May 24, 2021

In Durham, North Carolina — less than 15 miles from the University of North Carolina at Chapel Hill — a public health campaign called “Back on the Bull” has been supporting local businesses throughout the COVID-19 pandemic.

The UNC Gillings School of Global Public Health became involved when Steve Schewel, the Mayor of Durham, invited faculty members to manage a community health ambassador program with the goal of helping small businesses in Durham County reopen safely following lockdown.

To date, more than 1,000 business have taken the Back on the Bull pledge. Their shops display signs in support of the campaign, which also aims to improve health equity in Durham (called the “Bull City”).

Dr. Yesenia Merino

Dr. Yesenia Merino

Dr. Patsy Polston

Dr. Patsy Polston

Dr. Kurt Ribisl

Dr. Kurt Ribisl

Kurt Ribisl, PhD, Jo Anne Earp Distinguished Professor and chair of the Department of Health Behavior at the Gillings School, works with Patsy Polston, PhD, a Gillings alumna and adjunct instructor of health behavior, to supervise 10 health ambassadors. Yesenia Merino, PhD, the School’s director of inclusive excellence education and training, is a co-investigator, and Gillings students Marlyn Pulido, Hailey Mason, Joia Freeman and Elliot Krause supported the effort.

Earlier in the pandemic, the team promoted an online certification that highlights industry-specific health and safety checklists for the pandemic. Now, they are focused on increasing vaccination rates in minority populations.

“SARS-CoV-2 variants are on the rise,” Ribisl says. “We’re racing against time to get as many people vaccinated as possible. We’re also worried about clear disparities in vaccination rates. In Durham, the Black population is experiencing a very high death rate from COVID-19, and the Hispanic community makes up 13% of the population but is overrepresented with 34% of the cases. So, we’re centering our vaccination efforts on Black- and Latinx-owned businesses.”

“While vaccine supply is higher than demand, our goal is to facilitate access to vaccines within the Black and Latinx communities to decrease the gap in vaccination rates, because marginalized communities are still struggling with access,” Polston adds. “We’re sending health ambassadors out into the field to speak with business owners directly — and we were intentional about the ambassadors we hired. They are Black and Latinx, mostly from Durham, and have well-established networks, which has enhanced their ability to build the trust needed for community-engaged work.”

When a health ambassador visits a Durham business, they share educational materials, provide personal protective equipment for employees and customers, and bring other supplies — like floor stickers to mark 6-foot distances in check-out lines. So far, the team has distributed more than 30,000 face masks.

“The ambassadors have witnessed great excitement from business owners and employees. They’ve received warm welcomes in the establishments they visit,” Polston says. “They tell us they are proud of the work they’ve been doing, and they know they’re having an impact in their community.”

In an effort to eliminate barriers to vaccine access, Ribisl, Polston and the ambassadors are collaborating with six local groups, including the Durham County Health Department, El Centro Hispano, N.C. Central University, N.C. Specialty Hospital, Greenlight and Activate Durham. So far, the health ambassadors have scheduled close to 500 appointments for Durham County residents, 85-90% of whom identify as Black or Latinx.

Sometimes, eliminating a barrier to vaccination is a straightforward as helping a person navigate a computer to register for an appointment online.

“As a frontline worker, one woman was really concerned about taking COVID home to her family,” Polston shares. “We worked together and got her signed up then and there. What’s critical is listening to community members when they voice their concerns. We’ve facilitated a lot of discussions about the different vaccine options and met people where they were with facts and gentle support so they could make informed decisions.”

The Back on the Bull website displays partner logos.

The Back on the Bull website displays partner logos.

At their most recent event, the health ambassadors partnered with Compare Foods — a Latinx grocery store in Durham — to vaccinate employees on-site during the workday. While the mobile community clinic was in the parking lot, 48 more people walked up and received vaccinations.

Polston says they were drawn in by the “music, community feel and “fun energy” of the event, adding, “We made the vaccine an accessible and easy choice.”

Now, the team is in communication with other local businesses that want to host similar events. It’s become clear that — rather than inviting people to travel to large vaccination events — public health practitioners need to bring smaller events into local communities.

“The Durham County Health Department has been so helpful, despite being slammed,” Ribisl reports. “They give us reserved vaccine appointment slots and they provide the vaccine doses for pop-up events. If public health in general were better funded, our efforts wouldn’t be needed, but we’re honored to fill in as a staff-extending outreach group. What we’re struggling with now is getting enough health providers to work our events.”

“We have more vaccines than arms to put them in,” he adds. “We’re hopeful that the mayor and City Council will find additional resources to make this initiative more sustainable. What’s required now is constantly sending trusted people into the community as part of an extended vaccination campaign.”

Back on the Bull is run by the Durham Recovery and Renewal Task Force and the City of Durham. It was created by The Center for Advanced Hindsight at Duke University and McKinney, a Durham-based creative and media agency.

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