Overcoming vaccine hesitancy among communities of color: past, present and future hurdles
“I will not be their guinea pig!”
“I don’t trust any vaccine made in less than a year.”
“It will change my DNA or make me sterile, and that’s what they want.”
Vaccine hesitancy, reflected in these examples, takes a myriad of angles and directions. The fears I have heard have been disproportionately voiced by my patients of color. Given past and present treatment by the scientific community, I deeply appreciate their worries and concerns. Looking back on history and addressing existing barriers, the question becomes: What lessons can we learn and what tools can we apply to improve a drastically broken system?
How we handle inclusion in mass vaccination — essential to raise us individually and collectively out of the medical, social and economic turmoil unleashed by the SARS-CoV-2 pandemic — sets a precedent moving forward.
The deliberate, cruel and deadly practices of the Tuskegee experiments serve as a stark, grotesque, oft-cited example of exploitation of African Americans in the name of science. Sadly, there are many more. Another past atrocity involved the barbarism of Southern surgeons testing procedures on slaves without explanation or consent. Many of these procedures now serve as the “celebrated work” of James Marion Sims and are practiced in modern gynecology — a sickening reminder of the abuse. The horrific litany also includes birth control and involuntary sterilization that targeted women of color, as well as experiments on black men, indigenous populations and young immigrant children falsely portrayed as “naturally aggressive” criminals. These are all blatant examples of deep-seated prejudices, disregard for life and inhumane treatment toward people of color.
More subtle forms of discrimination in science include disproportionate investment of U.S. research funding for diseases that predominately impact white people. Within the health care system, there remains persistent ignorance of differing pain thresholds and physiological responses of black versus white patients, for example. Additionally, there are an inordinate number of barriers to access of equitable, pertinent, prompt and comprehensive health care for underserved populations.
As a black physician, working in a predominantly white health care system, many of my patients of color voice trust and comfort, as they are able to see themselves reflected in me. They also are relieved to have access to quality care that often is neither available nor offered to them. Given the aforementioned dreadful history coupled with present-day treatment by the health care system, no wonder the COVID-19 vaccine is not only accompanied by systemic barriers to access but also individuals’ internal hesitancy to receive one.
Overcoming that resistance, no matter how understandable, is important for multiple reasons, including achieving herd immunity. More pertinently, though, vaccinations for this vulnerable group will help abate the widening health disparity from the disproportionate impact of this viral disease on people of color.
We continue to make notable strides toward recognizing and addressing inequities of COVID-19 vaccine distribution, administration and access related to both clinic locations and computer or internet connectivity. In late March the Biden-Harris administration invested $10 billion to expand access to COVID-19 vaccines and build vaccine confidence in hard-hit and highest-risk communities. Overcoming these tangible obstacles that have preferentially allowed people from more affluent communities to avail themselves of immunization opportunities is critical. Still, hesitation to receive the vaccine by people of color due to fear and distrust remains a prevailing limiting factor.
There are no quick fixes for the intergenerational traumas of past events perpetrated under the guise of science. However, experience suggests that methods to activate and enlist community resources, as well as collaboration with family and friends, have proven the most effective in managing the pervasive mistrust of the system.
Cancer, diabetes and blood pressure awareness campaigns that engage local institutions like churches, supermarkets, barber shops and hair salons have a successful track record in reaching individuals within underserved areas. Invoking the help of family members and friends whenever possible is similarly fruitful. Having minority clinicians advise about, and administer, the vaccine adds tremendous reassurance. Patients of color who have had a vaccine often say things such as “Well, my doctor, nurse, or preacher said it was safe and had one themselves, so I did it too”; “We were frustrated and confused but my daughter-in-law helped work the computer system to book our appointments”; “My cousin arranged for us to go as a family, so we all got ours together”; or “I saw a flyer in my hairdresser’s window that nurses were going to come there to vaccinate people.” Community-based interventions warrant focus and resources to leverage buy-in among communities of color and subsequent vaccination.
Without those deliberate mechanisms, money would be poorly allocated or squandered.
Thinking long-term, health and health care disparities highlighted by this tragic pandemic — like other systemic and institutional inequities — need to be thoughtfully evaluated and revamped. The process is multifactorial. Steps involve, but are not limited to, increased numbers of practitioners who look like the communities we wish to serve; access to functioning, streamlined, user-friendly technology platforms as well as reliable connectivity; and mobilization of trusted community sources, including family, friends and clergy as partners to build bridges.
We must strive to reach people in ways that are meaningful to them, void of prejudice, presumption and, most especially, dehumanizing exploitation. Perhaps COVID-19 and our collective drive to emerge from this health and economic crisis, via widespread vaccination, might be the impetus to consider facets of change to improve not only health care access and delivery for all but also the process of scientific investigation itself — remembering always that a failure to address the pandemic in any community is a failure to address the pandemic in every community.
It has never been more important to address these health care issues than now, as we try to ramp up vaccine uptake among communities of color.
Dara Udo, M.D., MPH, is the chief media correspondent for the Vaccine Immunotherapy Center (VIC) at Massachusetts General Hospital and an urgent and immediate care physician at Westchester Medical Group, White Plains (N.Y.) Hospital and Greenwich (Conn.) Hospital.
Jacki Hart, M.D., director of the Bassuk Center in Needham, Mass., and Mark C. Poznansky, M.D., Ph.D., director of the Vaccine and Immunotherapy Center at Massachusetts General Hospital, contributed to this column.