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As a black man and nurse practitioner working at the US Department of Veterans Affairs Hospital in Long Beach, Walter Perez hears a lot of goofy stuff from his black patients.
Like how the next 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 these vaccines. Or how vaccines might actually prove to be more harmful than 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 really paranoid about this.”
Indeed, in the United States, only 32% of black adults say they would definitely or likely take a COVID-19 vaccine, according to the Pew Research Center. Another study by 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 less than 30% of blacks stating that they would likely or definitely be vaccinated – the lowest percentage of any racial group surveyed by California’s Public Policy Institute, although Latinos do. are not far behind.
The fact that we are here – with blacks, alongside Latinos, still dying disproportionately from COVID-19, and Pfizer, Moderna and AstraZeneca on the verge of rolling out their life-saving vaccines – is no surprise to blacks .
Many of us grew up hearing stories of how black men suffered during Tuskegee’s Syphilis Study, and as adults we have lived our own stories of fighting disparities to try to get adequate care.
In all my life, I have never had a black doctor. I am 43 years old. Since last year, only about 2.6% of the country’s physicians and 7.3% of medical students this year were black. Due to persistent inequalities in education and household income, these numbers have not changed since I was born. Considering the many studies that show black people tend to perform better when treated by trusted black doctors and nurses, this is a problem.
That’s why convincing millions of black skeptics to get vaccinated – a crucial step to achieving around 70% herd immunity and bringing the pandemic under control – won’t be as simple as many elected officials and public health officials would like. .
In the same way that the murder of George Floyd in Minneapolis made it clear how this country has never truly addressed its history of systemic racism in law enforcement, the COVID-19 pandemic has exposed the unresolved history of systemic mistrust and racism in health care nationwide. system.
Perez and his fellow black nurses and doctors understand this better than anyone. And they rightly want a calculation.
“Is there mistrust of vaccines and the health system in black communities? Yes. But this mistrust is very well deserved, ”said Dr. Tiffani Johnson, an emergency physician in the pediatric ward at UC Davis Medical Center in Sacramento. “So I think we as doctors, researchers and health systems need to take a step back and instead say, ‘Why don’t black people trust us? say, “What have we done to gain trust?” “
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So far, most plans for COVID-19 vaccines have focused on the relatively simpler issue of access, which is understandable. These are desperate times.
The disease has already killed 266,000 Americans. Coronavirus cases are growing at a frightening rate, with about 1 in 145 people infected and contagious in Los Angeles County last week. Thanksgiving plans have been turned upside down, and new closure orders and curfews have once again thrown small business owners into chaos.
So, in hopes of ending this pandemic as soon as possible, California is preparing to move forward with mass vaccinations, starting with healthcare workers and other first responders. In Los Angeles, public health officials are working on ways to store and distribute the doses once they become available in a few weeks.
On Monday, Governor Gavin Newsom assured Californians that “a vision of equity is part of our goal.” In other words, ensuring communities of color have access to vaccines is a top priority – and it should be. But it could backfire because the issue isn’t so much access as it is trust.
Dr Flojaune Cofer, epidemiologist and senior policy director at 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, Latin and indigenous populations are receiving COVID-19 at higher rates and dying from it younger than the rest of the population. population. . This will lead to accusations that “there is no fairness because you just give it to everyone willy-nilly at the same time.”
The second option is to target blacks and deploy it in neighborhoods that have seen the most cases. “But then,” Cofer said, “people are going to say, ‘Oh, no! You’re not going to experiment on us like you did with Tuskegee. ”
The third option is to deploy it specifically to white people living in neighborhoods that haven’t been so badly affected by COVID-19. But then the blacks will say: “So you are going to save yourselves and leave us to fend for ourselves?”
And these three hot takes, added Cofer, “are absolutely valid and correct”.
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So what is the solution then? I suspect the recommendations of a number of black doctors who have agreed to verify federal regulators’ decisions on COVID-19 vaccines will help allay people’s fears. But in the meantime, so will honesty and humility.
“We have to go out and say, ‘Look, vaccines have helped human history. And we want to hopefully get to where you feel comfortable taking a vaccine, ”Cofer said. “’We recognize that some of you are ready tomorrow, and some of you will not be ready for several years. And that’s OK. ”
Eric J. Williams, former president of the National Black Nurses Assn. and acting associate dean of health sciences at Santa Monica College, said he expects black nurses and doctors to play an extraordinary role in persuading other black people to get vaccinated.
One of the reasons is that they will lead by example, as health workers will be among the first to get vaccinated. These will be the real guinea pigs.
Another reason is that nurses, in particular, are used to teaching. Perez, for example, says he turns to the facts when patients confront him with conspiracy theories and uses examples about the importance of vaccines, like how many Indigenous people would have been saved if they had had. access to smallpox vaccine.
“We teach every day when we interact with patients, their families and the community,” said Williams.
Going forward, however, the real solution must be to restore public confidence in the nation’s healthcare system, something black nurses and doctors have been asking of their white peers for decades.
The fact that more than 13 million Americans have been infected with a potentially fatal virus and that millions more – of all races – would rather take their chances of catching it rather than take a vaccine speaks volumes. This is not a problem that black doctors and nurses can solve on their own, and neither should they be asked to do so.
“If you want patients to be vaccinated, we also need to do our part to build some kind of trust in the community,” Johnson said. “I think there needs to be a call to action for all health care providers to think about it.”
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