparities were especially highlighted in the beginning of the pandemic, when we saw significantly worse COVID-19 outcomes for people of color. We've seen cases of bias and discrimination where people's symptoms weren't taken as seriously, with devastating results. We've seen cases where African-Americans were given lower prioritization for hospital admissions and lifesaving care for COVID-19-related illness.

We need to use culturally appropriate ways to reach people with credible information dissemination and trust-building related to vaccines. We need better ways to show all groups why their inclusiveness in these efforts matters as we fight this pandemic. We don't want anyone to be left behind – all communities should receive optimal health care to protect them from this virus.

It is also important to acknowledge that communities hardest hit by the virus are also often experiencing disparities in social determinants of health, such as access to healthy foods, safe and affordable housing, secure jobs and adequate transportation options. These factors are all underpinnings of health disparities and risk factors for COVID-19 as well as other diseases.

What drives you personally to help lead this effort?

Marsh: I grew up and live today as part of an underrepresented community. My drive doesn't come from my academic background as much as a personal passion and upbringing grounded in love, equity and justice. 

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I study the science of community engagement but I also live and breathe it. I'm among many who have seen biases in academics and in healthcare up close and personally, and who want to stand up and be part of making a must needed change.

I may not be an infectious disease doctor, but as a physician I care deeply about the community and the impact of COVID-19. In addition, I am part of the African-American community. This is the community where I live, worship and have friendships and partnerships. 

Our team is committed to standing shoulder-to-shoulder with our community and academic partners, ensuring that all of the communities we serve are positioned to defend themselves from COVID – and to ultimately conquer COVID.

C3 is guided by a steering committee that oversees all aspects of this project. The partner organizations involved are: Arab Center for Economic and Social Services (ACCESS), Bethel AME Church, Bibleway Outreach Ministries, Bridges into the Future, Buenos Vecinos, Community Based Organization Partners, Community Health and Social Services Center, Inc. (CHASS), Detroit Hispanic Development Corporation (DHDC), Eastside Community Network (ECN), Friends of Parkside, Health Net of West Michigan, Historic King Solomon Baptist Church, National Center for African American Consciousness, New West Willow Neighborhood Association, and Spectrum Health.