Marilyn Burns, a longtime community advocate in Woodhill Homes on Cleveland’s east side, started off opposing the COVID-19 vaccines.
“Let me be very clear, I was so against COVID, taking that vaccine,” Burns said. “I was talking about it like, ‘Mmhmm they trying to kill us.’”
What changed her mind wasn’t just the science, but something more spiritual. Burns’ dear friend, who’d gotten the vaccine, presented her with a Biblical analogy one Sunday during a “Soul Chat.” COVID-19, the friend said, is like the plagues God rained down on the Pharaoh in the Biblical story of Moses. The vaccine, then, is like the lamb’s blood the Hebrews marked their doors with to protect them from the final and most terrible plague.
“When she said that to me, it resonated with my whole spirit,” Burns said. “I said to myself, ‘OK God, you sent her to tell me this message.’ And the next day, I got on the phone to set up my appointment.”
The vaccines had already been out for nearly a year when she and a group of local advocates, each representing a different Cleveland community, gathered in a conference room at the LGBT Community Center near West 65th St. and Detroit Ave. on the west side. It was November 2021, and although they had all been working together on the same project for months, known as the Guardians of Cleveland initiative, this was the first time they’d all been in one room together.
“It’s like a meeting of the Avengers,” joked Kevin “Chill” Heard, a longtime rapper and local journalist from Lee-Harvard who worked at the Call and Post newspapers for about 25 years.
Later that afternoon, they found themselves sitting across from another group of powerful Cleveland leaders: executives from the city’s foundations and public health agencies. It wasn’t some cinematic battle, though. Those executives came specifically to listen to the community advocates who, like Burns, had been opening up raw conversations about the COVID-19 vaccines with those who are both hesitant and resistant to them for the better part of a year.
Those conversations have been themselves like a vaccine – not against COVID-19, but against the hesitation, resistance or other reasons that have driven more than half of Clevelanders away from the vaccine. The Guardians of Cleveland campaign is an initiative recruiting grassroots community advocates to provide their neighbors with information about the vaccines, using a block-by-block, neighbor-by-neighbor approach to overcome mistrust in them.
Although roughly 60% of Cuyahoga County residents are fully vaccinated, the rate drops sharply when you cross into the city of Cleveland, where 45% of people are vaccinated. About 54% of Ohioans overall have been fully vaccinated, while across the U.S., about 62% of the population has taken the shots. The numbers have ticked up slightly due to the rise of the omicron variant.
Vaccination rates are even more uneven across Cleveland itself. Data obtained by The Land from April 28, 2021 shows that lower-income, majority Black, east side neighborhoods had markedly lower vaccination rates than higher-income, mostly white neighborhoods. For example, University Circle, downtown and Goodrich-Kirtland Park had vaccination rates nearing 50%, while Buckeye-Woodhill and Broadway-Slavic Village did not break 20%.
COVID-19 has unequally affected many racial and minority groups, putting them more at risk of dying from COVID-19, according to the Centers for Disease Control and Prevention. About 46% of the COVID-19 cases in Cleveland have impacted Black individuals, while 27% have been white, according to the city’s COVID-19 dashboard. Nearly 22% of individuals are listed as “other” or “unknown.” The city has not provided data about vaccination levels by neighborhood.
But neighborhood-level vaccination data alone does not reflect the fact that each community, each cultural pocket and each individual Clevelander has their own unique perception of the vaccine. That’s what the local marketing firm behind the guardians initiative and the guardians themselves have sought to emphasize. This initiative is about authentic, tailored messaging delivered by trusted community voices, not a one-size-fits-all approach.
The Guardians of Cleveland initiative is the brainchild of shark&minnow, a Shaker Square-based marketing firm owned by the husband and wife team of Eric Kogelschatz and Hallie Bram Kogelschatz; Mariely Luengo, a local nonprofit consultant who received the 2020 Irene Zehman Volunteer Award of the Jewish Federation of Cleveland; Angela Barnes, a consultant from ADB Strategies; and Anthony Whitfield, a consultant from Milestones Partners. To pay the guardians and cover all of the project’s expenses, shark&minnow has so far been paid about $450,000 from the Greater Cleveland COVID-19 Rapid Response Fund, through the fund’s vaccine communications task force, which is headed by Adam Nation and Daniel Cohn of the Mt. Sinai Health Foundation. With that funding, shark&minnow, Luengo, Barnes and Whitfield researched vaccine hesitancy and medical mistrust, recruited residents, created commercials for television, radio and social media, put up billboards and bus stop posters, and sent the guardians to more than 100 community events in neighborhoods across the city. Even now, they’re still recruiting more guardians and continuing the campaign.
While much attention has been given to conspiracy theories and misinformation about the vaccine, less attention has been given to the reasons for vaccine hesitancy and mistrust in urban communities of color. In those communities, both historical and ongoing racism contribute to general medical mistrust, and in turn, vaccine hesitancy and resistance, according to the CDC.
Whether it’s through raw conversations at barber shops and churches or television commercials, the guardians have been tapping their deep community roots to encourage their neighbors to get vaccinated by speaking personally and specifically to their concerns.
“We needed to invest in developing relationships, in identifying and deconstructing and dismantling misinformation, and ... having real dialogue with residents to understand, not their barriers, but what’s going to get them over the finish lines to do what’s healthy for them, to do what’s healthy for your loved ones,” said Cohn, vice president of strategy with the Mt. Sinai Health Foundation and one of the funders and partners of the guardians initiative.
A creative solution
Months before the COVID-19 vaccine even became available, a small group of Cleveland’s public health executives saw vaccine hesitancy and resistance bubbling up all over, Cleveland included. From his conversations with Gov. Mike DeWine, Cohn discerned that the state government wasn’t prepared to devote resources to vaccine messaging.
So he and the others at the rapid response fund created a vaccine communications taskforce, bringing together public health experts, pastors, community health care workers and other leaders to brainstorm ideas for effective pro-vaccine messaging. The task force intentionally included advocates from communities of color to help open up conversations about how institutional racism, both historical and contemporary, can play a role in different cultural communities’ views on the vaccine and medical institutions as a whole.
Several guardians, for example, noted that vaccine hesitancy and resistance in some of Cleveland’s Black communities is often tied to general medical mistrust.
“I don’t often, at the (Cleveland) Clinic, see anybody that looks like me, as a medical provider, as a patient,” said Carrie Reeves, a guardian active in the Fairfax and Central faith communities. “I don’t see me. In leadership at the (Cleveland) Clinic, I don’t see me.”
The vaccine communications task force initiated the project at the beginning of 2021 when it put out a call to marketing firms across the country. They asked for a communications strategy that could fill vaccine information gaps in local communities and, in doing so, help assuage the concerns of the vaccine hesitant, and maybe even change the hearts and minds of the vaccine resistant.
Essentially, they needed a new, creative solution to a decades-old problem. Vaccine hesitancy isn’t new. In fact, it was present even when the polio vaccine released in the 1950s. The best way to overcome vaccine hesitancy is to understand your audience and reach them in culturally appropriate ways through messengers they trust and understand, according to the CDC.
shark&minnow and Luengo answered that call. They pitched their idea to recruit neighborhood-specific community leaders, and out of some two dozen other proposals, they won the Rapid Response Fund’s support. Luengo and shark&minnow got to work diving into communities across Cleveland, spending time simply getting to know the many neighborhoods that make up the city and building trust with the folks who would become the faces of the guardians campaign.
Trusted community voices
With institutional mistrust wrapped up in vaccine resistance, Luengo said building trust among the guardians wasn’t always easy at first. She didn’t have any proof of concept when she started, she said, and her idea required these longtime community advocates to stake their reputations on the guardians initiative.
“These are real people, and now real friends,” Luengo said. “I tell them, you know, when they Google your name, they’re going to see that you participated in this campaign forever. And because vaccination work is so political, I want to know that they know that their endorsement of this is a pretty serious one with consequence.”
Kevin “Chill” Heard got a taste of those consequences after one of his guardians commercials aired. Heard is known affectionately as MC Chill around Lee-Harvard, the neighborhood he spent most of his life in.
“I’ve put blood and bone into Lee-Harvard,” he joked, pointing out a spot on Lee Road where he’d lost a tooth in a fight decades ago.
As a lifelong local journalist, Heard has been dispelling misinformation for decades. He had even hosted conversations about anti-vaccine conspiracy theories on his Chill Talk radio show years before the COVID-19 pandemic even began, he said. When he started hearing concerns and doubts about the pandemic and the vaccine, he dove into researching it, aiming to inform himself and pass it on to his community. That was before the guardians team reached out to him.
Given the opportunity to speak his own piece about the vaccine for a guardians commercial, Heard sought to dispel what he said was a common misconception about the infamous Tuskegee Syphilis study which he said African Americans cite as a reason to mistrust the vaccine. Many falsely believe that the experimenters had injected Black people with syphilis. In reality, although no less horrific, those experimenters had withheld syphilis treatment from Black people who already had the disease.
In his guardians commercial, Heard walks down neighborhood streets and stops in Carl’s Barber Shop on Lee Road. He quips, “I get it, they’ve been doing Black people dirty for years. So why wouldn’t you be worried? The truth is, if we don’t protect ourselves, nobody will. We’re at over 150 million people vaccinated, and the truth is, if your mother and your doctor haven’t turned into zombies by now, you won’t either.”
In response, some asked if he’d “sold out,” he said. “Like, ‘Oh my God, Chill, they must have got to you,’ you know? ‘Are you an agent? Are they paying you off?’”
Neighborhood by neighborhood, community by community
The guardians campaign began with just a handful: Heard, of Lee-Harvard; Burns, of Woodhill; Carrie Reeves, of Central/Fairfax; Kim Fields, of Buckeye; Nar Pradhan, representing the Nepali and refugee communities; Ana Dumett, representing the Hispanic and immigrant communities; and Terri Williams, representing the LGBTQ+ community.
But their numbers have grown, despite their uphill battles. Now, there are 25 guardians each tailoring messages to the communities they’re a part of. And they need that many to effectively communicate to the many cultures and communities that make up Cleveland as a whole.
Reeves, active in the Fairfax community, said she frequently hears resentment toward what residents feel is inequitable redevelopment of the neighborhood by large medical institutions like Cleveland Clinic.
In Woodhill, Burns said many of her neighbors are tired of being used for surveys and studies that net grants for large medical and academic institutions, but rarely do any material good for their communities. “They come down, they want to survey to death,” she said. “You come down here with these damn surveys, then you want to ask somebody, ‘Where you see yourself in five years?’ Hell, they can’t see themself to the next day.”
Reeves and Burns said the Tuskegee experiments never came up in vaccine conversations in their communities. Reeves said the people she meets don’t necessarily believe in conspiracy theories, but simply lack information about the vaccine. Through her church, East Mt. Zion Baptist in Fairfax, Reeves said she also encounters people who believe their faith in God will suffice to protect them from COVID-19.
The ways in which those cultural perceptions of the vaccine played out were reflected in a map created by researchers from Case Western Reserve University’s Graphic Information Systems Health and Hazards Lab with data from the Cleveland Clinic Foundation and University Hospitals. It showed Cleveland’s lower-income, majority Black, east side neighborhoods had, in some cases, lower vaccination rates than that of higher-income and mostly white neighborhoods.
The guardians initiative dug into all the cultural nuances affecting vaccine acceptance in different communities in rejection of how vaccine disparities were being framed in popular conversations, Luengo said.
“It’s this narrative that, ‘Oh, if they don’t participate, it must be Black people, it must be Hispanic people, right?’” she said. “Sometimes, it was in a condescending way: ‘Well, you know, they’re too poor to get the vaccine. They’re too uneducated to get how important it is.’”
West Park, which the map shows had vaccination rates hovering around 35%, highlighted exactly that, Luengo said. West Park, which includes Kamm’s Corner, Jefferson and Bellaire-Puritas has several pockets of immigrant communities, she said.
Many of those immigrant communities struggled to access health care even before the pandemic, said Nar Pradhan, a Guardian from Bhutan who owns Himalayan Restaurant in Jefferson. Some immigrants he’s spoken to about the vaccine feel alienated by language barriers, he said, and they’re not used to regularly visiting hospitals.
“Being a refugee, I am a citizen now, but most of the refugees, they don’t know the culture,” Pradhan said. “When COVID comes, our community, they suffer a lot…This platform helps us to educate more and more of our community to get vaccines.”
Data shows the problem is not intractable, and vaccine hesitancy and resistance can be overcome with outreach and education. In the U.S. overall, the Kaiser Family Foundation, which has been monitoring public attitudes toward COVID-19 vaccines using surveys and qualitative research, found that “similar shares of adults now report being vaccinated across racial and ethnic groups (71% of white adults, 70% of Black adults, and 73% of Hispanic adults). Large gaps in vaccine uptake remain by partisanship, education level, age, and health insurance status.”
Repairing relationships with health care institutions
shark&minnow recently started organizing data on the impact of this initiative, and Luengo said it could be ready as soon as this month, but anecdotal evidence from the guardians themselves seems promising, though it’s qualitative more than quantitative.
Reeves recalled recently helping a patron of her church in her 70s get the vaccine. This woman, Reeves said, has long believed in the healing powers of her faith in God more than those of modern medicines and vaccines.
“When she started making comments and asking questions, I found out she didn’t have much information,” she said. “She didn’t understand what’s the components of the vaccine, what’s the procedure for the vaccine, all of that.”
For Heard, even getting just one single person vaccinated could mean preventing potentially dozens from catching COVID-19.
“We’re planting seeds,” Heard said. “And hopefully those seeds will grow to other people who will also continue this information, however it came to them. I refuse to believe that we’re not making a difference.”
It has been just about half a year since the campaign first launched, but the guardians with whom The Land spoke all seem to agree that it’s far from over. There will always be a need for hard conversations about health, especially in Cleveland.
“When we did the research for the guardians and we put the campaign together, we wanted something that will be there for the next public health emergency,” Luengo said. “Because it will always boil down to trust.”
Even beyond conversations about the COVID-19 vaccine, Burns said the guardians campaign could play a pivotal role not only in building trust in Cleveland’s health care institutions, but also in healing the communities that feel forgotten and betrayed by Cleveland’s institutions across the board.
“We’ve seen the validity in this,” Burns said. “Not just here today and gone tomorrow, but something that’s going to help build our communities for a long period of time. This will resonate trust, it will resonate empowerment, it will be able to resonate and enlighten a community of hope. We need to bring that light back into our communities that have been blinded so long in darkness. We need to take the veil off of things. We need to let each other know that we are loved.”
Michael Indriolo is a reporting fellow at The Land