Boost Oregon Origins Part 1: How did we get here?
Have you ever wondered who the organization is behind Boosting Our Voices and Neighborhood Doctor? You may have heard of Boost Oregon before; have you ever wondered how we came to be, our goals, our ideals, and what we hope a better world looks like? This two-part series attempts to address those questions. In this portion, we talk about how our non-profit started and how we developed into who we are today. Founding Executive Director Nadine Gartner steps in to tell the story while Ari is out on leave.
Part 2 on the long-term goals of Boost Oregon will be released on March 20.
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Our Host
Nadine Gartner
Transcript:
Nadine Gartner: (00:02)
Hi everyone. My name is Nadine Garner, and I know I'm not the usual voice of the show, but I'm standing in today for Ira o' Donovan while she is on holiday as a regular listener of IRA's and Dr. Ryan Hassan's, you're probably familiar with the name Boost Organ. We're the organization behind those podcasts, and while our usual hosts are away, we wanted to take some time to tell you more about who we are. So this is the story of Boost Organ's origins.
Nadine Gartner: (00:40)
Let me set the scene. I'm sitting in a crowded brunch spot with three girlfriends from what else? A CrossFit gym. We mostly followed the adage of, if you do CrossFit, you must talk only about CrossFit. But on this particular morning, it took a different turn. I was three months pregnant with my first child and ready to announce the good news to my friends, two of whom had become mothers recently, while the third expected her first baby in just a few months. After an immediate round of congratulations, hugs, and promises to share their spreadsheets of vital baby gear. One woman asked me, what's your vaccine plan? I paused and stared surprised by the question and wondered if I understood what she asked. What do you mean? I responded? Another friend explained, do you plan to vaccinate your baby? Yes. I said, slowly. Why do you ask?
Nadine Gartner: (01:37)
I then learned that one woman who was fully vaccinated herself and got her annual flu shot because her employer required it refused all vaccines for her baby. Our pregnant friend offered to loan me her copy of a book that recommended an alternative vaccine schedule, one that cherry picked which vaccines to accept, and when She also had a list of local health practitioners who touted that schedule, the third friend sat silently and shrugged her shoulders. She later disclosed to me privately that she follows her pediatrician's recommendations and vaccinates her baby fully. She thought it futile to argue with our friends and had learned to sit silently. Whenever the topic of vaccines came up, I was shocked. My friends were thoughtful, conscientious mothers who carefully avoided soft cheeses and caffeine during their pregnancies. They grew up white and middle class. They hadn't faced systemic barriers or historical trauma.
Nadine Gartner: (02:37)
They were college graduates with professional careers and access to great healthcare. They themselves had been fully vaccinated as children. What led them to opt out of vaccinating their children back at home that afternoon? I quickly learned online that my friends were not alone. Oregon had the lowest rate of immunization among kindergartners, and it only seemed to be decreasing. How did so many people in my state decide against decades of scientific research and near consensus by medical doctors? My first attempt at exploring my friend's claims was, of course, Google. I entered a simple search for my home in Portland. Are vaccines safe for children? The result was page after page of anti-vaccine information. I now know that my location influenced my results. Google displayed results that were popular with others searching in Oregon, so the search engine was reinforcing what other Oregonians sought. Some of the sites listed were quite sophisticated using scientific jargon, footnotes and fancy formatting to appear legitimate.
Nadine Gartner: (03:46)
As a lawyer, I was trained in reading text closely and finding vulnerabilities in arguments. Nevertheless, it took me up to 20 minutes on some sites to determine that they were not scientifically sound. In fact, in that first Google search, I did not find a single source supporting vaccines until the fourth page. The sources there were the CDC and the NIH. Their sites were full of dense text and numbers regarding doses administered lives saved and serious diseases prevented. There were no personal stories or persons really that brought those numbers to life. Whereas the anti-vaccine websites were full of personal anecdotes, blaming vaccines for everything from a broken limb to a neurological disorder. The government cite spewed facts and statistics with little context. It seemed to me that the science was completely detached from the personal and that this would lead to devastating consequences in Oregon and beyond.
Nadine Gartner: (04:50)
I scoured over Facebook parenting groups and saw that any mention of vaccines led to vitriolic rhetoric and disparaging comments. Parents who comforted each other in a thread about sleep deprivation were now ripping each other apart over their vaccine decisions. Some parents would leave that particular parenting group and then join or create a separate group, one devoted to pro-vaccine parents or anti-vaccine parents. The lack of civility around this topic and siloing of parents worried me. I feared that surrounding ourselves only with people who think like us would exacerbate the divide and increase the already alarming rate of unvaccinated children. I wanted to find a way to reach parents beyond their computer screens, to talk to medical professionals and other parents without fear or judgment to be heard without being told what to do and to be empowered to make the best possible decisions for their family's health.
Nadine Gartner: (05:53)
That brunch in 2012 planted the seed for what became Boost Oregon. Four other parents and I founded Boost Oregon in July, 2015 with the intention of meeting parents where they were leading with empathy and compassion and making evidence-based information accessible. All of our work would start from our core belief that every parent wants the best for their child. We established Boost Oregon as a nonprofit entity funded only by individual donors and community foundations. We would not accept donations of any kind from pharmaceutical companies. In our first year, we leaned into a community workshop model, a free session held in a nonclinical setting, yoga studios, libraries, toy stores, grocery stores, sometimes with childcare, always with snacks we're expecting, and current parents met with a pediatrician and got answers to all their questions. We created a curriculum that addressed parents most frequently asked questions, how vaccines are made and monitored for safety, the ingredients in the vaccines, how vaccines work in the body, and why the recommended schedule is what it is.
Nadine Gartner: (07:08)
But most importantly, we gave time and space to parents' own questions. We started each session with a whiteboard and marker, and parents would ask their most pressing questions upfront. We then posted that whiteboard front and center so that the doctor would answer them. Over the course of the workshop, parents entered the workshops with their shoulders to their ears, clutching notebook, pages of handwritten questions or printouts of websites and Facebook groups. The workshop ended only when everyone's questions were answered, which took at least two and sometimes closer to three hours. We recognized early that vaccine education is not a one size fits all model vaccine. Hesitancy is not a monolith. People may feel hesitant because of systemic racism or bias, historical trauma, poor personal experiences with the medical field, misinformation, disinformation, social pressures, or a thousand other reasons. Because of that diversity, we organized workshops specifically for particular communities like Somali immigrants or Spanish speaking parents.
Nadine Gartner: (08:18)
Somali culture, for instance, favors oral education and storytelling over written materials. Also, raising children and making medical decisions for them are very much within the mother's purview. With that in mind, we hosted a lunch for 22 mothers with traditional Somali foods and translators and Arabic and Somali. We didn't use a pre-planned presentation or whiteboard. Instead, the mothers shared stories about their families and their experiences receiving medical care. In Oregon, our pediatrician educator shared about his family before diving into the mother's questions. In short, we made it personal. We connected personally with each mother and built a foundation for an ongoing trusting relationship between them and Boost Oregon. Similarly, we partnered with a medical clinic that primarily serves Latino families Based on their recommendations. We held an evening workshop over dinner and provided childcare so that parents could engage our Spanish speaking. Pediatrician started with PowerPoint slides, but attendees quickly jumped in and shared their own experiences.
Nadine Gartner: (09:29)
The evening turned into robust conversations about personal experiences with vaccine preventable diseases in their native countries, appreciation for vaccines and inquiries about keeping their children up to date on their immunizations. Although highly successful, the workshops were very time and resource intensive. Most workshops took place in evenings or weekends. When our volunteer pediatricians were not in clinic and the number of families attending varied from three to 30, how could we take our methods and scale it effectively to reach more families? We began to design an arsenal of materials that incorporated the spirit of the workshops. No judgment, no fear, meaning no needle imagery, no photos of babies suffering from vaccine preventable diseases. Instead, we used photos or graphics of smiling families wrote in plain language and analogized to everyday things that would make the science relevant to a non-scientific audience. We wrote an in-depth parents' Guide for college educated parents who wanted to dive deeply into these issues.
Nadine Gartner: (10:39)
We created a fact pack for parents who just wanted the quick and dirty on each vaccine, the whys, the whens, and whats of every vaccine recommended from birth. Through age 18, we produced a myriad of fact sheets full of colorful graphics and simple text to communicate the importance of various vaccines. We filmed and distributed two different video series, one with real parents and newborn babies at their well visits with a pediatrician and another animated series that breaks down the science of vaccines with humor. And just as we had tailored our workshops to specific communities, we made our printed and digital materials culturally and linguistically relevant, applying the same principles of no judgment, no fear, and personalizing complex scientific concepts. We created materials in seven different languages with photos that looked like the communities we served. Representation matters, and we knew early on that our materials needed to reflect the people we wanted to reach.
Nadine Gartner: (11:46)
Doing so builds trust and credibility between the communities and Boost Oregon. Ultimately, trust is the key to combating vaccine hesitancy, distrust, and mistrust of government entities. The medical field and the pharmaceutical industry have contributed greatly to the rise of vaccine hesitancy and refusal. Much of it is earned mistrust from the horrendous wrongs committed against black men. In the Tuskegee study to the recent opioid crisis spawned by big pharma, these institutions have not done themselves any favors. Skepticism of institutions and their recommendations, including those regarding vaccines, should be expected, not surprising. So how do we build trust? We make it personal and we bring it closer to home. A recommendation from a faceless, nameless scientist at the CDC may mean nothing to a parent in Ashland, Oregon, but a recommendation from her own physician, a person she has known for years and who has cared for her when she was ill carries a lot of weight.
Nadine Gartner: (12:59)
To that end, most of Boost Oregon's efforts now focus on training medical providers, social services professionals, head Start, and WIC employees, teachers, anyone in the helping fields who interacts with members of the public and may have ongoing relationships with them through seminars and workshops ranging from one hour to multiple days. We teach people how to communicate effectively about vaccines, how to answer difficult questions, and even how to teach others to investigate claims they may hear or read online. Vaccine hesitancy has existed since the very first vaccine smallpox, and as an aside, it's a testament to vaccines that we no longer inoculate against it because the vaccine eradicated the disease. But no matter how many myths we debunk, a new one will always arise. It's critical that folks understand how to scrutinize claims and can wade through the seas of myths and disinformation that fill our screens.
Nadine Gartner: (14:01)
Building trust necessitates building relationships with the people whom you want to reach. For Boost Oregon. That means partnering with community-based organizations, meeting with their constituents, listening to them, and creating materials and programs that respond to their needs and wants. It also means showing up to community events, providing our services for free or low cost Boost. Oregon does not refuse service on inability to pay and connecting partners to local and state resources and funding. Witnessing firsthand that influence of community members, we built a peer advocacy program to promote vaccine confidence in schools and neighborhoods free of charge and open to anyone who is interested. We train advocates on how to communicate effectively about vaccines to their friends, families, and neighbors. Most advocates have no medical or scientific background. They're simply concerned citizens who want to promote good health among their communities. We provide ongoing support to advocates and give them access to all our materials for free.
Nadine Gartner: (15:09)
The feedback from advocates is overwhelmingly positive. They report back to us that they are more readily raising the topic of vaccines into everyday conversations, engaging in compassionate discussions and strengthening bonds with their neighbors. Several advocates even organized group trips within their communities where they got vaccinated together and socialized afterward. Vaccine hesitancy has changed since the COVID-19 pandemic. Back in 2015 when we founded Boost Oregon, I used to tell folks that vaccine hesitancy spanned the political spectrum. Crunchy granola moms on the left and libertarians on the right, both refused vaccines, albeit for very different reasons. The COVID-19 vaccine rollout, however, aligned vaccine refusal or acceptance with political beliefs in ways very different from what we had seen in the past. By the fall of 2021, the best indicator to determine whether someone would accept a COVID-19 vaccine was their political party affiliation. Vaccine hesitancy and refusal was now enmeshed with one's political identity.
Nadine Gartner: (16:23)
In the months following, we observed something similar transpiring with religious and social affiliations. People refused to get vaccinated because they viewed it as a betrayal against their political or religious values, or they feared being ostracized from their social groups. No amount of data or scientific facts will persuade someone to accept a vaccine if it means losing their social network or questioning their core identities. How do we reach people for whom vaccine refusal has become a part of their identity? For Boost Oregon? The answer is motivational interviewing known as MI for short, MI is an evidence-based approach to conversation that supports behavior change. It's a collaborative approach. The provider engages the patient in a facilitated dialogue as opposed to talking down from a place of expertise, and that leaves people feeling respected, heard, and more likely to consider recommendations from trusted providers and helpers. MI gets to the root of an individual's hesitancy and talks through the potential options and outcomes.
Nadine Gartner: (17:38)
To do MI properly requires intensive training and time, but we think it's the only way forward. The COVID-19 pandemic demonstrated that billboards, TV ads, and other large campaign tools are not enough to change people's behaviors. We need individualized approaches that meet people where they are, honor their whole selves and get to the root of their fears. To that end, we are now training as many people as possible. In mi, we have one program focused on rural physicians, another program on dentists and HPV, vaccine Awareness and Uptake, and a third on traditional health workers and home nurse visitors. These are the folks known by community members whom they see at their places of worship and are invited into their homes. They have existing relationships with the people we want to reach, and a level of trust already exists. By teaching these trusted messengers how to use MI and guide facilitated decisions about vaccines, we can combat vaccine hesitancy and promote vaccine confidence.
Nadine Gartner: (18:49)
So in many ways, boost Oregon has gone full circle from starting with an individualized approach to returning to the importance of that personalized attention with the quick pace of miss and disinformation, the continued silo-ing on social media and politicization of vaccines and public health, generally, there is no shortage of obstacles ahead of us. It can be a frustrating and difficult journey, but as my intrepid grandma used to tell me, nothing worthwhile is ever easy. Increasing community immunity against vaccine preventable disease is possible. We need to focus on the people in our communities and earn their trust. We need to improve science literacy among all ages and teach people how to decipher fact from fiction online. Above all else, the fear underlying vaccine hesitancy needs to be replaced by love. Love for ourselves, our families, and our neighbors. Immunization is an act of love, and we need to work together, listen to one another, and do the hard work of connecting and understanding each other just like vaccines themselves. These methods only work when most of the community participates. I hope that you will find ways to connect with your neighbors and promote the health of your communities.
Nadine Gartner: (20:20)
Thanks for listening. Come back in two weeks for part two of Boost Oregon's story, where we talk about our future and how you can be a part of it.