TABLE 2.

Barriers to and Suggestions for Fully Undertaking Pandemic Influenza Interventions Among Racial/Ethnic Minority Populations: Stakeholders Meeting, May 1–2, 2008

Pandemic Mitigation Interventionsa	Barriers Identified by Stakeholders	Stakeholder Suggestions to Protect Racial/Ethnic Minority Populationsb
Use of antiviral medication and prepandemic and pandemic vaccines (pharmaceutical interventions)	Lack of inclusive preparedness and response plans and engagement of stakeholders	Include racial/ethnic minority populations, their service providers, and trusted community leaders in all aspects of preparedness planning and response plans for a pandemic.
	Community characteristics (e.g., limited access to health care, economically distressed, chronic stress, diversity of beliefs, mistrust and distrust of government and health officials, limited knowledge, and language and cultural barriers)	Develop a strong public health system and community health system, including outreach activities to racial/ethnic minority populations.
	Limited initial supply and lack of a transparent system for allocation and distribution	Create a transparent system for ethical and equitable allocation and distribution of an adequate supply of pharmaceutical interventions for ensuring access (particularly among uninsured) and improving acceptance of interventions.
	Potential for real or perceived inequitable allocation because of limited priority groups for initial targeting of antiviral medications and prepandemic and pandemic vaccines	Provide culturally competent and low-literacy prepandemic educational and communication materials across diverse racial/ethnic minority populations with effective messages (e.g., visual ads with simple instructions) and multiple channels. Channels should include trusted sources of information (e.g., community members and organizations) ethnic media, comic books, radio, and television).
	Nonacceptance of antiviral medication and vaccines
	Limited culturally and linguistically competent communication
	Some erosion of public health infrastructure and safety net	Strengthen public health infrastructure through an adequate investment to support and sustain a coordinated response from the public health and community health systems using CBOs, FBOs, NGOs, service providers, and other stakeholders.
Isolation of sick persons, quarantine of contacts, good hygiene practices, and use of PPDs	Limited individual and community financial resources to stockpile food and water and to prepare a family survival kit	Educate early about isolation, quarantine, hygiene, and use of PPDs, building on education and communication focusing on behavioral change and not merely on increasing knowledge (e.g., hand washing as a means of protecting self and family from deadly virus).
	Lack of strong community partnerships	Establish social policies (at multiple levels) to address survival needs of vulnerable racial/ethnic minority populations.
	Self-interest of individual or family for survival: need either to go to work to keep job or to stay home with children	Develop partnerships with nontraditional public health partners who are stakeholders (e.g., businesses and American Red Cross).
	Undocumented immigrants with stigma, fear of deportation, and consequent fear of self-identification as pandemic influenza cases or contacts	Ensure adequate supply, distribution and use of PPDs through a clean stamps program for PPDs.
	Lack of information about PPDs and potential for inequitable supply and distribution
School closure, workplace policies, and avoidance of public gatherings	Lack of adequate community preparedness, response planning, and community engagement	Create or strengthen preparedness and response plans now for schools, workplaces, FBOs, and CBOs.
	Challenges associated with school closure, including free lunches, educational needs, and supervision of students (e.g., parents with multiple jobs)	Establish key community partnerships with schools, businesses, CBOs, FBOs, programs such as Meals on Wheels, healthy volunteers, and students (from local universities and middle and high schools, outside of study time) to assist with food distribution and educational campaigns.
	Inadequate workplace policies, especially for small businesses (e.g., rules or policies to address worker return, limited worker benefits, job security, low wages, child care, and undocumented workers)	Use education and communication materials following previously mentioned stakeholder recommendations and building on existing systems to alert children, their families, teachers, employers, employees, CBOs, and FBOs.
	Unclear restrictions on public gatherings (e.g., need for education and planning with event planners such as FBOs, CBOs, and NGOs before the canceled event) and need to maintain community and family networking at social gatherings, mental health issues, and managing deaths and funerals (relying heavily on FBOs, but restructuring large gatherings alters FBOs’ potential to respond)
	Ineffective education and communication
Mass communication of pandemic status, affected communities, risks and recommended actions	Lack of phone, no phone lines for persons with limited English proficiency, and lack of translation and interpretation services	Have open communication between community and leaders of city, county, and public health agencies that includes consistent engagement of all sectors, identification and translation of best practices into public health interventions with ample resources.
	Community discomfort and distrust about reporting cases, differentiated and segregated areas, false sense of security, and changing demographics	Recognize everyone's expertise and unique roles in the community, including the development of a registry that lists the agencies, services, and vulnerable populations and their barriers and assets.

Note. CBO=community-based organization; FBO=faith-based organization; NGO=nongovernmental organization; PPD=personal protective device.

^aPandemic mitigation interventions are listed in order of discussion by stakeholders.

^bSuggestions from stakeholders are listed in order of response and may apply to more than 1 pandemic mitigation intervention. Suggestions are for racial/ethnic minority populations, their families, service providers, and other stakeholders.