Vaccinating the Bhutanese global community

Rochelle Frounfelker

We are now engaged in the latest phase of the global fight against COVID-19, that of widespread vaccination. Where do we stand with the global Bhutanese community? Let us reflect on this together, and propose strategies to move forward.

As a public health expert working with resettled Bhutanese, I believe vaccination campaigns and efforts will be successful only if they acknowledge and address the barriers to vaccination within the community. 

First, these challenges must be considered within the broader context of barriers to healthcare faced by refugee and immigrant populations more broadly. 

For instance, research suggests that migrant populations often underutilize health care because of a lack of knowledge about the services, legal restrictions to accessing care, and language barriers.  

Additionally, formal care providers tend to overlook, and at times fail to address, the broader issues that can take precedence over healthcare issues among migrant populations, including concerns about safe housing and financial insecurity.  

Finally, health care providers can sometimes lack the skills and expertise to engage with migrant populations who hold culturally specific beliefs about health and wellness.

These dynamics related to access to healthcare among migrant populations intersect with challenges specific to vaccination campaigns. 

For instance, some are hesitant to receive the vaccine because of concerns over its effectiveness, possible side effects, and potential long-term negative health outcomes that are as of yet unknown given the timeline of the development and approval of vaccines. 

Marginalized communities, including migrant populations, might have additional concerns over the overall intention of government-led vaccination campaigns given prior negative experiences with healthcare more broadly.  

These concerns are far from irrational, and should be addressed in thoughtful ways by our public health care system. We need hope and confidence in federal, state/provincial, and local public health care to move forward.  So how do we address these challenges in order to promote the health and wellbeing of resettled Bhutanese? 

Most importantly, healthcare workers need to engage with the Bhutanese about their concerns and fears regarding the vaccine.  

They need to find out what Bhutanese are worried about, provide answers, and be clear about what and what is not known.  For example, elders may ask, “If I become vaccinated, will I be able to finally visit with my children and grandchildren?”  Younger Bhutanese may ask, “If I am pregnant, should I get the vaccine?”  These are all extremely important questions, and the CDC (Centers for Disease Control) are coming up with guidelines, updated weekly, on how to answer these questions based on the best scientific evidence.  

Overall, transparency is the best approach. Those providing health care need to be honest about what is known, why the vaccines have been approved, and why healthcare providers and the government believe vaccination is the best way forward.  

Health care providers also need to understand the barriers to vaccination facing Bhutanese. Many migrant populations lack transportation to formal health care services. Service providers also need to consider language barriers. Providing information on vaccines via written, translated material is insufficient where some members of the Bhutanese community are illiterate.   In short, opening health clinic doors to Bhutanese for vaccination will not make vaccination happen: clinics need to adopt creative approaches to outreach and engagement to make sure Bhutanese are aware of vaccination opportunities.

Vaccine must involve partnerships between healthcare providers and the Bhutanese community. Bhutanese community organizations and leaders need to be consulted and engaged in order to make services more acceptable and accessible.  

Healthcare providers should work with Bhutanese community health workers to act as cultural brokers and conduct outreach efforts with individuals and families. 

The value of community health workers goes beyond overcoming language barriers and includes integrating in-depth awareness and understanding of the needs and strengths of the Bhutanese into clinical interactions with members of the community.

It is also important for Bhutanese who have gotten vaccinated to share their experience with others in the community.  For instance, talk with others who are hesitant to get vaccinated and answer questions about any side effects you had, and why you made the decision to get the vaccine.

There are many challenges ahead in the fight against coronavirus and ensuring widespread immunity to the virus amongst the Bhutanese community. However, I am confident that if the Bhutanese and healthcare providers collaborate and work together, vaccination efforts will be successful.

The author is a Post-Doctoral Fellow in the Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal.