Vaccination resistance a public health problem
As administrators, health officials and policy makers create logistical plans and strategies to roll out vaccines against COVID-19 according to recent Centers for Disease Control and Prevention (CDC) guidelines, many Americans are wary, for many good reasons.
Pending the upcoming emergency authorization approval from the Federal Drug Administration (FDA), this country needs a protective strategy in place to stop the spread of misinformation, acknowledge past misconduct and the resulting mistrust.
As practicing physicians, we see firsthand how this wariness could be a barrier to the slowing and elimination of the pandemic.
As the U.S. recently saw its highest daily death toll of nearly 2,600 deaths, bringing the total number of deaths in this country to over 280,000, it is essential to note that mistrust of the medical establishment is deep, and it contributes to an individual’s skepticism to receive a COVID-19 vaccine.
Despite an overwhelming scientific consensus on the efficacy and the safety of vaccines for most people independent of their race, resistance emanates from many narratives. These are not only culturally rooted fears, but also conspiracy theories, including a claim that there are aborted fetal tissue fragments in one of the COVID-19 vaccines under development.
Operation Warp Speed, a joint effort by the Department of Health and Human Services, the Department of Defense and the private sector, aims to develop and deliver 300 million doses of free or low-cost COVID-19 vaccines before the end of 2020. The excitement of accomplishing such a great feat in a record short span of time might be brief, as it may be followed by an ongoing increase in COVID-19 deaths due to vaccines’ rejection by the public.
In a recent Pew Research Center survey, Black and Hispanic adults stand out as more likely than whites to see professional or research misconduct as a very or moderately big problem. There are numerous examples of medical exploitation of Black/African American and Hispanic/Latinx individuals documented in history. Injustices and disparities continue to this day.
According to Harriet Washington, lecturer in bioethics at Columbia University, African Americans receive different treatment from doctors and don’t get as much access. “When they describe their symptoms, they are not believed as often as Whites are. Medical technology is withheld from them. All of these things are a matter of record.”
Dr. Anthony Fauci recently said that people like him — a white guy in a suit and tie — can’t go into African American communities and try to relate because it won’t work. You have to go to these communities with “people who look and think and act like the people you’re trying to convince.”
“Mistrust is always there when you don’t invest in trustworthiness,” said John Daniels, an attorney advising a COVID-19 group for the Church of God in Christ, the largest Pentecostal denomination in the United States with millions of Black congregants. The key for researchers is to invest in long-term relationships with the Black community, and not call just at the beginning of a trial, asking Black people to roll up their sleeves and take the injections, he said.
The term “vaccine hesitancy,” coined in 2015 by the World Health Organization Strategic Advisory Group of Experts on Immunization, is defined as “a delay in acceptance or refusal of vaccination despite availability of vaccination services.” It is a growing problem worldwide.
It has been identified as one of the top 10 global health threats in 2019 by the WHO. Vaccine hesitancy determinants can be grouped in three categories: “Contextual influences” (influences as a result of sociocultural, environmental, health system/institutional, economic or political factors); “Individual and group influences” (stemming from personal perception or from social/peer environment); and “Vaccine/vaccination” (specific issues related to the vaccine itself or vaccination procedures).
More than ever, given the current COVID-19 pandemic and growing death rates, health care providers and administrators, policy makers, religious and community leaders, educators and the media need to harmonize straightforward and accurate messaging to minimize hardship and loss.
Working with a well-planned initiative, all of these groups need to direct public attention to the acceptance of vaccines as an important tool for public health, especially in community sectors most affected and ones that historically have been seriously harmed by socially irresponsible health programs.
Community-academic partnerships have evolved over decades into an effective way to enhance the design and dissemination of a health care intervention. Community leaders work with a playbook describing the key components of a clinical trial, the importance of public health measures such as using masking, frequent hand washing or social distancing, as well as discussing a new treatment such as a vaccine.
They also acknowledge past abuses in health care and medical research, and learn about how there are structures in place to prevent abuses now and in the future. The community leaders can disseminate information within their social networks, which could include but not limited to places of worship, church faith ministries, barber shops, hair and nail salons, sororities and community centers.
It is of utmost importance to set up and develop a sustainable groundwork for communities to obtain accurate information from trustworthy culturally and linguistically appropriate sources.
To be sure, in the United States, one of the most valued ethical standards is the principle of autonomy — a person’s ability to act in accordance with their own values and interests — and decide for themselves and pursue the course of action mostly suited to their principles.
Nonetheless, another ethical principle with comparable importance is moral agency, pertaining to an individual’s ability to act responsibly based on the notion of right and wrong, being held accountable for such actions.
This can happen one community at a time, one person at a time until COVID-19 is no longer claiming lives.
Fernanda Heitor, MD, is a medical director in a five-star Medicare-Certified Nursing facility and a clinical instructor of Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine. She is Public Voices fellow of The OpEd Project.
Rosalind Ramsey-Goldman, MD, DrPH, is the Solovy Arthritis research professor of Medicine at Northwestern University Feinberg School of Medicine and a Public Voices fellow of the OpEd Project.