Some Black MS residents are skeptical of COVID vaccine. Can researchers change minds?
A few days ago, Vanessa Reed got a letter in the mail. A company called ClinicalResearch.com wanted her to know she could get up to $740 and potentially a free COVID-19 vaccine if she signed up for a clinical trial.
Reed, who is Black and Native American, tossed the letter aside.
“To me it’s dangerous,” she said of the vaccine. “I do believe in vaccinating your children. But I just don’t trust any of this. People can tell me it’s OK, but their body is not my body.”
Reed’s skepticism of the vaccine reflects the mistrust some Black Americans have developed toward the medical establishment over years of unequal treatment. A Pew Research Center study published earlier this month found that 42% of Black adults said they intended to get a vaccine if it was available, compared to 61% of white adults, 63% of Hispanics and 83% of Asian Americans.
Now, researchers, doctors, nurses and even social media influencers across the state are racing to try to rebuild that trust enough to address Black Mississippians’ concerns about the coronavirus vaccine.
Mississippi was one of 11 states where researchers were awarded a $1 million grant from the National Institutes of Health to join the Community Engagement Alliance Against COVID-19 Disparities, or CEAL. Researchers are partnering with grassroots community health workers to reach Black, Choctaw and Latino communities around the state, with the goal of building trust and boosting access to solid public health information.
The public health workers are fighting history and contemporary phenomena, from betrayals like the Tuskegee Study, to inequities like Black women dying from pregnancy complications at two to three times the rate of white women, to individual experiences of dismissal and disregard at the doctor’s office.
“With Black people, (historically), the message is, ‘We’re trying to help you,’ but that action conflicts with what the outcome is,” said Traci Hayes, an assistant professor at the University of Southern Mississippi. She’s a project leader on one of the studies supported by the NIH grant, focusing on Black young adults. “So we don’t trust medical research because of that: You told us one thing, but you were doing another.”
The stakes are especially high because Black Mississippians have suffered disproportionately from COVID-19: about 38% of the state’s population is Black, but Black people have suffered 43% of all cases and 46% of deaths. (The disparity has narrowed since the beginning of the crisis, likely because, as State Health Officer Dr. Thomas Dobbs has noted, Black Mississippians now more consistently adhere to public health guidelines around mask-wearing and social distancing than their white counterparts.)
Claude Brunson, executive director of the Mississippi State Medical Association, is concerned about vaccine skepticism across demographics. If too few people take the vaccine, Mississippians will continue to suffer.
“We’re not going to get to herd immunity without a vaccine,” he said. “We’ve got to do better messaging about it.”
More diverse vaccine trials?
One goal of the NIH grant was to support efforts to recruit members of racial minorities to participate in vaccine studies. The pharmaceutical industry has long failed to ensure study populations look like America, officials say.
Black Americans, at 13% of the U.S. population, comprise only 5% of clinical trial participants. Scientists are concerned that non-representative trials could misrepresent the efficacy of the vaccine for certain groups, or contribute to mistrust of the vaccine if people feel they weren’t included.
Pfizer, whose vaccine received a recommendation from an FDA panel Thursday afternoon, reported that 10% of its trial participants are Black.
There have also been promising signs in the clinical trials taking place in Mississippi for coronavirus vaccines and treatments.
Caroline Compretta, the lead project investigator for CEAL and an assistant professor at the University of Mississippi Medical Center, said that across the five clinical trials at UMMC for treatments (not vaccines), 61% of participants are Black. Compretta said representation is likely partly due to long-term projects like the Jackson Heart Study, the country’s largest single-site study of African American cardiovascular health, now in its 20th year.
“There’s been trust and relationships built which I think has allowed those patients to be introduced to clinical trials that may not be the case in other states,” she said.
But in Gulfport, the company MedPharmics struggled to recruit Black participants to its trial for the Pfizer vaccine. CEO Andrea Jeanfreau said the company had about 350 people enrolled, few of whom were Black.
Jeanfreau said the letter Reed received was probably intended to direct recipients to her company’s trial for the AstraZeneca vaccine, which is now recruiting. This time it’s much harder to find willing participants of any race, and Jeanfreau isn’t sure why.
She also said she doesn’t understand why there are so few Black participants in clinical trials in general.
“I don’t know if it’s just, we don’t reach out to the population,” she said. “I’m not sure why we don’t have more African Americans.”
Earlier this month, some of the employees at MedPharmics’s Gulfport office were at home after contracting COVID-19. Jeanfreau said all the absences were affecting their work, which has already been complicated by a shortage of equipment as hospitals buy up items they need to care for coronavirus patients. Jeanfreau was troubled by what she’d heard about lack of trust in the vaccine.
“If we don’t get people vaccinated, this is going to continue,” she said.
Listening sessions and influencers
One of the five projects supported by the NIH grant has involved holding focus groups over Zoom with Black residents in Forrest and Hinds counties.
Susan Mayfield-Johnson, associate professor at USM’s School of Health Professions, said many focus group participants were interested in getting the vaccine eventually, but not right away. The vaccines have been developed in record time, and the FDA panel’s approval of the Pfizer vaccine came quickly, too, though the agency has emphasized that speed would not come “at the expense of sound science and decision making.”
The politicization of the pandemic also has become a hurdle to building trust, Mayfield-Johnson and other Mississippi researchers said. In a climate of partisanship and conflict between political leaders and medical experts, people feel unsure who to listen to, and skepticism seems less costly than trust.
One focus group participant brought up the news that Pfizer’s CEO had sold $5.6 million worth of stock in the company the day after it announced its vaccine was more than 90% effective in clinical trials.
“So if the vaccine is so good and you’re gonna make a billion dollars, why are you selling off your shares?” Mayfield-Johnson recalled the man saying. “You don’t even believe in the vaccine, let me take a step back.”
Pfizer said the sale was part of a pre-set trading plan designed to shield the CEO from allegations of insider trading. But the incident showed the fragility of public trust.
Hayes — whose project in collaboration with Tougaloo College involves outreach to Black young adults enrolled in college and in the workforce — said that early discussions have shown young people without health issues may feel they don’t really need the vaccine to stay safe.
But reaching them is especially important because young people can spread the virus to older, more vulnerable people. Infections among young people in particular drove the summer surge in cases, according to health department data.
“Information is needed,” Hayes said she has learned so far. “And that they are skeptical, because they just don’t know enough about it.”
One aim of Hayes’ project and of the other NIH-funded efforts in the state is to identify the most effective messaging and messengers around the vaccine. For young adults, that means a focus on social media and influencers who will be able to reach large numbers of peers.
Educating young people on herd immunity will be a priority: they can help the country reach an 80 to 90% immunity rate, what experts estimate is necessary for a return to normalcy.
Mistrust across the board
Plenty of Mississippians of all races are wary of the vaccine, as the comments on almost any Facebook post about coronavirus will show you.
Dobbs has pointed out that white Mississippians have been less likely to respect public health guidance around masking and distancing, and infections among white residents now outpace those among Black residents, a reversal from early in the crisis.
When the state health officer testified before senators last month to talk about the vaccine, it was a white, conservative lawmaker who seemed the most skeptical. Chad McMahan (R-Itawamba, Lee) asked Dobbs if the vaccines would have “nanotechnology,” apparently referencing a conspiracy theory that Bill Gates is seeking to use the vaccine to insert microchips into the population for tracking purposes. (That’s not true, Dobbs said.)
“I’m not in that camp, but I will say I get a lot of questions about it, so I wanted to try to be well-informed to answer my constituents’ questions about it,” said McMahan, whose constituents are mostly white.
David Buys, state health specialist for Mississippi State University Extension, works with a network of health workers with a full-time presence in every county, from the Delta to the Coast. So far, he’s concerned by what he’s hearing from his colleagues who are deeply rooted in their communities all over the state.
“What I’m getting is skepticism, I’m getting a sense of uncertainty,” he said.
He noted that a recent Gallup poll found 33% of white Americans said they wouldn’t take the COVID-19 vaccine if it was available at no cost.
The same poll found that among Republicans, just 50% said they’d get the vaccine.
Mississippi’s demographics — with the country’s largest Black population by percentage and a solid majority of Republican voters — create a confluence of concerns for public health officials hoping to convince people to take the coronavirus vaccine.
Culturally specific messaging will be key, researchers agree.
“Each group deserves to be communicated with or to in a way that is appropriate for them and makes them comfortable,” Hayes said.
Meanwhile, some Coast doctors and nurses say they’re fighting the public relations battle every day through their conversations with patients.
Nurse practitioner Jeanette Shabazz runs Baz Family Medical Clinic in Pascagoula. She estimates about 45% of her patients are Black, 35% are Latino (she employs a Spanish-speaking nurse) and the rest are white. She’s preparing her clinic to get state authorization to administer the vaccine when it’s widely available. But her patients are reluctant.
“Of the people that I’ve spoken with, nobody’s really interested in getting the vaccine,” she said. “And I do promote it, obviously, because I do believe in science.”
Her patients feel the approval process was rushed and politicized, she said, and they don’t trust the government to act in their best interest. Even her staff are wary.
She recently saw a patient who is obese and has diabetes, both risk factors for serious complications from COVID-19, and was not planning to get the vaccine.
“I shared with her that I will be getting it and she said, ‘I’ll see how you do with it,’” Shabazz said. “’And once I see that you’re okay, then I will.’”
This story was originally published December 21, 2020 at 12:00 AM.
