Many thanks to Dr. Cherriese Thompson for a thought-provoking Grand Rounds this week titled "Is it Vaccine Hesitancy?" in which she explored the historical and present day impediments that make it challenging for BIPOC to accept and receive the COVID-19 vaccine and discussed ways to mitigate barriers to vaccine admin and acceptance.
Dr. Thompson defined vaccine hesitancy as: "a delay in acceptance of refusal of vaccines despite availability of vaccine services". This definition, Dr. Thompson, told us, assumes a level of complacency, convenience and confidence. We may want to question these assumptions.
A recording of her presentation is available HERE.
Here are my notes:
We all know that COVID-19 disproportionately affected BIPOC in the US with increased rates of hospitalizations and death over population levels (see image below)
Racial breakdown of vaccine trials: while these vaccine trials have been praised for inclusion and diversity, there is still much work to be done to be sure they are reflective of the population
Rates of vaccination by race/ethnicity (updated 9/21/2021):
For Black/African American people
- Centuries-long history of experience of discrimination in health care, being ignored or dismissed: "if you haven't cared about me in the past, why should I believe you care about me now?
- slave ships in Middle passage: sick slaves thrown overboard or forced treatment
- medical experimentation on black women's bodies
- withholding medical treatment for slaves
- 1973: yellow fever outbreak, one physician believed black people were immune and didn't give treatment
- 1932-1972 Tuskegee study, knowingly withheld treatment to 400 black men for syphilis to watch the progression (100+ died)
- Concerns about vaccine incentives: lack of trust in governmental organizations
- "Medical racism: The New Apartheid" antivax organization, film specifically targets black communities, weaponized history of experience of black people, "should you really get this vaccine?", false claims regarding potential vaccine harm
- Social media: misinformation on Twitter and FB, e.g. Nicki Minaj (famous rapper) on Twitter:
- concerns about female fertility
- concerns that the vaccine contains stem cells, ethical to take vaccine if prolife?
- worries that the vaccine itself may give you COVID
- Spanish language information (on Whatsapp and Telegram channels) discuss ineffectiveness of masks, vaccine ineffective
- Vaccine being used to track down immigrants and deport them
For Native American/Indigenous
- historical trauma leading to skepticism
- 1970: Family Planning Act: sterilization of more than 25% Native American women without consent
- 1989 Havasupai Tribe asked for assistance from John Martin, anthropologist to understand diabetes in their community; blood samples provided were used without their consent to study schizophrenia, alcoholism, inbreeding and origins and migrations of their people
- concern people might be injected with COVID from the vaccines
- huge concern about speed of manufacture
- historical distrust: "Am I willing to gamble that they care this time?"
- lack of involvement of their own populations in clinical trials
And, unfortunately, this is not just about historical trauma, but ongoing/current lived experiences for BIPOC
- 2.2020: Jean-Paul Mira, French intensivist suggested studying COVID in Africa where there are no masks, no ventilators, no resuscitation--> propose trialing meds in Africa to ensure safety
- 9/2021: Arkansas prisons: physicians giving ivermectin without consent (experiment) to treat COVID-19, "we never knew they were running experiments on us"
- 9/2020: ICE detention centers in Atlanta: immigrant women having hysterectomies without their consent/knowledge
- 2020 Dr. Susan Moore, family medicine physician and geriatrician in Indiana, died of COVID-19 2 weeks after videoing her story and expressing concern that her treatment at her local hospital was compromised due to her being black: having been called a drug seeker. "I put forward and I maintain that if I was white, I wouldn't have gone through that . . .This is how black people get killed: when you send them home, and they don't know how to fight for themselves."
https://www.youtube.com/watch?v=7v1Oyp_bBGk
- Among the impediments: skepticism, lack of accurate information, actual vaccination access, including online only signups, issues with appointment scheduling transportation
- Having the time to be vaccinated: working multiple jobs
- Valid concerns about being unable to get vaccinated due to vaccine side effects and not be able to take time off work, or because you are caring for others
- Pharmacy Deserts (residents living >1/2 mile from a pharmacy), many exist in communities of color. A lot of these communities lack reliable transportation to get/to from pharmacies to get vaccines. CVS, Rite Aid, Walgreens, local pharmacies may not have capacity to carry and administer these vaccines
1) Get more BIPOC included in clinical trials
- recruitment of diverse populations, particularly Native American communities-- working with sovereign government and respecting data sovereignty
- FDA: Enhancing the Diversity of Clinical Trials, ideas include reducing visit frequency, provide flexibility, using electronic communication if possible
- PhRMA's Equity Initiative
- building trust and acknowledging mistrust
- reducing barriers to clinical trials access
- utilizing real world data
- boost info of diversity and inclusion in clinical trial participation
2) Increase access to trusted information
- There is so much misinformation/disinformation out there, more accessible
- meet people where they are: go into the community, being present to answer questions
- being a resource to isolated populations
- Empower individuals to question info they see on social media, question the source, question the validity
- Provide trusted information: Voto Latino partnered with another organization to provider accurate info to Latinx (they also partnered with Uber/Lyft to transport Latinx to vaccination)
- CDC: information on vaccine equity, increasing uptake in racial/ethnic communities, communication toolkits, printed resources and posters in multiple languages
3) Improve access to vaccination sites
- mobile vaccination units
- reach places where access to healthcare is already a problem (rural and urban)
- targeting opening vaccination sites within vulnerable communities (i.e. Roseland Library)
- pop up vaccination sites
- home vaccination (to the most vulnerable)
- clinics and pharmacies providing access
4) Foster trust and utilize empathy
- creating a space for patients in the room
- take the power away, ask the patient "Can I talk to you about the COVID vaccine? What are your concerns? What have you heard about it? How has it affected you?"
- Create open dialogue to explore skepticism
- foster continued discussion
- provide accurate information
- show empathy: patients often will trust their doctor over time, if they felt heard/held
5) Shift the blame
- there will be skepticism; don't blame the individual patient for their skepticism
- relieve the blame to foster an environment of trust and open dialogue
6) Increase BIPOC pipelines in healthcare
- more funding and access for BIPOC in healthcare
- "Because I am black, and I have been vaccinated. . .and I hear your concerns. . .Here is what I experienced." That means so much to a lot of my black patients
7) Dismantle structures of racism inherent in medicine
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