Author: Christopher Montgomery, MD, MPH

Conquering fear and misinformation through trust and knowledge

Posted June 06, 2023

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

As the tip of the syringe moved toward his shoulder, I witnessed an ever-expanding fear grow in the eyes of Teddy, a 6’ 6”, 260-pound Police Officer at New York City Health + Hospitals (NYC H+H), in Harlem.

Teddy, a Harlem native, was supported, loved, and grew up in the surrounding community, and he now returns the favor every day, taking care of his community in a space meant to be safe. As the needle pierced his skin, its protective contents pushed into his body, he immediately looked at me. Teddy asked me to be with him for his first COVID-19 vaccination. Seeing doubt and fear in his eyes, questioning what he had just done, was, for lack of a better word, painful. However, Teddy receiving that life-saving (for many) vaccine, trusting what he was taught, and relying on the information he learned, was motivating.

When I reflect on this moment, I feel somewhat selfish and uncomfortable with what I describe as a feeling of personal victory. I convinced Teddy to get his first COVID-19 vaccine! But then I remember who Teddy is, and why his decision to get vaccinated is so important to me.

Teddy was born and raised in Harlem, a permanent resident of the “Black Mecca,” a loving husband, and a proud father. During COVID-19 first wave, he was a transporter of lives lost, stored in refrigerated containers due to a lack of space in the morgue. Throughout the pandemic, Teddy was steadfast in protecting his community, a pillar in his post, often unmasked due to the limited availability of N-95’s. As a health care worker (HCW), his risk of testing positive for COVID-19 is 11.6 times higher than the general community, and as a Black male, he is 2.1 times more likely to be hospitalized due to COVID, and 1.6 times more likely to die from COVID-19 compared to white, non-Hispanic persons. Teddy was also one of 542 HCW’s at NYC H+H/Harlem who took part in the Community Activation Model: COVID-19 Vaccine Educational Seminar (CAM). Teddy getting that vaccine was a victory!

On August 16th, 2021, New York Governor Andrew Cuomo announced that all HCW’s in the state must be vaccinated against COVID-19 by September 27th, 2021. This preventative measure was needed due to a growing deficit in HCW availability, combined with hospitals being overwhelmed by the influx of non-COVID-19 patients due to delayed care, compounded by the Delta Variant spreading across the City. For systems like NYC H+H, where approximately 20% of its 42,000 employees had yet to receive their first vaccine, meeting this requirement would be no small task.

After my third year of medical school, I took a gap year to work at NYC H+H, and was part of a team responsible for reducing the potential downstream impacts of this mandate on the care we provide. A majority of my work was completed at NYC H+H/Harlem, where 22% of the workforce was unvaccinated.

Alongside other efforts I developed the CAM as an intervention to retain employees and to increase vaccination rates among the workforce. The foundation of the CAM is centered on respecting the individuality and unique needs of the population you seek to serve. Therefore, as part of designing the CAM, we conducted key informant interviews with hospital staff, in order to identify key drivers of vaccine hesitancy at NYC H+H/Harlem, which included:

  1. Lack of trust in the vaccine due to difficulty in accessing information that is easy to understand.
  2. COVID-19 no longer being a threat – “we lived through the first two waves without a vaccine.”
  3. The importance of personal agency – disregard for autonomous decision making.

Respecting the unique needs of the Harlem community, I designed a teaching curriculum to answer the questions and concerns related to the population, and provide accurate knowledge to enable informed decision making. Simplifying immunology, virology, and vaccine history and development to a middle school reading level, and requiring every unvaccinated employee to take part in the seminar over a 3-week period.

The results were tremendous, with a reduction in unvaccinated employees by September 27 from 22% to 4.4% (NYC H+H average of 7.8%).

While I recognize the mandate as a critical driver of vaccine adherence, the efforts of the CAM played a major role in vaccine understanding, comfortability, and acceptance. While misinformation will always have an enormous impact on healthy and informed decision making, we learned through this experience that it is just as important to increase accessibility to understandable and accurate information that anyone can use to combat misinformation.

Dr. Christopher R. B. Montgomery’s professional journey has spanned various roles and responsibilities. After serving as Assistant Health Care Program Planner and Analyst at NYC Health + Hospitals, he is now an intern at the UCLA Reagan/Olive View Emergency Medicine Residency. His academic journey began in Germany, where he received a Baccalaureate of Science from the University of Mainz and a Bachelor’s degree in Biology from the Technical University of Kaiserslautern. He then pursued an MD with distinction from the University of California, San Francisco, preceded by a Master’s in Public Health with a focus on Global Health, Epidemiology, and Biostatistics at Loma Linda University. His experience extends to the San Bernardino Department of Public Health, where he worked as an epidemiologist, contributing to systems improvement, resource optimization and community engagement.