Hoping for a reckoning in health
In Black communities, access to a vaccine isn’t the primary issue. For many, it’s trust.
As a Black man and a nurse practitioner working at the U.S. Department of Veterans Affairs hospital in Long Beach, Walter Perez hears a lot of cringeworthy stuff from his Black patients.
Like how the forthcoming COVID-19 vaccines won’t be safe because Big Pharma is cutting corners to make more money. Or how the medical establishment wants to use Black people as guinea pigs to test those vaccines. Or how the vaccines could actually prove more harmful than getting COVID-19.
The list goes on. “The only way I can describe it is there’s a paranoia,” Perez said. “A lot of people are just really paranoid about it.”
Indeed, across the U.S., only 32% of Black adults say they would definitely or probably take a COVID-19 vaccine, according to the Pew Research Center. Another study by the COVID Collaborative and the
NAACP found that most Black people don’t believe a vaccine will be safe or effective, and don’t plan to get it.
In California, it’s even worse, with fewer than 30% of Black people saying they would probably or definitely get vaccinated — the lowest percentage of any racial group surveyed by the Public Policy Institute of California, though Latinos weren’t far behind.
That we are here — with Black people, alongside Latinos, still disproportionately dying of COVID-19, and Pfizer, Moderna and AstraZeneca on the verge of rolling out their lifesaving vaccines — comes as no surprise to Black people.
Many of us grew up hearing stories as children about how Black men were left to suffer during the Tuskegee Syphilis Study and, as adults, have lived out our own stories of fighting through disparities for adequate care.
In my whole life, I’ve never had a Black doctor. I’m 43 years old. Only about 2.6% of the nation’s physicians as of last year and 7.3% of students in medical school this year were Black. Because of persistent inequities in education and household income, those numbers haven’t changed since I was born. Considering the many studies that show Black people tend to have better outcomes when treated by trusted Black doctors and nurses, this is a problem.
All of which is why convincing millions of skeptical Black people to get vaccinated — a crucial step toward achieving a herd immunity of about 70% and bringing the pandemic under control — won’t be as simple as many elected and public health officials would hope.
In the same way that the killing of George Floyd in Minneapolis made plain how this country has never truly dealt with its history of systemic racism in policing, the COVID-19 pandemic has made plain the unaddressed history of distrust and systemic racism in the nation’s healthcare system.
Perez and his fellow Black nurses and doctors understand this better than most. And they rightfully want a reckoning.
“Is there mistrust for vaccines and for the healthcare system in Black communities? Yes. But that mistrust is very well earned,” said Dr. Tiffani Johnson, an emergency physician in the pediatric ward of UC Davis Medical Center in Sacramento. “So I think that we, as physicians and researchers and healthcare systems, need to take a step back and instead of saying, ‘Why won’t Black folks trust us?’ say, ‘What have we done to earn trust?’ ”
So far, most plans for the COVID-19 vaccines have focused on the easier issue of access, which is understandable. These are desperate times.
The disease has already killed some 266,000 Americans. Coronavirus cases are multiplying at a terrifying pace, with about 1 in 145 people infected and contagious in Los Angeles County. Thanksgiving plans have been upended and new shutdown orders and curfews implemented, again throwing small-business owners into chaos.
So, hoping to bring this pandemic to an end sooner rather than later, California is preparing to barrel ahead with mass vaccinations, starting with healthcare workers and other first responders. In L.A., public health officials are working on ways to store and distribute doses once they become available in a few weeks.
On Monday, Gov. Gavin Newsom assured Californians that “an equity lens is part of our focus.” In other words, ensuring that communities of color have access to the vaccines is a top priority — which is the way it should be. But that could backfire because the issue isn’t so much access as it is trust.
Flojaune Cofer, an epidemiologist and a senior director of policy at the statewide nonprofit Public Health Advocates, describes it as “three hot takes” that add up to a no-win scenario.
The first option for counties is to roll out the vaccines to everyone at the same time, ignoring the fact that Black, Latino and Indigenous populations are getting COVID-19 at higher rates and are dying of it at younger ages than the rest of the population. That will lead to accusations that there’s “no equity because you’re just giving it to everybody all willy-nilly at the same time.”
The second option is to target Black people and roll it out in the neighborhoods that have logged the most cases. “But then,” Cofer said, “people are going to say: ‘Oh, no! You’re not gonna experiment on us like you did with Tuskegee.’ ”
The third option is to roll it out specifically to white people in neighborhoods that haven’t been hit as hard by COVID-19. But then, Black people will say, “So you’re going to save yourselves and leave the rest of us to fend for ourselves?”
And all three hot takes, Cofer added, “are absolutely valid and correct.”
So what’s the solution then? I suspect that recommendations from a number of Black doctors who have agreed to vet federal regulators’ decisions about COVID-19 vaccines will help allay people’s fears. But, in the meantime, so will honesty and humility.
“We have to come out and say: ‘Look, vaccines have helped human history. And we want to hopefully get to the place where you feel comfortable taking a vaccine,’ ” Cofer said. “‘We recognize some of you are ready tomorrow, and some of you won’t be ready for several years. And that’s OK.’ ”
Eric J. Williams, a past president of the National Black Nurses Assn. and interim associate dean of health sciences at Santa Monica College, said he expects Black nurses and doctors to play an outsize role in persuading other Black people to get vaccinated. One reason is they will be leading by example, as healthcare workers will be among the first to be vaccinated. They’ll be the real guinea pigs.
Another reason is that nurses, in particular, are used to teaching. Perez, for example, says he turns to facts when patients confront him with conspiracy theories, and uses examples about the importance of vaccines, such as how many Indigenous people would’ve been saved if they’d had access to the smallpox vaccine.
“We teach every day when we do interactions with patients and their families and the community,” Williams said.
Looking ahead, though, the real solution must be about rebuilding public trust in the nation’s healthcare system. That more than 13 million Americans have been infected with a deadly virus and millions of others — of all races — would rather take their chances catching it than take a vaccine speaks volumes. That’s not a problem Black doctors and nurses can fix alone, nor should they be asked to.
“If you want patients to get vaccinated, we also need to do our part in order to kind of create trustworthiness in the community,” Johnson said. “I think that there needs to be a call to action for all healthcare providers to think about that.”