As the worldwide coronavirus pandemic has been unfolding, Dr. Emily Brunson of Texas State University’s expertise in vaccine decision-making, health crisis communication, and access to healthcare have launched her onto the international stage.
But despite the research and blueprints that Dr. Brunson and her colleagues have created to help lower hesitancy around vaccination, as governments have scrambled to quickly respond to this crisis, many entities have charged down paths that ignore best practices.
“As soon as COVID happened, I recognized that vaccine uptake would likely be overlooked until it was too late to adequately address,” says Brunson, Ph.D., who is an associate professor in the Anthropology department at Texas State University, and an applied anthropologist specializing in medical anthropology.
These gaps included solely focusing on the vaccine technology and delivery aspects and making choices like naming the vaccine development initiative “Operation Warp Speed” when what people really wanted to be assured about was that enough time was being taken to develop and test a safe vaccine.
People’s reasons for being hesitant about COVID-19 vaccines vary. Some worry about possible side effects. Others cling to debunked conspiracy theories, like the one about the vaccine including a tracking device (it doesn’t). National polling indicates splits along political lines (more Republicans than Democrats plan to turn down vaccines), gender (more women than men have concerns), and race, which is often related to historic health-related mistreatment. Examples of the latter include the plight of hundreds of Black men in Tuskegee, AL, who were secretly denied access to syphilis treatment from 1932 to 1972 so that the course of the untreated disease could be studied.
Despite these challenges, we now have a golden opportunity to consider and address equity, especially in Texas, with Hispanic and Black populations in particular. “COVID is forcing the need for outreach and communication,” Dr. Brunson explains. “It’s making it necessary to ensure that testing and vaccination are done in a fair way that people also interpret as being fair.”
Simultaneously members of the public are listening, paying attention to, and showing interest in equity in a way that hasn’t happened in a generation.
“All of this can allow us to turn this difficult situation into something positive. We have the opportunity to change the way that public health works in the state and in the country, especially how it works with communities of color. We can repair the wrongs and oversights that have caused lack of trust and inequity in the past,” says Dr. Brunson. “We can move forward in a better direction than where we started.”
Dr. Brunson focuses on healthcare access for people operating outside of the healthcare system, such as the many Texans without medical insurance. She also notes that there is ongoing systemic, race-based denial of access to health care that is now influencing vaccine acceptance.
“For some communities, there are longstanding issues of trust and that influences how they think and feel about COVID-19 vaccines,” Dr. Brunson says.
Access to vaccines is especially key for marginalized communities, and in these unprecedented, challenging times, the rollout in Texas has not been smooth. In Houston, testing sites for COVID-19 initially were almost all located in northern neighborhoods.
“That meant that most people living in poverty in the southern half of the city had little access. Testing wasn’t available to the most vulnerable,” Dr. Brunson says. “We’re seeing similar access issues across the state with the COVID vaccination centers.”
While Houston’s number of testing centers was adequate for its population size, the gaps in access raised the question of how to make testing and vaccination easy to access for even the most marginalized, underserved people in the community. “We need to make the vaccination easy for everyone to get,” she says.
Other people in Texas are beaten down by lack of access to health care, exacerbated by being ineligible for health care coverage.
“In Texas, state leaders and even public health officials will talk about people not accessing health care like it’s a choice, like Texans don’t want health insurance,” Dr. Brunson says. “Many Texans desperately want health care but don’t have access to it.”
Texas has the highest percentage and number of people without health insurance in the United States. In 2018, 17.7 percent of adult Texas residents under 65—about 5 million people—were uninsured, according to the U.S. Census Bureau. That’s compared to the 2018 national uninsured average of 8.9 percent.
In light of COVID-19 vaccinations, the professor worries that some Texans will be less interested because they feel disenfranchised about how they’ve been kept outside of the system for so long. “And that matters, because unless we can vaccinate pretty much everyone, this isn’t going to work the way we hope,” she says.
Along the border, vaccine administration has faltered where people need to cross a checkpoint to access a shot clinic. “Some people won’t do that because that feels unsafe,” Dr. Brunson notes. “But COVID-19 is a public health issue: It doesn’t matter if someone is in the country legally or illegally, we need to get them vaccinated. Across the border, across the entire world, we are literally in this together. We will either all become immune, or we won’t.”
“In my professional opinion, health literacy may be one of the most important issues facing the collective global community,” says Rodney Rohde, Ph.D., chair and professor of the Clinical Laboratory Science Program at Texas State University, where he is also associate director of the Translational Health Research Center. Dr. Rohde and Dr. Brunson worked together on a study called “Vaccination Knowledge, Attitudes and Behaviors among College Students,” which researched attitudes about COVID-19 vaccination among Texas State students.
“The work that Dr. Brunson is conducting in this area is critical to our understanding of why individuals do not take vaccines or why they do take them,” he says. “Moving forward, it will continue to help us mitigate issues of health disparities in all types of health-related areas.”
There have been multiple pandemic-related roles that Dr. Brunson has filled over the past year. These have included positions involved with the CONVERGE initiative that produced two national, foundational COVID-19 reports, as well as advisory board posts for such entities as The National Institutes of Health, National Academies of Sciences, Engineering and Medicine and the National Science Foundation. Dr. Brunson’s pandemic articles appear in prominent journals, while she and Dr. Rohde are also currently studying Texas State University students’ attitudes toward COVID-19 vaccination to discern broader implications for vaccine hesitancy.
Dr. Brunson’s contributions pinpoint social and behavioral factors in COVID-19 vaccine uptake, plans for working with communities of color, and communication about vaccination—key factors in helping all of us move beyond the current pandemic. She also co-leads CommuniVax, a national coalition aiming to remove biases and barriers to vaccination for historically underserved Black, Indigenous, and Latino populations. (See below.)
Influence for Dr. Brunson’s early career was close at hand as she grew up: Her mother was a nurse who played an active community role. “I would often see her helping people with health issues,” Dr. Brunson explains. “The neighbors would drop by to ask if they should take their child to get stitches or ask about a rash. I really admired what my mother was able to do.”
Inspired, Brunson planned on becoming a doctor. At Utah State University, she went into full pre-med mode, and along the way, took a class in anthropology.
“I hated the class, but I liked some of the things I was learning, and eventually I came to realize that anthropology put together all of my interests in one place, including biology, health, history, and the way societies work,” she says.
Brunson headed to graduate school at the University of Washington for a biocultural anthropology doctoral program and obtained a master’s in public health while she was there.
“It was all health related, but I got more into the cultural rather than the biological aspects of anthropology,” says Dr. Brunson, who joined the staff at Texas State University in 2011.
“Texas State is a fantastic institution and very supportive in allowing me to be exactly where I needed to be with pandemic response,” Dr. Brunson says. “And I’ve been able to involve students with a number of research projects, including one we did two years ago that considered how to allocate ventilators during a pandemic when the need outstripped the supply.”
Brunson wrote her dissertation about parental acceptance or refusal of vaccinations for their children, a focus that readily expanded to vaccine hesitancy in other settings, including pandemics.
Dr. Brunson often collaborates with Monica Schoch-Spana, Ph.D., a medical anthropologist and senior scholar with the Johns Hopkins Center for Health Security, regarding communication during public health emergencies, with a sharp focus on medical countermeasures like vaccines.
In 2016, the duo wrote a report for the Food and Drug Administration on the topic and followed it with a prospective scenario, published in 2017, about communication dilemmas set against a fictitious coronavirus outbreak called “The SPARS Pandemic 2025–2028: A Futuristic Scenario for Public Health Risk Communicators.”
Within the fictitious scenario, the academics used actual applicable measures that have proven almost eerily relevant for public health departments and others planning COVID pandemic responses. Since early 2020, their article has been downloaded more than 198,000 times and used all over the world by people helping their communities respond to COVID-19 outbreaks.
“It actually ended up being pretty accurate with what has transpired so far with COVID-19 and the response to rolling out the vaccines,” notes Dr. Brunson.
While their imagined scenario has been a foundation for much of the COVID-19 response around the world, it is Dr. Brunson’s work in the here and now that is having a strong influence on how the U.S. government approaches widespread vaccination.
One possibility of ending the pandemic is by achieving community immunity, a situation that would likely be reached when 70 to 85 percent of the U.S. population (adults and children) is vaccinated, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. By late April 2021, vaccines were made available for every person in the U.S. aged 16 or older; some 25 percent of the U.S. adult population was fully immunized, and 40 percent had received one of two vaccine shots.
But having a vaccine available for every U.S. adult is very different from access to and acceptance of vaccination. While some 69 percent of U.S. adults are either already vaccinated or plan to be, the remainder are still hesitant or plan to refuse immunization, according to the Pew Research Center. “You can have the perfect vaccine and have it ready to put into people’s arms, but if those people won’t take it, it doesn’t matter,” says Dr. Brunson.