How Black Doctors Are Addressing COVID-19 Vaccine Worries
Many Black people simply don't trust the COVID-19 vaccine. Our columnist talks to an immunologist about how to change that.
After months of fast-tracked development, the COVID-19 vaccines are finally available for those who qualify (the rollout process varies by state). But the racism embedded in the United States’ medical system has many Black people hesitant to be inoculated. That leaves doctors worried that the communities hit hardest by the coronavirus—and the chronic health conditions it leaves in its wake—will not be immunized.
That concern pushed the National Medical Association (NMA), the nation’s largest organization for Black doctors, to create a COVID-19 vaccine task force to provide an additional layer of vetting for the federal government’s review of the vaccines. The hope is to make the process more transparent and help Black people feel comfortable getting vaccinated.
I talked to task force member Dial Hewlett, Jr., M.D., who is also medical director of disease control for the Westchester (New York) County Department of Health and adjunct associate professor of microbiology and immunology at New York Medical College in Vallhala, NY, about the historical and contemporary factors that make some Black people wary of COVID-19 vaccines—and how to restore trust in the medical system.
Kenrya Rankin: First things first: Why is it important for Black people to be vaccinated against the novel coronavirus?
Dial Hewlett Jr.: According to recent data from the Centers for Disease Control and Prevention (CDC), African Americans are more than three times more likely than our white counterparts to require hospitalization due to complications related to COVID-19 and more than two times more likely than our white counterparts to die.
Also of importance is the fact that a significant percentage of individuals infected develop long-term symptoms, which can be debilitating. A recent study conducted in the United Kingdom estimated that about 10% of individuals may fall into that category. This can conceivably impact an individual’s future ability to work or pursue educational opportunities. The risk for developing long-term complications increases with age.
KR: How do the history of racism and current realities of the medical system in the United States impact some Black people's trust in modern vaccines?
DH: We realize that there have been negative events in the history of African Americans here in the United States that have created elements of distrust of both the medical establishment and also of the U.S. government. The well-known Tuskegee experiments, which were conducted by the U.S. Public Health Service between 1932 and 1972, placed an indelible mark on the reputation of our government with regard to the mistreatment of African Americans.
Then there are the critically flawed studies conducted by Dr. Andrew Wakefield and colleagues published in the medical journal Lancet in 1998 and in 2002, which attempted to erroneously link childhood vaccines with autism. It was subsequently proven that the publication was based on fraudulent research that ultimately resulted in a prison term, but the belief that childhood vaccines are linked to autism have persisted and fueled the current anti-vaccine movement and resent outbreaks of measles and other childhood diseases.
African Americans aren’t immune to this thinking. Studies reveal that African American adults are 10% less likely to have received a flu vaccine during the previous 12 months compared to white counterparts. Unfortunately, according to 2018 and 2019 CDC data, African Americans also had the highest rates of influenza related hospitalization of any U.S ethnic group studied.
Moreover the behavior of the Trump administration has created an additional layer of distrust among African Americans and other individuals of color who reside here in the United States. The failure on the part of that administration to recognize scientific facts throughout the COVID-19 pandemic combined with the devaluation of members across the scientific community has created a dangerous barrier of distrust.
KR: What are some concerns that the Black medical community has around the development of vaccines for the novel coronavirus?
DH: African Americans have expressed concerns regarding the accelerated development and approval of the COVID 19-vaccines. Many are also distrustful of the Trump administration, which has lacked integrity on many counts and shown disregard for the health of persons of color through their behavior and actions during the past four years. Funding reductions to the CDC, National Institutes of Health, and other federally supported healthcare programs along with the removal of regulatory processes all made it abundantly clear that there was little concern regarding the health of poor persons and persons of color. And the lack of leadership displayed throughout this pandemic was directly linked to the excess death.
As African American physicians and health care providers, it is now up to us to regain the trust, specifically regarding the COVID-19 vaccines. Although we have pointed out the many flaws and errors of the former administration, we must all acknowledge the successful development and approval of effective and safe vaccines that will ultimately help end this pandemic.
KR: How can vetting by bodies outside of the FDA impact the development and the uptake of vaccines?
DH: NMA members voted to establish a task force to vet and review data from the COVID-19 vaccine trials and subsequently serve as trusted messengers for our respective communities. African American physicians are in a position to serve as messengers and identify others who can further pass along positive messages.
There is a need for persons who are from our communities to provide positive messages. Individuals who have commercial interests or business investments in immunization are viewed with skepticism. Those of us who have no commercial or business interest in the vaccine are in the best position to message the communities.
KR: What can the government and drug manufacturers do to reassure Black communities that the vaccines are safe and efficacious?
DH: Government and manufacturers can work with not-for-profit groups such as the National Foundation for Infectious Diseases, the Infectious Diseases Society of America, Bill and Melinda Gates Foundation and Robert Wood Johnson Foundation to develop and fund positive information campaigns around the COVID-19 vaccine.
KR: Cornell University is allowing students of color living on campus to seek an exemption to the school's flu vaccination mandate, citing “historical injustices and current events.” How do you think policies like this impact the health of students?
DH: Unfortunately immunization waivers will result in gaps that will allow for outbreaks to occur on the campus. Information should be provided along with counselling to discourage the use of waivers.
KR: What does success in this area look like to you?
DH: Success will be the halting of the current pandemic. We also need to reinstitute the nation’s previous pandemic preparedness plans and create a national health care plan to help all Americans maintain health and treat and control underlying health issues like diabetes, hypertension, chronic respiratory disease and obesity, which place them at higher risk for hospitalization and premature death.
KR: Is there anything else our readers should know?
DH: Yes! All of our African American family members, relatives, friends, and co-workers should know that the lead clinical investigators for the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 vaccine are two brilliant African American women: Dr. Judith Absalon of Pfizer and Dr. Kizzmekia Corbett of the National Institutes of Health. These vaccines will save countless lives—we just have to roll up our sleeves and accept the medicine!
Vaccine Distribution Guidelines: Centers for Disease Control and Prevention. (2020). "How CDC Is Making COVID-19 Vaccine Recommendations." cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html
Hospitalization and Mortality: Centers for Disease Control and Prevention. (2020). "COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity." cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
Long-term Impact: The BMJ. (2020). "Management Of Post-Acute Covid-19 In Primary Care." bmj.com/content/370/bmj.m3026
Long-term Impact: Journal of American Medicine. (2020). “As Their Numbers Grow, COVID-19 ‘Long Haulers’ Stump Experts.” jamanetwork.com/journals/jama/fullarticle/2771111
Tuskegee Experiments: Centers for Disease Control and Prevention. (2020). "The Tuskegee Timeline." cdc.gov/tuskegee/timeline.htm
Discredited Autism Studies: Indian Journal of Psychiatry. (2011). “The MMR Vaccine And Autism: Sensation, Refutation, Retraction, And Fraud.” ncbi.nlm.nih.gov/pmc/articles/PMC3136032/
Fraudulent Research: The BMJ. (2011). “How the Case Against The MMR Vaccine Was Fixed.” bmj.com/content/342/bmj.c5347
Flu and Flu Vaccination Stats: Centers for Disease Control and Prevention. (2020). "Flu Disparities Among Racial and Ethnic Minority Groups." cdc.gov/flu/highrisk/disparities-racial-ethnic-minority-groups.html