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Medical students Kaitlynn Esemaya, Anamaria Ancheta, and Annique McLune discuss their article, “Why vaccine access still fails America’s most vulnerable groups.” They highlight how social determinants of health drive pervasive inequities in vaccination rates among marginalized U.S. communities, exacerbated by the COVID-19 pandemic. Kaitlynn, Alexis, and Annique cite CDC data showing updated COVID-19 vaccine uptake for Non-Hispanic Black and Hispanic adults at 8 percent, nearly half that of white adults (15 percent) for 2023–2024. This disparity extends to other vaccines like HPV and influenza, with poverty being a key factor. The discussion covers the post-pandemic drop in childhood vaccinations due to access barriers like lack of insurance and provider shortages, particularly in rural areas. They also touch on HPV vaccine disparities, where only 76 percent of U.S. children received one dose by 2022, and varying awareness levels, such as only 40 percent of adults with less than a high school education being aware of HPV compared to 78 percent of college graduates. Kaitlynn, Alexis, and Annique point to the resurgence of measles, with 301 U.S. cases by March 2025, and address the critical issues of vaccine hesitancy, medical mistrust, and misinformation, noting that these challenges even affect health care workers. The conversation emphasizes the need for increased education, public promotion of vaccinations, and improved access to address these persistent failures.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. So today we have a group of medical students with us: Kaitlynn Esemaya, Anamaria Ancheta, and Annique McLune. They’re all co-authors of the KevinMD article, “Why vaccine access still fails America’s most vulnerable groups.” Everyone, welcome to the show.

Kaitlynn Esemaya: Thank you. Thank you for having us.

Kevin Pho: All right, so Kaitlynn, tell us about this article for those who haven’t had a chance to read it.

Kaitlynn Esemaya: So this article is just one of many that we’ve created over the past two years. This article in particular was chosen mainly to raise awareness of vaccination hesitancy within the nation, as well as the real-time consequences that we are seeing when it comes to the increase of rates of individuals being diagnosed with these viruses at a rapid rate.

This article in particular focused on the disparities within immunizations when it comes to minority groups and possible factors and barriers that are implicated when it comes to the under-immunization rates. It also addresses some possible aspects that we as health care providers can do in ways to improve these vaccination rates.

Kevin Pho: All right. And obviously, as you all know, vaccine hesitancy has been a huge issue, especially with some of the more recent news and the interaction between vaccines and the current administration. So Kaitlynn, tell us some numbers that we’re talking about just to give us a scope and context for our discussion.

Kaitlynn Esemaya: As of March, there were about 301 cases of measles confirmed in over 15 states. Since March, that number has already grown. I don’t have the particular number at the moment, but these preventable diseases are on the rise within the U.S., and vaccination hesitancy and a decrease of vaccination education are also increasing as well.

So I do think that we play an active role right now in trying to decrease those numbers of people who are unvaccinated and give proper education, as well as factoring in possible barriers and why people aren’t getting vaccinated and just trying to get to the root cause and understanding the individual’s decision.

Kevin Pho: Anamaria, the article talks about the various social determinants of health that sometimes drive the disparities between vaccination rates between certain groups. So talk more about that intersection.

Anamaria Ancheta: Of course. Specifically here in New Mexico, where our medical school is located, we’ve seen a big rise in just access to the vaccines. Most of our patients that live in our nearby counties live in very rural areas, so having access to physicians to have even more time to spend with different patients and their parents or their guardians to talk about why they may be having vaccine hesitancy. Some of the workarounds the New Mexico Department of Health have done have been to offer vaccines near, during, and after school times. So it allowed children to go immediately from school to get the vaccine, and we’ve seen that that has caused an increased uptake in the vaccine, at least in our area.

In terms of also just having access to pay for the vaccine, a lot of folks have expressed hesitancy in terms of cost and coverage. And so we always like to remind our patients in our area that this cost usually is covered by their insurance but also through the public health department that is with us.

Kevin Pho: Anamaria, from your experience, which vaccines in particular are we talking about? Is there any one vaccine that people are more hesitant to get or for clinicians to give when you talk about vaccines in general?

Anamaria Ancheta: Here in New Mexico, we have seen that vaccination rates prior to kindergarten age have been taken up more widely. The MMR vaccine, unfortunately, was just a vaccine that a lot of folks were expressing hesitancy towards. So we’ve been trying to do work with local medical societies to raise awareness for the community members and the physicians to be equipped with the knowledge that they need to discuss the MMR vaccine with their patients.

Kevin Pho: Anique, when you’re co-writing this article, what are some of the reasons why people may be hesitant to receive some of these vaccines?

Annique McLune: I think for the most part, it stems from education and just not having access to information about the drawbacks of not getting the vaccine. And so particularly when we’re coming up with ideas of how to disseminate this information with our medical ethics newsletter on campus, we always think about what we see in clinics too and just how we have to educate our patients about why it’s important to take these vaccines. Because sometimes they find that they just don’t know, and if you don’t know, you can’t learn. And so we always have to go back to why education, in general, matters the most.

Kevin Pho: And Anique, when you said that people need more education on the vaccines, are you talking about the fact that these vaccines exist, or are there specific misconceptions or misperceptions about the vaccines themselves that they need to be educated about?

Annique McLune: It’s that the vaccine exists and what the vaccine does. I think particularly on a couple of my rotations, I’ve seen, especially for the HPV vaccine, people just don’t know what it is and what it protects against. And so sometimes it’s just the bare minimum of what it is and what it’s used to protect against. I think that is where some of that disconnect lies.

Kevin Pho: Give us an example. So what are some of the specific questions that you’re hearing from patients during your rotations? Let’s say about the HPV vaccines. What would a typical interaction be like from a patient who has questions about that?

Annique McLune: So typically, when we go into a patient’s room and we’re talking about a general well-woman exam, we’ll ask, “OK, have you ever done a Pap smear? Have you ever been vaccinated against HPV?” And they may ask, “What is HPV?” And then we explain, “This is a virus that puts you at increased risk with certain strains to get cervical cancer.” And then we have to go into why it’s important that you get your Pap smear. Doing your Pap smear is very important, but getting the vaccine is protective up to age 45, and you can start as early as nine. So we go in and tell them.

Sometimes it’s easier when, as a woman, you can say, “Well, I’ve also gotten this vaccine,” or “My sister has gotten this vaccine.” And so you can kind of build that rapport as well to get them to understand more that it’s something that’s not going to really have detrimental impacts on their life if they get it, but that it’s giving them some protection. And so we have to kind of make that rapport as well, because it’s an intimate setting in the OB-GYN office. So we’re kind of building that rapport when you express that you also have received that vaccine.

Kevin Pho: Kaitlynn, when you spoke, you talked about the rising rates of measles. Right? And now we’re having hesitancy with the MMR vaccine, which traditionally has had almost universal uptake. Tell us about some of the stories that you’re hearing specific to the MMR vaccine because, in contrast to the HPV vaccine, which is relatively more recent, the MMR vaccine has been much more established and has a much wider uptake. Are you seeing or reading about more hesitancy for people who are questioning something as established as the MMR vaccine?

Kaitlynn Esemaya: Yes, I’m definitely reading and experiencing a lot of hesitancy when it comes to the MMR vaccine as well as a multitude of other vaccines. And it’s not just with the patients; it’s also with other health care providers as well, whether it be nurses, medical assistants, other physicians, or medical students. And I think it also just stems from a mixture of distrust within the health care system as well as possible distrust in the pharmaceutical system as well.

Kevin Pho: And Kaitlynn, you said medical students, so you are experiencing some medical students who are also questioning the safety and efficacy of vaccines?

Kaitlynn Esemaya: Yes, and I think it’s honestly the rise of vaccine misinformation and pseudoscience. Right now, I believe that there is a definitely huge push going towards using natural medications or treatments and trying to stray away from pharmaceutical uses to heal the individual.

But I think it’s very important to understand why we even came up with vaccinations, why they’re important, and why we need them. And it’s not just because of our own safety and our own health; it’s also to help many around us who are unable to get these vaccinations because they may have an immunodeficiency disorder or they may have extreme reactions that make them unable to obtain these vaccinations. We are getting these vaccines to help those other people as well.

Kevin Pho: So, Kaitlynn, what are those conversations like? If you have one of your fellow medical students who is questioning the efficacy and safety of vaccines, do you guys have debates? Do you try to convince them? How do these conversations go if you have fellow medical students who presumably have a strong basis in science, which is why they’ve gone into medical school in the first place? Where do these conversations lead?

Kaitlynn Esemaya: So they do always have a debate-like quality to them, but we also come to an understanding. Obviously, we are able to understand the medical background of things. We’re able to understand the science background of everything. And I think honestly, their misunderstanding comes from more of a subjective standpoint rather than an objective one. They kind of come at it from, “Oh, well I never get sick. I don’t do my influenza vaccine, or I’m just doing the influenza vaccine because I have to have a check mark on my vaccination list to be able to complete the year.”

And it’s not necessarily that their argument is wrong. I do understand that their argument is valid, and I do understand that everybody’s argument is valid. But I do feel like they are missing key parts within their argument by saying that they are not going to get this vaccination because of X, Y, and Z. I think that was the main reason why I even started the medical ethics newsletter: because there were these gaps in understanding when it comes to medical injustice or health disparities within minority groups, which lead to these disparities in immunizations.

Kevin Pho: Anamaria, tell us about a path forward. We are living in a highly politically charged time where science is being attacked by the current administration and trust in our health care authorities is at an all-time low. So what are some paths forward in terms of how we can stem that tide?

Anamaria Ancheta: I believe at its core, it truly comes down to building rapport with your patients. If you have that extra five to 10 minutes to spend with your patients and discuss their concerns, and really talk to them and try to unveil what it is that they’re hesitant about. A lot of folks that we have encountered have continually reported back to the 1998 study about autism being linked to vaccines. And so really trying to dispel that information and talk to them and say, “This study was disproven. That physician no longer has their medical license.” It really kind of makes them take a step back and reevaluate the information that they are receiving.

We, as medical students, have a unique role in that we are allowed to have that extra time with those patients, so we can have that extra time that maybe physicians don’t have. I think the best thing that we can do is continue to have different town halls, different communication methods, and, much like our own medical ethics newsletter, try to dispel the information as trusted messengers.

Kevin Pho: Anamaria, have you seen a success story or read about a success story where sometimes these conversations can lead someone—it could be a patient, colleague, or clinician—to change their mind? Have you ever seen someone change their mind about vaccines because of the rapport that you’re talking about?

Anamaria Ancheta: Yes, 100 percent. So during the COVID-19 pandemic, I was working on a study here in San Diego about the COVID-19 vaccine. And so we were working in communities where they had the highest rates of COVID-19. What we started to do was have discussions about the COVID-19 vaccine and what it meant for patients. A physician was leading a discussion on it, and one of the parents came up to me and said, “I’m just here to listen. I’m not really sure. I never wanted the COVID-19 vaccine, but I’m here with my child because I want to learn.”

And after the event, they came up to the physician and me and shared how wonderful it was that we gave the information to them. No one had spent the time to discuss with them what the COVID-19 adverse effects could be and what it meant to protect not only themselves but their grandparents at home. And so because of that, they were willing to take the vaccine and got their vaccination a week later. I really do believe that it comes down to just hearing people and what their concerns are and trying to give them the information so that they can make their own autonomous choice to get the vaccine.

Kevin Pho: Anique, I mentioned earlier medical mistrust and that trust in our public health authorities is at an all-time low. Sometimes medical mistrust among certain racial demographics is more prevalent than others. So how can we overcome some of this medical mistrust, especially among underserved communities who may have had poor experiences with the health care system? How can we in the health care field overcome that history of mistrust?

Annique McLune: So I think the most important part is to acknowledge that it happened. I know we can’t go back and change things that happened in the past, but we have to acknowledge that it happened and it continues to perpetuate the system because that’s just how it was set up.

But I think having culturally competent care is really important because we’re meeting people where they’re at. We’re expressing information, and we’re building trust with them by meeting them where they’re at and learning about what sort of hesitancy they may have, addressing it, and cautiously trying to shift them to the other side if they can get there. But if they can’t, we also must not demonize them for their thoughts and their actions, because it’s a real injustice that continues to happen in our society.

So I think we’re meeting people where they’re at, and we’re going slowly and surely towards getting them to the other side of it, where we have good, culturally competent care that we can use for everyone and not have anyone feel ostracized because of their thoughts or actions.

Kevin Pho: So for those who aren’t familiar with the term culturally competent care, Anique, what does that mean to you?

Annique McLune: For me, culturally competent care is understanding that everyone is different and exists within their own culture. For me, I was born in Jamaica, so my culture of medicine and herbal medicines is part of my thought practice as a future physician because I understand that other people come in with their own ideas of what health and medicine might mean to them.

It’s understanding that they have their thoughts and I have my thoughts, and we’re going to meet in the middle. I’m going to be humble enough to understand that I can never live their experience of their culture, but I understand that it impacts their health and their livelihood. And so I’m going to meet them where they’re at. We’re going to come up with a plan of action to make sure that we’re giving them the care that matches what they expect and what science also expects, or what medicine in general expects.

Kevin Pho: We’re talking to three medical students: Kaitlynn Esemaya, Anamaria Ancheta, and Annique McLune. The KevinMD article that they co-wrote is, “Why vaccine access still fails America’s most vulnerable groups.” Now, I’m going to ask each of you just to share some take-home messages that you want to leave with the KevinMD audience. Kaitlynn, why don’t we start with you?

Kaitlynn Esemaya: I think one thing that I want to leave with the audience is that we all have biases, whether they be conscious or unconscious. And that is OK that we have these biases, but I think it is crucial that we acknowledge that we do have these biases and make sure that they do not interfere with the way that we treat others. Because that is when it becomes a problem. It is OK to have them, but once it interferes with how we view others and how we treat them, that is when it becomes detrimental to everybody around us.

Kevin Pho: Anamaria, your take-home messages.

Anamaria Ancheta: I think I want to encourage health care professionals to be advocates within their community, not just within the clinic, but outside. Vaccine hesitancy begins before patients come into the clinic. So get involved with your local medical societies. Learn what your local departments of health are doing and try to be in the community and dispel information by being that trusted messenger that you are.

Kevin Pho: And Anique, finally, your take-home messages that you want to leave.

Annique McLune: I think I want us all as health care and future health care providers to be culturally humble, to understand that everyone has their own lived experience. Because of that, we have to meet people where they are, making them feel understood and willing to participate as we take this journey as patient and physician to improve their overall well-being.

Kevin Pho: Everyone, thank you so much for sharing your perspectives and insights, and thanks again for coming on the show.

Annique McLune: Thank you.