Health Equity

Arkansas BCBS exec: Vaccine disparities come from a mistrust of the health care system

Gabriel Perna | June 1, 2021

Creshelle Nash, MD

Across the country, disparities in vaccine rollout are a continuous challenge for industry stakeholders.   

According to the latest data from Kaiser Family Foundation, 56 percent of Black adults have received at least one dose of the vaccine compared to 65 percent of White adults. Nearly one-quarter of Black adults say they will wait and see before getting vaccinated. When the data has been broken down on a county level using social vulnerability index, there are similar disparities.  

In some states, especially those with a heavily rural population like Arkansas, it’s an even greater challenge to get Black and other communities of color vaccinated. According to recent data from the Arkansas Department of Health, about 76 percent of the state’s shots have been given to White people, 10 percent to Black people and 4 percent to Hispanics.  

Health Evolution Forum CEO Guide: Increasing Vaccine Uptake in Diverse Communities  

Health Evolution recently spoke with Creshelle Nash, MD, Medical Director for Public Programs and Utilization Management at Arkansas Blue Cross Blue Shield about disparities in vaccine rollout in the state, strategies she has seen work in underserved communities and what doesn’t work in reducing these disparities.  

What have you seen in Arkansas with disparities in vaccine rollout? 

We’re really seeing disparities in vaccines that mirror the disparities that we have known about for a very long time in health care. Recently, the health department has started to report vaccine administration rates by race and ethnicityAfrican Americans makeup about 16 percent of the population in the State of Arkansas and the data shows a lag with African Americans making about 10 percent of the vaccine uptake.  

Those disparities are due to a number of things that the pandemic has shown us in real time. People really don’t have some of the resources that they need to be healthy. For example, accurate information to decide whether or not to get the vaccine. Transportation issues, connectivity issues, access to pharmacies and even access to the mass vaccine clinics. There are a lot of things wrapped up in there and this is all about health equity. We’re trying to address all of those issues.  

Another thing that I would add in terms of the disparities is that we can’t talk about health equity without talking about race specifically and really structural racism. What I mean by that is systems of disadvantage that pre-dated COVID that COVID is showing us. We have to address those policies and practices that actually can be barriers for people and actually cause disparity without intent. 

The last thing I would make a comment on is about the term vaccine hesitancyI would call it something much stronger than hesitancy. It’s actually a mistrust of the health care system. There is a mountain of evidence in the literature that suggestcommunities of color don’t have access to quality health care. We have to address those fears and understand that while we’re trying to address these disparitiesCOVID-19 is having a disproportionate impact on the very people who need the vaccine. We’re trying to address all of that in our efforts in the state of Arkansas. 

I think also the pandemic has shown us that we are capable of addressing health equity across the board through partnerships and collaboration. It takes a will, it takes intentionality and it takes action.

Creshelle Nash, MD, Arkansas Blue Cross Blue Shield

What are some of the strategies you’ve undertaken that have worked in underserved communities? 

We have started a partnership across the State of Arkansas called “Vaccinate the Natural State” where we are working with large employers, the Department of Health, the Chamber of Commerce, health systems, and community-based organizations from one corner of the state to the other to address these concerns in minority and rural communities. And not only to address the concerns, but to be sure that we’re bringing the vaccine to these communities. Our major strategy really is community engagement, working side by side with organizations who have been doing this work on the ground pre-pandemic and will continue after we get the pandemic under control. 

What does work and what doesn’t work in your experience? 

A top-down approach doesn’t work in my experience. We have to realize that local people and local leaders are experts in their community. And we have to understand local communities in their concerns to have an impact. We cannot assume that a one-sized-fits all strategy works. In our community engagement model, we are working with the existing organizations that are trusted in their communities and they are defining what their local needs are. Our interventions, our community engagement may vary depending on the community. In some areas, it is providing information or a PR campaign and in other areas it’s actually boots on the ground volunteering in vaccination clinics. In some cases, it’s being a connector of organizations and resources, it’s funding through our foundation efforts. In other ways, it could even be using our data to help identify critical gaps in deployment of the vaccines and what resources can have the greatest impact. It’s very flexible. We are paying particular attention to community needs. 

What are the major lessons we need to take from the pandemic in terms of health equity, access to care, and social determinants of health?  

That is my passion and that’s the $64 million-dollar question. The pandemic has really put a spotlight on health equity that already existsI’ve made reference to some of it already, but we’re talking about everything from food insecuritybehavioral health needs, transportation, the digital divide, etc. All of those things and we have seen that real time in the pandemic.  

What are the lessons learned? The first one is to improve the health of this nation we must address health equity and health in all communities—not just in this infectious disease pandemic, but it’s much larger than that. It’s really to improve the health of the nation. I think the other lesson learned is that we need to get upstream to address the policy level that’s driving the social determinants of health in local communities. 

I think also the pandemic has shown us that we are capable of addressing health equity across the board through partnerships and collaboration. It takes a will, it takes intentionality and it takes action. We in Arkansas are trying to take that action to ensure that we are addressing health inequity. What that means is the interventions that we’re trying to do to address those social determinants of health, they have to remain in place long after the pandemic has subsided. Health equity has to be a component of health and health care going forward. 

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email at or on Twitter at @GabrielSPerna