Loose Lips: Local health leaders

One Shot With data showing that residents are hesitant to get a COVID-19 vaccine, DC Health must craft its public message carefully.

By Mitch Ryals

@MitchRyals

While Mayor Muriel Bowser is trying to pry more doses of a coronavirus vaccine from the federal government, her health department is wondering how to convince more people to get the vaccine when it becomes available. DC Health Director Dr. LaQuandra Nesbitt expects 6,800 doses of a vaccine could arrive in D.C. as early as this month, but those will only cover a fraction of the 85,100 District health care workers who are first in line to receive it.

Beyond availability, another significant obstacle to inoculation in the District (and throughout the country) is vaccine skepticism and resistance. Preliminary local survey data from DC Health shows that about 44 percent of Black residents polled and about 11 percent of Hispanic residents polled would not accept a COVID-19 vaccine. Resistance among White and Asian people, according to the survey data, ranges from about 3 to 4 percent, respectively.

Broken down by employment, the data shows that 50 percent of Black essential workers and 46 percent of Black health care workers who responded to the survey would not accept a coronavirus vaccine. Twenty percent of Hispanic essential workers and 10 percent of Hispanic health care workers also would not accept a vaccine. Eighteen percent of health care workers and about 25 percent of essential workers, regardless of race, wouldn’t accept the vaccine, according to the survey’s initial results.

That data, presented last month during a vaccine advisory committee meeting, mirrors national trends. Black, Hispanic, Latinx, and Indigenous people throughout the country are generally more skeptical of vaccines—and for good reason, given America’s history of medical experimentation on Black and Brown bodies.

National polling also suggests that, regardless of race, Americans are skeptical of a coronavirus vaccine, though confidence is increasing. A Pew Research Center survey conducted from Nov. 18 to 29 found that 60 percent of Americans would “definitely” or “probably” take the vaccine, up from 51 percent in September. Nearly 40 percent of respondents said they probably would not get a coronavirus vaccine.

Photo illustration by Julia Terbrock

D.C.’s COVID-19 vaccine advisory group, made up of health professionals and community members, is tasked with reviewing and providing feedback to DC Health on vaccine clinical trials. During its November meeting, the committee discussed strategies around public messaging in light of the data around vaccine hesitancy.

The survey data carries particular importance considering the coronavirus’ disproportionate impact on Black people, who make up 47 percent of D.C.’s positive cases. As of Dec. 7, 518 Black D.C. residents have died from COVID-19, making up 74 percent of the total deaths, compared to Hispanic and Latinx people, who make up 13 percent of deaths, and nonHispanic White people, who make up 10 percent of deaths.

“We are very aware that, when we go out and talk to people about getting this vaccine, we may have one chance not to lose their trust,” Nesbitt told the committee.

Exhibit A for how not to craft messaging about a vaccine comes from the White House. Forget the mixed messages coming from the current occupant of the Oval Office, the insults lobbed at the country’s top infectious disease expert, and the politicization of public health guidance. Just the name of President Donald Trump’s vaccine program—Operation Warp Speed—is enough to raise suspicions.

“The moment I heard it, I went, ‘Oh no,’” says Sandra Quinn, a public health professor at the University of Maryland who studies health care trust in communities of color. “It raised concerns that didn’t have to be there.”

During the vaccine committee’s November meeting, Dr. J. Desiree Pineda, an endocrinologist and internist who serves on the committee, relayed a conversation with one of her patients. The patient expressed concern about the speed with which the vaccine was produced and could be approved. Pineda told the group that her strategy has been to acknowledge the speedy timeline, but to emphasize that all the necessary steps were followed.

“They know that it was all done quickly, and to create trust in the patient, we really have to tell them … why it was done that way. Not that the results were compromised, but that it was just done quickly,” she said in the meeting.

The speedy timeline is one of Sheila Bunn’s primary concerns. The Ward 8 resident, who works as Ward 7 Councilmember Vincent Gray’s chief of staff but is speaking on her own behalf, says she will get the vaccine, but wants to wait for more information on its safety.

“I think, like any person, once there’s been evidence that it works, and that I’m not turning into Dr. Jekyll and Mr. Hyde, then I’ll get it,” Bunn says “But like with anything, you want to make sure it’s safe. I’m not gonna rush out there and jump to get it, but I’m confident that I will.”

Bunn says it’s essential that the government be as transparent as possible about the vaccine, including what happens if a person refuses to get it.

“I want folks to get the vaccine, but I understand there’s a segment of folks who won’t,” she says. “That’s why the government has to be clear and strong in its messaging that it’s safe.”

Ward 5 resident Patrice Lancaster echoes Bunn’s concerns about the quick timeline.

“I was concerned about how quickly it’s being rolled out,” Lancaster says. “I would have liked it to go through some trials where we could have a year or so to see how it affects people. Let Congress go first. [Sen.] Mitch McConnell should go first.”

Misinformation about vaccines in general, like the widely shared but never validated theory that they cause autism, also contributes to skepticism. But for Black people in particular, there are plenty of facts that provide a basis for distrust in vaccines.

Medical experiments on enslaved people are well documented, as are those on Black people in more recent memory. Perhaps the most infamous example is the Tuskegee syphilis experiment, which ended in 1972. For 40 years, the U.S. government lied to Black men infected with syphilis in order to study the disease’s effects on the human body. Men in the study went untreated and were left to suffer, even after penicillin became available as a treatment.

While the unethical Tuskegee experiment looms large in the minds of many Black people, the coronavirus vaccine comes with its own set of concerns. In the November meeting, Nesbitt grappled with the need to get information out quickly and accurately while still waiting for answers to crucial questions the public will have. Are there any long-term side effects? How long will protection from the virus last? Is the vaccine safe for young children? Does it affect a 60-year-old Black man and a 25-year-old Latinx woman differently?

“We don’t have subpopulation analysis yet. We don’t have the data profiles on pediatrics. We don’t have the data profiles on pregnant women. We don’t have the data analysis on chronic disease patients or the level of sub-analysis for racial and ethnic minorities,” Nesbitt said. “So how do we balance ... our need to start effectively communicating what we do know, if a vaccine is going to be in our community in a matter of weeks?”

Dr. Kimberly Henderson, DC Health’s director of communications, said at the November meeting that the department will follow the CDC’s “Vaccinate with Confidence” guide, which emphasizes transparency about the process for approving the vaccine and leaning on physicians, people, and organizations with credibility in the community to deliver the message.

One such partner is the D.C.-based Black Coalition Against COVID-19. Ambrose Lane Jr., a co-founding member and chair of the local health advocacy group Health Alliance Network, says one message will be that “if you live in the past, you might die in the future.” Lane says messaging campaigns seeking to boost confidence in the vaccine should highlight Black people in positions of authority in medicine and science and lean on historically Black colleges and universities, churches, community-based organizations, and trusted community leaders.

Lane says he’s participating in Howard University’s forthcoming clinical vaccine trial.

“We have to show by our actions that we can trust the science, and we need the involvement of African Americans if we’re going to have an effective vaccine,” he says.

The BCAC also recently released a Love Letter to Black America. The letter, signed by prominent Black health professionals, including Howard University president and surgeon Wayne Frederick, urges Black people to participate in clinical trials and to take the vaccine.

Quinn, the UMD professor and researcher, emphasizes the importance of trusted community members’ role. She adds that, based on her research on flu vaccine uptake, messages around the benefit for the larger community could resonate.

“I think for communities being devastated by this, that may be a powerful message: ‘How do we look out for our neighbors, our families, our broader community?’” Quinn says.

To address unanswerable questions, Nesbitt has suggested DC Health needs to be upfront about what they don’t know and emphasize confidence in the processes that produced the vaccine. So far, two companies, Pfizer and Moderna, have applied to the U.S. Food and Drug Administration for emergency approval following large-scale clinical trials involving tens of thousands of people.

Pfizer says its vaccine is 95 percent effective in a trial with more than 40,000 participants; Moderna states its trial of about 30,000 people showed 94.5 percent effectiveness. Both clinical trials resulted in only mild side effects for participants. Emergency approval would allow some Americans to receive the vaccine before the FDA can complete the usual monthslong authorization process. The U.S. Advisory Committee on Immunization Practices would subsequently recommend how to use the vaccine.

On Tuesday, the FDA confirmed that its review of Pfizer’s data aligned with the pharmaceutical company’s claim that its vaccine is 95 percent effective. The vaccine’s efficacy was similar “across age groups, genders, racial and ethnic groups,” the FDA determined.

Nesbitt told D.C. councilmembers during a conference call last week that DC Health has convened focus groups and interviews with community messengers.

During her appearance on WAMU’s Politics Hour last Friday afternoon, Bowser said she will take the vaccine when it’s available and encouraged others to do the same.

“Like most people, I was concerned, especially concerned about the political nature of it,” Bowser said. “I pay close attention to the scientists. We had a member of our team [Deputy Mayor for Health and Human Services Wayne Turnage] participate in one of the trials, and I’ve gotten a lot of feedback from him. Dr. Nesbitt has been intricately involved with the Warp Speed project. So, I have very high confidence in taking it, and I will take it as soon as I can.” DC Health’s efforts are playing out as the D.C. Council is considering a bill that would allow children as young as 11 to get vaccinated without parental consent. Ward 3 Councilmember Mary Cheh introduced the bill in March 2019 in response to a measles outbreak in 11 states. In 2019, the vaccination rates in D.C. public, charter, and private schools ranged from about 90 to 91 percent, shy of the 95 percent that DC Health recommends. Routine vaccinations for children under 3 dropped from 14,346 administered in the first half of 2018 to just 9,685 administered in the first half of 2020, WAMU reported.

The bill passed 10-3 on first vote and will come up for a second and final vote next week before it lands on Bowser’s desk. Ward 8 Councilmember Trayon White, Ward 5 Councilmember Kenyan McDuffie, and At-Large Councilmember Robert White voted against it.

Robert White voted against the bill because he believes 11 is too young to choose “to override parental consent on a major health issue that could have side effects. We shouldn’t dismiss that.” He pointed out that the Council rejected a bill in 2018 that would have extended voting rights to 16-year-olds.

He clarified during an interview last week that he believes vaccines in general are safe and does not subscribe to the anti-vaccine movement.

Trayon White has voiced similar concerns about taking away parents’ rights to make medical decisions for their children. He’s also expressed skepticism of vaccine safety in the past. McDuffie has not responded to requests to explain his vote.

Robert White, for his part, says he plans to take the coronavirus vaccine as soon as it’s available.

“I think the government, not that long ago, breached its trust with African American communities in a very real way, in the lifetime of several councilmembers,” he says, referring to the Tuskegee study. “We can’t ignore that fact, nor demand communities must get over it without acknowledging where the distrust comes from.

“As a public official, I have to take the vaccine to really set the example because it is so important for the public health, and I will do that,” he adds. “We have to, as a government, lead by example on this, as opposed to trying to mandate it.”

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