By Meera Jagannathan
Earlier in their careers, OB-GYN Margaret Larkins-Pettigrew and her husband lived and worked in Tuskegee, Ala., once the site of the shameful decades-long government experiment in which Black people were intentionally denied treatment for syphilis. They are “very, very aware” of structural racism that still exists in the United States, she told MarketWatch, and of well-earned mistrust of the medical establishment.
But they’re also aware that Black Americans have died in alarming numbers from COVID-19 , and that people of color are underrepresented in clinical trials. They trust in the scientific process — and oversight — that has allowed a vaccine to be developed and deployed in record time .
For these reasons and others, Larkins-Pettigrew and her husband, Chenits Pettigrew, enrolled as participants in the Pfizer /zigman2/quotes/202877789/composite PFE +1.50% -BioNTech /zigman2/quotes/214419716/composite BNTX -4.81% COVID-19 vaccine trial. They’re now urging others to get vaccinated once the newly authorized vaccine is made available to them .
“I am encouraging those folks — who I know may lose generations of family members — to intentionally research the science, understand the science, ask the questions and make the decision to move to take the vaccine,” she said. A lot of the people dying from COVID-19 don’t look like Larkins-Pettigrew, she added, but a disproportionate number of them do .
Larkins-Pettigrew, who recently started her new job as the chief clinical diversity and inclusion officer for Allegheny Health Network in Pittsburgh, said she had participated in webinars about the virus, answered questions in a virtual town hall with Rep. Marcia Fudge (D., Ohio), and talked to her patients about protecting themselves.
She is part of a broader nationwide effort to counter vaccine hesitancy as the U.S. struggles to beat back the pandemic. Though polls point to some progress in recent months , many Americans still say they wouldn’t get vaccinated against COVID-19.
Some are skeptical about the vaccine’s research-and-development process , which has proceeded at an unprecedented clip, and many have expressed mistrust of the federal government . Meanwhile, anti-vaccination activists continue to circulate misinformation ; some parents , who tend to be affluent and white , opt out of vaccinating their kids.
Vaccine-hesitant groups also include substantial shares of people of color , for reasons including a history of medical racism and experimentation — certainly not limited to the stain of the Tuskegee study — as well as longstanding systemic racism and discrimination .
Among Black Americans, just 14% trust that a coronavirus vaccine will be safe, 18% trust it will be effective, and 28% say they’re confident it will be tested for safety in their specific racial or ethnic group, according to a nationally representative study conducted this fall by the COVID Collaborative initiative, Langer Research, UnidosUS and the NAACP.
Thirty-four percent of Latinx Americans trust in a vaccine’s safety, 40% trust in its effectiveness and 47% are confident in its culturally specific testing and safety, the study found.
In a recent Kaiser Family Foundation survey that found 35% of Black adults would not get a COVID-19 vaccine, top reasons cited by vaccine-hesitant Black respondents were worry about potential side effects (71%), the vaccine’s newness and their intent to wait and see how it works for other people (71%), and lack of trust in the government to make sure the vaccine is safe and effective (58%). The sample size was too small to report separate results for vaccine-hesitant Hispanic participants.
Pfizer and Moderna /zigman2/quotes/205619834/composite MRNA -1.20% have both published the number of minority enrollees in their trials: Among Pfizer’s U.S. participants , 13% were Hispanic or Latinx, 10% were Black, 6% were Asian and 1.3% were Native American. Moderna has said 37% of its trial participants were racial or ethnic minorities.
Experts have suggested that about two-thirds of the U.S. population would need to have COVID-19 antibodies to achieve herd immunity. The U.S. has never reached herd immunity from natural infection with a novel virus, they add; so far, vaccination has always been required.
This challenge calls for a multipronged approach: “Multiple reviews of the evidence have found that there is not a ‘one-size-fits-all’ solution to vaccine hesitancy,” says the National Academies of Sciences’ COVID-19 vaccine-allocation framework .
For starters, it will be important to have a national campaign that disseminates clear, consistent information — just as in public-health campaigns about HIV or influenza — about how the vaccine was developed, as well as transparency about its safety and effectiveness, said Helene Gayle, the president and CEO of the Chicago Community Trust and a co-chair of the committee that developed the NAS framework.
But local-level efforts tailored to specific communities’ needs must complement that national campaign, Gayle said, with buy-in from trusted spokespeople and stakeholders.
“It’ll be very important for communities — particularly communities of color that have been hard hit [by the pandemic] — that they see people who look like them, who they understand, who they trust, be able to provide information,” she said. That information must be provided in a variety of different ways to meet different audiences, she added.
The ideal messenger will vary by community, Gayle said. In some locations it could be clergy, she said; in others, it might be celebrities, local news outlets, barbershops, community-based organizations or local health centers where people seek medical care.
In a Johns Hopkins University report published in July on readying populations for a coronavirus vaccine, experts advised against an “If we build it, they will come” approach, and stressed the need for efforts to better understand COVID-19 vaccine hesitancy and other social and behavioral factors.
Public-health agencies should seek input and address concerns early on from populations that have been historically harmed by unethical medical practices in the U.S., they said, adding that finding champions of the vaccine in those communities would help boost vaccine uptake.
The National Institutes of Health announced in September that it had funded $12 million in community-engagement and outreach efforts in minority communities hit hard by the pandemic in 11 states. Meanwhile, groups like the Washington, D.C.-based Black Coalition Against COVID-19 have mobilized doctors, public-health advocates, faith leaders and academics to inform and engage community members, as well as encourage uptake of safe and effective vaccines among Black Americans.
The U.S. Centers for Disease Control and Prevention this month recommended that health-care workers be among the first in line to receive initial vaccine doses while supply is limited. This prioritization serves to protect frontline workers so they can care for sick people, but it also helps signal that these medical professionals feel the vaccine is safe “because we volunteered ourselves first,” said Monica Peek, a University of Chicago associate professor of medicine who researches health disparities.
“It’s one thing if the doctor says, ‘Go ahead and take it,’” Peek told MarketWatch. “It’s another thing if the doctor says, ‘… and I’ve already had mine.’”
Sandra Lindsay, a critical-care nurse in Queens, N.Y., who this week became one of the country’s first COVID-19 vaccine recipients outside of a clinical trial, told the Washington Post that as a Black woman, it had been important for her to get her shot in order to counter vaccine hesitancy among racial and ethnic minorities.
And Ala Stanford, the leader of the Black Doctors COVID-19 Consortium , which has worked to increase testing access in the Philadelphia area, also told WHYY she opted to get vaccinated to set an example for members of her community. She had originally planned not to do so immediately, because she had tested positive months earlier and wanted her body to mount an antibody response.
Peek said in a tweet Thursday that she had just finished seeing patients in clinic, all of them South Side Chicagoans. “NONE had planned on taking the vaccine when they got out of bed this morning,” she said. “ALL have committed to do so now (well, 1 is on the fence) and several have become advocates promising to spread the word.”
In the COVID Collaborative survey, Anthony Fauci, the nation’s top infectious-disease doctor, earned the highest marks for trust among both Black (53%) and Latinx Americans (50%) — ranking ahead of the Food and Drug Administration, pharmacies and clinics, drug companies and the Trump administration. Fauci received Moderna’s vaccine on camera Tuesday as “a symbol to the rest of the country” that he felt confident about its safety and efficacy.
People outside of health care, including those who have volunteered in trials, can also model vaccine uptake. Carlos del Rio, an infectious-disease expert at Emory University and investigator in Moderna’s vaccine trial, said he planned to enlist trial participants from minority communities to serve as ambassadors for the vaccine once the study is unblinded .
“[They] can say, ‘Hey, I took this and it was OK,’” he told MarketWatch.
Some of the distrust that minority communities feel toward the government extends well beyond the realm of science and medicine, Peek said. And it exists not just in the past, but in the present day: Black patients, for example, are less likely to be prescribed pain medication and more likely to have physicians underestimate their pain . Experts have linked implicit bias among doctors with Black women’s disproportionate maternal mortality rate .
“We’re not talking about Tuskegee; we’re talking about Black Lives Matter. … It’s the daily experiences that people are having that leads them to distrust the government,” Peek said. “Be that health care, education, protection from the police, equal justice from our criminal-justice system, you name it: Are we treated fairly, and are our lives valued, and are we given things that are there to protect us and to save our lives?”
A short-term solution has always been to leverage the social capital of trustworthy people, like doctors, pastors and public figures, into effective public-health messages, Peek said. But representatives of the health-care field, and the government at large, “have to become trustworthy again if we want to be trusted by minority communities,” she added.
“The question isn’t ‘Why are they distrustful?’” she said. “The question is, how can we become trustworthy?”
CommunityHealth, located on Chicago’s West Side, is the largest free health center in the country. Its roughly 8,000 active patients have no health insurance, and a majority come from immigrant communities, primarily Latinx and Polish, said CEO Stephanie Willding.
Some Latinx community members have expressed vaccine hesitancy, Willding said, suggesting there may be concerns about the vaccine’s safety or wariness of benefiting from a government program for fear it could be held against them later . The center is hearing concerns from immigrant patients in both undocumented and mixed-status families that “they won’t be included or factored into the vaccine distribution, because it wasn’t made for them,” she added.
“In Chicago, the Latinx community has accounted for the greatest proportion of COVID infections , and yet they believe they won’t be [eligible to receive] a vaccine,” Willding said. “That’s a really heartbreaking thought.”
She said she is “monitoring” reports that patients might be asked to provide personal information that could be shared with federal agencies, a move that New York Gov. Andrew Cuomo cautioned could discourage undocumented people from taking the vaccine. If such a plan moved forward, Willding said, “it is going to be very difficult to convince some from the immigrant community to get the vaccine.”
Patients who come to CommunityHealth consider it “a trusted place” to get medical care and know that the organization doesn’t share their information with the government, Willding said. When the center opened a coronavirus testing center in late April, it was “absolutely inundated” by patients who hadn’t felt safe going to a hospital for their test, she said.
“An equitable distribution of the vaccine will take into account those lessons that we’ve learned and make sure that community centers, organizations like CommunityHealth where patients know that they are safe and that they trust, can distribute the vaccine,” she said.
In addition to misgivings about the government, experts say a lack of access to accurate information — and materials not being available in the right language or literacy level — are contributing to Latino vaccine hesitancy.
The immigrant advocacy nonprofit CASA, which has been helping recruit Latino and Black community members for Moderna’s vaccine trial with the University of Maryland, had been fighting for better multilingual language access in its communities before the pandemic. But COVID-19 exacerbated this problem, as evidenced by press briefings and torrents of information early in the pandemic that were only available in English.
“With time, we have improved the information dissemination to all sectors of the community, including the Latino community,” said Michelle LaRue, CASA’s senior manager for health and social services.
It’s not just translating the message — it’s also adapting it to reach specific communities, LaRue said. The medium matters too: WhatsApp, for example, can be a useful way for local governments to communicate public-health information to immigrants, many of whom use the app to stay in touch with family members back home, she said.
While he advocates for vaccination, del Rio also acknowledges people need to make their own decisions. They may have pressing personal priorities right now beyond getting vaccinated, like paying the rent or finding a job. It might take time to build a relationship and convince someone, he said.
“I’ve learned from HIV that a lot of times it takes people two or three times to come to the clinic and start anti-retroviral therapy . They want to come to the clinic and talk to you and get more information,” del Rio said. “You don’t say, ‘You either start this today or you’re going to die.’ It takes time to get people to trust you.”
Larkins-Pettigrew, also accepting that some people might opt not to get vaccinated, urged them to make that decision based on an understanding of the science — not misinformation, political noise or fear.
LaRue is working to educate community members about what the vaccine is made of and how exactly it works, rather than asking them to take her word for it. (To explain how it builds the body’s immune response, she employs an analogy of scanning inventory in a clothing store.) And del Rio emphasizes that the vaccine wasn’t developed rapidly by accident; rather, it was helped by existing research on other coronaviruses like SARS and MERS , as well as decades of work on mRNA vaccines .
“If I didn’t take the time to understand the science and to really watch the ethics and the integrity around it, I would not have chosen to take [the vaccine] as well, because of the history of what’s happened in the health-care system — but I felt like I was responsible for understanding it, and I did,” Larkins-Pettigrew said.
“Now that we have the vaccine, it’s important for us to trust the science, take the vaccine … so that we can see our children grow up, so that our parents are with us.”