Dr. Fredrick Echols

“We have a lot of baggage from previous hurt caused by the medical and research community,” said Dr. Fredrick Echols, acting director of the City of St. Louis Department of Health. “We bring this baggage with us when we go to the clinician’s office.”

City health director tries to form bridge between COVID researchers and suspicious community 

As the country scrambles to develop a vaccine to combat COVID-19, African-American mistrust of the medical system is blaringly evident. According to COVID Racial Data Tracker, a collaboration of the COVID Tracking Project and Boston University Center for Antiracist Research, Black Americans are dying at 2.4 times the rate of whites. Yet, as noted by presidents of the nation’s four historically Black medical schools in a recent New York Times commentary, in “clinical trials overall, African-American participation hovers around an abysmal 5%, despite being 13% of the U.S. population.”

The low African-American clinical trial involvement rate is somewhat understandable. With cases like the notorious Tuskegee syphilis trials that began in 1932, where hundreds of poor Black men in Alabama were left untreated while the medical community studied the ravages of the disease, mistrust is ingrained in the DNA of African Americans.

Dr. Fredrick Echols, acting director of the City of St. Louis Department of Health, is personally committed to acknowledging the historical damage done by the medical community. And, as an African-American doctor, Echols said he’s equally dedicated to using his platform to assuage Blacks’ fears related to upcoming clinical trials.

“For communities of color, having someone that looks like them speak to them about engagement to the issue is really important,” Echols said. “It’s important because of the amount of distrust that currently exists within their communities from historical practices and the current health inequities that we see in our systems. In my role, I feel that it’s essential to deliver that message to our community.”

Echols joined COVID-19 vaccine researchers from Washington University and Saint Louis University on October 21 for a webinar titled, “COVID-19 Vaccine 101: The Truth about the Trials.” The universities have been tapped by the National Institutes of Health (NIH) to join in an historic effort to conduct expedited clinical trials that will test a variety of investigational vaccines for the coronavirus.

Echols, who spent most of his time during the webinar addressing African-American skepticism, said that topic wasn’t his only concern.

“Ultimately the message the health department was trying to convey was ‘hey, this is the truth about what’s happening,’” Echols said. “Our goal is to make sure our community has adequate information that they need to make informed decisions.”

When speaking to the clinical trials, Echols said his mission was two-fold.

“We wanted to dispel a lot of the myths circulating in communities of color to let them know exactly what’s going on at local universities,” Echols said, “but we also wanted them to know we understand the history of the trauma that’s been caused in the past.”

A Pew Research Center survey conducted earlier this year found that “Black adults are more hesitant to trust medical scientists, embrace the use of experimental medical treatments and sign up for a potential vaccine to combat the illness.”  

African-American mistrust of the medical system is firmly rooted in American history. In “The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present,” Harriet A. Washington details medical crimes before and after the infamous Tuskegee syphilis studies.

Washington notes how colonial-era researchers experimented on slaves to study brain and body functions, the female reproductive system and to experiment with new surgical procedures. Washington’s book revisits the mind control experiments between 1936 and 1960 where Black inmates, mental patients, and “misbehaving Black boys” (as young as five) were forced to undergo “blind-cut lobotomies.” She also included the New York Psychiatric Institute experiment that ended in 1996. In that test, 34 Black and Hispanic boys (ages six to 10) were given intravenous doses of fenfluramine, a component of the diet drug Fen-Phen, to see if violent or criminal behavior could be predicted and controlled by chemicals.

Echols said that implicit or embedded memories of racist medical experiments can be combatted when medical professionals address medical atrocities of the past while providing honest, accurate information in the present. That, he said, was also part of the webinar’s mission.

“We wanted the academic associations to acknowledge the fact that clinical research has caused harm to communities of color,” Echols said. “Although we may not have been in our current roles when it was happening, the hurt is attached to the organizations. It’s important that we not only acknowledge that but let the community know what mechanisms, what conditions are in place now to prevent the harm from happening again.”

Speakers during the webinar outlined many of the protocols instituted to detect and eliminate any implicit bias and protect participants during the “Phase 3 efficacy trials.” The real key to success with the trials, Echols stressed, will be how the medical community responds to communities of color once they choose to participate.

“We have a lot of baggage from previous hurt caused by the medical and research community,” Echols said. “We bring this baggage with us when we go to the clinician’s office. So, once we get them in our space, we have to make sure we’ve implemented a culturally sensitive, trauma-informed approach so we can provide the assistance, care and services that they need.”

During the vice-presidential debate last month, Democratic nominee, Kamala Harris, said she would not trust President Donald Trump’s endorsement of any potential coronavirus vaccine. Instead, Harris said, she would take the word of public health experts and scientists. Harris wasn’t speaking for African Americans. Echols, however, does speak to the Black experience with the nation’s medical institutions. If researchers, health experts and clinicians really want communities of color to participate in clinical trials, “trust” is the operative word.

Sylvester Brown Jr. is The St. Louis American’s inaugural Deaconess Fellow.

To learn more about participating in the COVID-19 vaccine trials at Saint Louis and Washington universities visit vaccine.slu.edu or email  idcru@wustl.edu or call 314-454-0058 or 314-977-6333 for more information.

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