The coronavirus pandemic has cast a spotlight on long-standing health disparities for Black and Brown people in the United States.
According to the Centers for Disease Control and Prevention, Black Americans are 1.4 times more likely to contract the virus, 3.7 times more likely to need hospital-level care and 2.8 times more likely to die from COVID-19, compared to white Americans. At 103 deaths per 100,000 residents, the rate of COVID-19-related mortality for Black Missourians is 1.9 times the rate for white Missourians and 1.4 times the rate for the entire state.
The tragically disproportionate impact of COVID-19 on Black Americans bears out in the latest national survey data from the Pew Research Center. In mid-November, 36% of Black respondents reported being “very concerned that they will get COVID-19 and require hospitalization.”
This was nearly twice the percentage of white respondents, 17% of whom were “very concerned.” In the same survey, however, Black respondents were the most reluctant group by far to indicate an intent to be inoculated when the vaccines become available — 42% compared to 61% of white, 63% of Hispanic and 83% of Asian respondents.
What paradox would explain the largest supply of very legitimate fear over COVID-19 coupled with the weakest demand for its cure within the same group of people? Institutional racism and the historical legacy of medical mistreatment is a condition of being Black in the U.S.
The historical context of medical mistrust among Black and Brown people is both well-founded and well-documented. Termed “Medical Apartheid” by Harriet A. Washington in 2006, the root cause of medical mistrust, particularly among Black Americans, is founded in atrocities such as the government-sanctioned Tuskegee Syphilis Experiment, with pernicious effects that are perpetuated throughout generations. It should come as no surprise then, that fewer than half of Black Americans, trust a government-sanctioned vaccine developed at “warp speed.”
The speed of COVID-19 vaccine development, along with concerns about political interference with the process, has left some people skeptical about COVID-19 vaccines. An initiative termed “Operation Warp Speed” could be viewed as traversing the galaxy at a speed far faster than most Americans wish to tolerate. And that tolerance threshold naturally is lower among Black and Brown people.
The paradox is that overcoming generations of well-placed mistrust during the coming months is the only hope of reversing the devastatingly disproportionate impact of COVID-19 on Black and Brown people.
What we know about the vaccines:
Diversity: Clinical trials for vaccine development were designed to include diverse populations — 10% of participants in the U.S. were Black, 13% were Latinx, 6% were Asian and 1.3% were Native American.
Side effects: Known reactions to COVID-19 vaccines are similar in frequency and symptoms to those of influenza and other common vaccines. Most commonly, some trial participants reported pain at the injection site, headache, muscle or joint pain, chills, or fever following the second booster dose.
Severe allergic reactions occurred in one-half of 1% of participants — importantly, the percent with severe reactions were similar among participants who received the treatment and placebo— individuals with a history of allergic reactions should discuss the risks with a physician before getting the vaccine.
Protection: The Pfizer vaccine, currently authorized for emergency use in the U.S., offers 52% protection after the first dose and 95% protection following the second dose. The Moderna vaccine offers 94.1% protection against COVID-19 after the second dose.
Age groups: The Pfizer vaccine is authorized for individuals ages 16 and older; it is anticipated that the Moderna vaccine will be authorized for individuals ages 18 and older.
Priority groups: Health care workers and long-term care facility residents and staff will be prioritized first in Missouri followed by all elderly individuals and people with underlying clinical risk factors. The second phase of distribution will focus on institutional residents and people with social risk factors, such as homelessness. The third phase expected to begin during the first half of 2021 will make the vaccines available to all Missourians.
Cost: Depending on insurance and vaccination setting, some recipients may have to cover the cost of administration out of pocket; this should be less than $25. Importantly, the state of Missouri has stipulated that vaccinators cannot turn away individuals who cannot afford associated fees.
The pandemic presents an opportunity for us to acknowledge and address past injustice by ensuring clear and honest communication, and prioritizing transparency, partnership and accountability with Black and Brown communities.
The path forward must recognize past bias and include “radical collaboration” with the communities that have been hardest hit to ensure we do not see another generation of unjust outcomes.
Increased acceptance of the COVID-19 vaccine will depend on our institutions’ willingness to acknowledge and rebuild historically broken trust. An approach that recognizes the need for an honest conversation, including understanding what communities of color deem most important, while providing valid information in response, will be the successful approach. This will support informed decisions that support health and well-being.
COVID-19 vaccines are now being delivered to the state. The speed of development and scientific evaluation of its efficacy and safety are unparalleled in human history. However, the more daunting task of building trust around that safety and efficacy lies ahead, particularly in communities of color, which have been devastated by the virus.
Extracting the most value from the vaccine will require extraordinary leadership — including clear and honest communication by health care providers, policymakers, and both secular and faith-based community leaders.
Missouri needs to maximize vaccine take-up to induce levels of population immunity required to mediate COVID-19-related disparities for Black and Brown Missourians.
As the vaccine extends to the general population, an “operation warp speed” of education and trust-building to reverse generations of conditioned skepticism is necessary.
Angela Brown, MPH, is CEO of the St. Louis Regional Health Commission; Bethany Johnson-Javois, MSW, is CEO of the St. Louis Integrated Health Network; Herb B. Kuhn, is president and CEO of the Missouri Hospital Association, and Will Ross, M.D., MPH, is associate dean for diversity, principal officer for community partnerships and Alumni Endowed Professor of Medicine, Division of Nephrology at the Washington University School of Medicine.