Addressing Vaccine Hesitancy in Communities of Color

The numbers are sobering: In just over a year since the coronavirus first appeared in the United States, global deaths have exceeded 2.5 million, according to Johns Hopkins data, with the US death toll surpassing the grim milestone of 500,000 in late February. Vaccine rollout is picking up pace, with an increased number of doses available each week. Now,  more than two million Americans receive a shot each day.¹

However, the progress made by Pfizer / BioNTech, Moderna, and now Johnson & Johnson in developing COVID vaccines and ramping up vaccination rollouts will be for naught if we can’t get at least 75 percent of Americans, roughly 240 million people, vaccinated to achieve herd immunity.

---

COVID-19 vaccine hesitancy is common

One would think it would be a no-brainer: a deadly disease and multiple vaccines that are 95 percent effective. Get two shots and you will protect yourself and others. But the percentage of the American public who are either uncertain or unwilling to receive the vaccine is staggering. The shocking figures persist even among health care workers who should know better:

• Ohio Gov. Mike DeWine was “troubled” by the low numbers of nursing home workers who have elected to take the vaccine–approximately 60 percent of nursing home staff declined the shot.

---

• Joseph Varon, chief of critical care at Houston’s United Memorial Medical Center, told NPR in December that more than half of the nurses in his unit informed him they would not get the vaccine.
• Hospital and public officials in Riverside, Calif., have been forced to figure out how best to allocate unused doses after an estimated 50 percent of frontline workers in the county refused the vaccine.
• Fewer than half of the hospital workers at St. Elizabeth Community Hospital in Tehama County, Calif., were willing to be vaccinated, and around 20 to 40 percent of L.A. County’s frontline workers have reportedly declined an opportunity to take the vaccine.
• Nikhila Juvvadi, the chief clinical officer at Chicago’s Loretto Hospital, reported that 40 percent of the hospital staff said they would not get vaccinated.

The problem is real. And it’s even worse in the Black, Latinx, and Native American communities, those who have been hit the hardest by COVID.

A recent report² from UnidosUS, the NAACP, and COVID Collaborative showed that only 14 percent of Blacks and 34 percent of Latinx Americans say they trust that a COVID vaccine will be safe. The numbers are similar for trust in COVID vaccine effectiveness. Only 18 percent of Black and 40 percent of Latinx Americans responded that they mostly or completely trust that a COVID vaccine will be effective.

The numbers are slightly higher for those who said they have trust in “culturally specific testing and safety” practices, i.e., those who are confident that a vaccine will be tested specifically for safety in their racial/ethnic group (28 percent of Blacks and 47 percent of Latinx Americans).

Centuries of inequity and harm

The historical inequities in health care that have disproportionately harmed these populations have created a lack of trust in the government and the U.S. health care “system.” This mistrust is the primary driver in the reluctance to get vaccinated.

–Experimentation on Black people without informed consent

History is littered with medical experimentation on communities of color. In “Secret Cures of Slaves: People, Plants, and Medicine in the Eighteenth-Century Atlantic,” an account of experiments performed on Caribbean slave plantations, author Londa Schiebinge describes how John Quier³, a British physician in Jamaica, tested the smallpox inoculation on 850 slaves during the 1768 epidemic.

Another notable example is J. Marion Sims, the “father of modern gynecology,” who operated on enslaved women in Alabama without their consent between 1846 and 1849. He performed these operations without anesthesia, reportedly because he believed that Blacks did not experience pain the way white people did.

Then of course is the infamous Tuskegee experiment beginning in 1932 in which 400 poor Black men were promised treatment for syphilis by the U.S. government, but were given placebos instead. The 40-year longitudinal study was meant to document the long-term effects of syphilis.

The body of injustices are compiled in Harriet A. Washington’s, “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present,” in which she chronicles the long history of how Blacks — men and women alike, prisoners, soldiers, and even children — were unwilling or unknowing participants in programs, some utterly horrific, like eugenics and forced sterilization, radiation experiments, genetic testing, experimental vaccines, and bioterrorism research.

–Native Americans subjected to medical atrocities

Native Americans have been subjected to similar medical atrocities. Dr. Andrea Smith⁴, a Native American scholar, describes how pharmaceutical companies performed new drug/vaccine tests on Native Americans, including children, without informed consent. You can read more about it in her study ‘Conquest: Sexual Violence and American Indian Genocide.’ 

Historian Samantha Williams also documented medical experiments on Native American boarding school students⁵. And researcher Jane Lawrence details the forced sterilization of Native American women⁶ by the Indian Health Service in the 1960s and 1970s, including two fifteen-year-old Native American women who were told they were getting tonsillectomies but got tubal ligations instead.

These examples are a sad testament to the fact that people of color were historically, and in many cases, are currently viewed by medical practitioners as expendable, all in the name of science.

Misinformation contributes to vaccine hesitancy

The entire nursing staff of a Kansas county health department, including the health department administrator, recently refused to distribute COVID vaccines citing false information⁷ about the newness of the technology and the safety of the vaccine.

Again, if health care providers who should know better are falling prey to the lies about the vaccine, we can see the extent to which misinformation is contributing to the mistrust driving vaccine hesitancy.

Thanks to social media, other falsehoods about the COVID vaccine abound:

• • • The vaccine was rushed (it wasn’t)
    • You can get COVID from the vaccine (you can’t)
    • The vaccine will alter your DNA (it won’t)
    • It causes infertility (it doesn’t)
    • The vaccine contains controversial or harmful substances (it doesn’t)
    • It contains a microchip so Bill Gates can track you (it doesn’t and he won’t)

These myths can have a devastating effect on communities in which English is not the first language. Dr. Eva Galvez, a family physician at Virginia Memorial Health Center in Hillsboro, Oregon, who treats a mostly Latinx population, told NPR⁸ that “information that we are reading in different media platforms is often not in a language or at a literacy level that my patients can understand.”  This leads to a lot of misinformation. Further, when people don’t have access to accurate information or have trouble understanding it, “they rely on other platforms, word of mouth, social media, and those are often not accurate.”

The solution: Build trust and data

It is no wonder then, that we are seeing this level of hesitancy among Black and brown communities. We must ensure that the rollout of the COVID vaccine does not reinforce existing health inequities by helping gain the trust of those marginalized populations. We can do this through thoughtful information dissemination.

We should arm communities with the trusted information they need to understand the vaccine — its development, its safety, and its importance in protecting themselves and others. But almost as important as the message is the messenger. Federal, state, and local public health and medical officials, health plans, local providers, and health systems have to reach these communities.

The most effective way to do this is to respect their audiences. We need to recognize that one size does not fit all. We need to adjust not only to the appropriate literacy level and appropriate language but also the appropriate culture. We have to listen to people, answer their questions, and address their individual concerns in a culturally and linguistically appropriate way.

We as members of the healthcare ecosystem must also arm ourselves, but with data. We must be able to understand not just who is willing or unwilling to receive the vaccine, but who has access, and where the disparities lie. Not enough states are collecting and reporting race/ethnicity and language (R.E.L.) data. This must change. If we can’t identify who we’re reaching, we can’t identify who we’re also failing.

Without communities of color trusting and receiving available vaccines, we will never get to the herd immunity we need to get COVID-19 and its variants under control to protect lives and end the pandemic.

---