A year ago, Chris Battelli faced a dilemma with no easy answer.
He was a nursing student at the University of Colorado Anschutz Medical Campus, studying for a career serving others in the health care system. He’d worked throughout the pandemic on the front lines, first as a COVID tester and then as someone administering vaccines. And he believed strongly in those vaccines, never missing an opportunity to explain their safety and effectiveness to others.
This was something new for him. He was raised in a household skeptical of the health care system, the result of bad experiences and expensive medical bills, and it wasn’t until he was an adult that Chris received any immunizations.
So then, as COVID vaccines rolled out to the general public, two passions of Chris’s life collided — his new love for health care and his love for his family.
“From my perspective,” he said recently, “my mom has decades of reasons not to trust health care.”
Thus, the dilemma: How would he ever be able to persuade his mother to get vaccinated against COVID-19? Was there anything he could say that would change her mind?
Number of people getting their first COVID vaccine at its lowest point
From a distance, Colorado’s efforts to reach unvaccinated adults appear to have hit a wall.
The number of doses administered each week as part of a “primary series” of the COVID vaccine — in other words, doses that are given to people who were previously unvaccinated, as opposed to booster doses — is lower than it has ever been.
Meanwhile, after months of breakneck urgency, the pressure on people to get vaccinated is waning.
Vaccine mandates, such as one imposed on city workers in Denver, are beginning to fall by the wayside. Infections and hospitalizations from the virus, which proved to be an effective motivator in the fall, are now dropping.
National polls show a declining percentage of people worried about catching COVID. And epidemiological models tout a high degree of immunity to the virus’ omicron variant across the state — including among people who are unvaccinated.
As a result, Gov. Jared Polis has declared it’s time to “turn the page and start a new chapter” on COVID. Polis has deemed vaccination a matter of personal responsibility, and, while he continues to advocate for the importance of vaccination, he has clearly grown weary of delivering the message.
“If you’re not fully vaccinated, I don’t know how many other ways I can say it,” Polis said last week.
It’s about the message — and the messenger
The governor often points out that Colorado has one of the highest vaccination rates in the country — more than 80% of people eligible for vaccination have received at least one dose.
But that focus glosses over the reality across the state: Colorado is highly vaccinated; many communities of Coloradans are not.
An estimated half-million Colorado adults remain unvaccinated against COVID, according to state figures.
“When you break it down into subcommunities, which is how viruses move, we see huge differences,” said Jennifer Reich, a University of Colorado Denver sociology professor who studies vaccine hesitancy.
Why subcommunities are under-vaccinated can also be hugely disparate. For some, it’s a matter of access to vaccine clinics at a convenient time. For others, language is a barrier. Maybe it’s politics or culture.
The different reasons people are not yet vaccinated are so numerous that it is difficult for the state to craft a single message to address them all.
Colorado is winding down Phase III of its vaccination marketing campaign. Much of the messaging materials created for the phase focus on booster shots and on vaccines for kids. To reach adults who are unvaccinated, the state is using personal testimonials.
“This campaign features testimonials of Coloradans who lost loved ones due to COVID-19 encouraging people to get vaccinated as a form of protection against COVID,” Joe Hollmann, a COVID-19 marketing specialist at the Colorado Department of Public Health and Environment, said during a news briefing in January announcing the new phase.
But that message may not be specific enough to offer much persuasive power.
“Who the messenger is is as important as the message,” Reich said.
So the efforts in Colorado to get more adults vaccinated has now, literally, become a door-to-door campaign. It’s one waged by determined community advocates, but also by sons and daughters and friends over weeks and months of time.
And it is still working.
Reich said she volunteered at a vaccination clinic at a community center in Aurora last week. More than 40 people who showed up were getting their first dose — some because they had finally heard enough about the vaccines to believe they are worthwhile, others because it was the most convenient clinic they had ever come across.
For Reich, the experience showed why the persuasion effort is not worth giving up.
“It’s too easy to hear that there are two camps of people: people who like vaccines and those who don’t,” she said. “For a lot of people, there’s a middle ground. … Decisions are contextual. It’s a mistake to write off people because they’ve made a decision at one point in time.”
But it also requires tremendous effort to change their minds.
“I go to the community. I never ask the community to come to me.”
This weekend, for Julissa Soto, was much like every other weekend for the past year.
On Saturday, she canvassed neighborhoods in Brighton, knocking on people’s doors, asking if they are vaccinated and inviting them to a vaccine clinic the following day at Saint Augustine Catholic Church near the city’s historic downtown.
On Sunday: “Showtime,” she said. The clinic’s doors stayed open from 9 a.m. to 4 p.m. She expected to vaccinate hundreds of people, mostly Latino — the culmination of a week of groundwork to persuade people to turn out.
Soto is an independent health equity consultant working with the group Colorado Access, a nonprofit health plan based in Aurora that often works with low-income populations. For the past year, she has worked to boost vaccination rates among the state’s Latino population. It’s a task Soto, a naturalized U.S. citizen who immigrated from Mexico and has more than two decades of experience as a community advocate, is well-suited for.
“I invite them like they’re my family member, like they’re my mom or dad,” Soto said. “I say, ‘Mija, come along, come to my vaccine clinic.’”
Soto said Colorado’s Latino community shows the fallacy of writing off those who are still unvaccinated as stubborn anti-vaxxers. Less than half of the state’s Hispanic population has received at least one dose of COVID vaccine, according to CDPHE figures. But Soto said she hears interest in the vaccine every time she talks with people.
The problem, she said, is a structural one. Many people in the community work multiple jobs, making it hard to reach vaccine clinics that run during their work hours or require time to drive across town. People who speak only Spanish may not have the same access to information that English speakers do. And medical clinics may be viewed as unfriendly places, with people of color more likely to report discrimination in the health care system than whites.
To address those, Soto schedules her clinics on the weekends, often coinciding with Spanish-speaking Mass times. The clinics run for at least seven hours each.
“I go to the community,” she said. “I never ask the community to come to me.”
But just as important is how to talk about the vaccine, she said. It has to be done in a way that resonates. The message must have cultural relevance.
When Soto talks to people, here’s her argument: “We must protect our family. If you don’t believe in vaccines, do it for your grandpa, do it for your grandma. Do it for the pregnant woman at your home.”
In other words, if you won’t do it for yourself, do it for someone else.
“Everyone works on their own timeline”
Chris Battelli waited a bit before talking to his mom about the vaccines. He didn’t want to push too soon, and she wanted to put off the conversation, too, not wanting to be an early recipient of the vaccine if she did decide to get it.
Chris knew that his mom, Paula, wasn’t anti-vaccine. She never criticized people who were vaccinated. And she was hardly a COVID denier, taking precautions whenever she went out in public. But he also knew she had a firm skepticism of the health care system.
The family struggled at times while Chris was growing up and went through periods of being uninsured. Doctors’ visits became something to avoid because they racked up expensive medical bills and other traumas.
Paula recalled one visit when Chris’ younger sister went to the emergency room with what would turn out to be Lyme disease. But the doctor misdiagnosed it and, fearing meningitis, conducted a painful spinal tap while keeping Paula out of the room. That was 26 years ago, but she still grimaces at the memory.
“It was very traumatic,” Paula, who is now a successful real estate agent, said. “Extremely traumatic. I carried a lot of guilt about that.”
Chris’ mom and dad bought a book called “How to Raise a Healthy Child … In Spite of Your Doctor,” and they followed its guidance. That meant no vaccines for Chris growing up.
He doesn’t judge his parents now. They were just trying to do the best they could to raise their kids — both of whom grew up healthy. But, as he became interested in health care as an adult following his dad’s death, Chris began to see a community value to vaccination. It was about protecting those around him, something that felt true to his values.
When he and his sister began talking to their mom about the COVID vaccines, it was a difficult conversation. Chris was living with Paula at the time, and he explained to her how he worried his work in health care could end up exposing her to the virus. She didn’t always appreciate why he insisted on space between them, he said.
“There was passion and frustration on my end because I believed it would help her and I didn’t want her to be hurt,” Chris said.
Paula, too, would sometimes be irritated by how often they talked about the vaccine.
“Everyone works on their own timeline,” Paula said. “I think to push people that you have to do this today is a turnoff.”
To diffuse the tension, though, they gradually learned how to talk openly while also respecting one another’s positions. They developed empathy for each other. And they realized there was something more important than vaccination at stake.
“If you didn’t have a relationship on the other end, it wouldn’t be worth going through it,” Chris said. “You have to remember that they are still people and they are more than their vaccination status.”
The process drew them closer together, even if they still didn’t agree on the vaccine. But, this summer, after listening to Chris and doing some research on her own, Paula decided to get the Johnson & Johnson shot. In her telling, it was an anti-climactic decision and not one she made for her own health.
“I took the vaccine because I wanted to make sure my family was comfortable around me,” she said. “I didn’t make a big deal out of it.”
Chris was relieved.
When the day of the vaccine appointment came, Paula and Chris walked in together. She sat down and rolled up her sleeve. She waited for the syringe to be readied.
Chris held her hand, tightly.