Clergy and Community Leaders as Vaccination Advocates in Rural Guatemala
Joshua Williams, MD, Denver Health
Introduction: In Guatemala, only 59% of children aged 12-23 months are fully immunized, and vaccine hesitancy (VH) is a growing public health threat. Historically, in resource-limited areas, partnerships with community leaders (e.g. clergy, teachers) have been critically important to promoting public health. Today, it is unclear whether Guatemalan community leaders themselves are vaccine hesitant or would be willing vaccination advocates. We conducted a cross-sectional pilot survey aiming to (i) compare rural Guatemalan community and religious leaders’ attitudes toward childhood vaccines, (ii) describe their experiences and comfort with vaccine advocacy, and (iii) describe community members’ perceptions of trust in them as vaccine advocates.
Methods: We surveyed community members (parents of children ≤ 5 years; n = 150), recognized clergy (n = 50), and established community leaders (n = 50) around the Southwest Trifinio clinic in Coatepeque, Guatemala in 2019. We asked basic demographic questions, including items measuring religion and religiosity, and probed vaccine hesitancy with a validated scale. Also, we asked clergy and community leaders about past vaccination advocacy work and current comfort with vaccine advocacy, and we asked community members about who they trusted for advice on childhood vaccines. We used descriptive and multivariable methods to compare clergy and community leaders’ attitudes to childhood vaccines, leaders’ comfort and experiences with vaccine advocacy, and community members’ levels of trust in leaders or clergy as advocates.
Results: We recruited 250 participants (response rate 99.2%). Table 1 summarizes our sample, stratified by participant type. Most respondents were poor, married with children, had limited formal education, identified as Evangelical or Catholic, and were highly religious. On average, clergy reported serving for longer than community leaders (13.5 ± 10.9 years vs. 4.4 ± 6.7 years; P < 0.01). Overall, one in seven (14%) participants was vaccine hesitant (14%), without significant differences among caregivers, community leaders, or clergy (P = 0.71).
In the prior year, fewer than half of all community and religious leaders had spoken about vaccines to their communities, and only one in six leaders reported that a member of their community had asked them about vaccines in the same time period (Figure 1). There were no significant differences between leader types on advocacy-related questions. Fewer community members trusted politicians “a lot” for vaccination advice (28%) versus clergy (49%; P < 0.01) and teachers (48%; P < 0.01). Community members trusted native healers least of all (Figure 2).
Conclusions: This pilot study identified a non-negligible level of vaccine hesitancy among young parents, clergy, and community leaders in a rural Guatemalan context. Clergy and teachers were highly trusted by their community, yet these leaders rarely, if ever, engaged in vaccine advocacy. These findings suggest clergy and teachers especially are willing but underutilized advocates for child health in rural Guatemala. Public health and governmental officials in rural Guatemala and other similar contexts should enlist these trusted leaders, address concerns they may have about vaccines, and engage them in regular advocacy work.
Methods: We surveyed community members (parents of children ≤ 5 years; n = 150), recognized clergy (n = 50), and established community leaders (n = 50) around the Southwest Trifinio clinic in Coatepeque, Guatemala in 2019. We asked basic demographic questions, including items measuring religion and religiosity, and probed vaccine hesitancy with a validated scale. Also, we asked clergy and community leaders about past vaccination advocacy work and current comfort with vaccine advocacy, and we asked community members about who they trusted for advice on childhood vaccines. We used descriptive and multivariable methods to compare clergy and community leaders’ attitudes to childhood vaccines, leaders’ comfort and experiences with vaccine advocacy, and community members’ levels of trust in leaders or clergy as advocates.
Results: We recruited 250 participants (response rate 99.2%). Table 1 summarizes our sample, stratified by participant type. Most respondents were poor, married with children, had limited formal education, identified as Evangelical or Catholic, and were highly religious. On average, clergy reported serving for longer than community leaders (13.5 ± 10.9 years vs. 4.4 ± 6.7 years; P < 0.01). Overall, one in seven (14%) participants was vaccine hesitant (14%), without significant differences among caregivers, community leaders, or clergy (P = 0.71).
In the prior year, fewer than half of all community and religious leaders had spoken about vaccines to their communities, and only one in six leaders reported that a member of their community had asked them about vaccines in the same time period (Figure 1). There were no significant differences between leader types on advocacy-related questions. Fewer community members trusted politicians “a lot” for vaccination advice (28%) versus clergy (49%; P < 0.01) and teachers (48%; P < 0.01). Community members trusted native healers least of all (Figure 2).
Conclusions: This pilot study identified a non-negligible level of vaccine hesitancy among young parents, clergy, and community leaders in a rural Guatemalan context. Clergy and teachers were highly trusted by their community, yet these leaders rarely, if ever, engaged in vaccine advocacy. These findings suggest clergy and teachers especially are willing but underutilized advocates for child health in rural Guatemala. Public health and governmental officials in rural Guatemala and other similar contexts should enlist these trusted leaders, address concerns they may have about vaccines, and engage them in regular advocacy work.