As COVID-19 ripped through Connecticut this year, the Rev. Robyn Anderson saw longstanding systemic health disparities intensify as people of color, many of whom work in high risk, front-line jobs and live in densely populated communities, caught the virus and died from it at a greater rate than white residents.
For some of these people, deeply rooted mistrust of the health care system has heightened, and Anderson knows that will make it more challenging as she prepares to engage communities of color across the state on the importance of getting a COVID-19 vaccination. The first doses of the experimental immunization are expected to be available by the end of December.
“A lot of it has to do with trust, not really trusting the system, because the system has sometimes shown itself to not be trustworthy,” Anderson said. “There are unique challenges here because of the marginalizing that people of color, especially African Americans, have experienced and how the system has not given them the best care or access to the best care.”
In the coming months, Anderson will reach out to her network of more than 5,000 people across 36 congregations to discuss the science behind the vaccine, the likelihood of side effects, how to get the immunization and whom to consult for advice.
Through her organization, the Ministerial Health Fellowship, she’s planning a series of online listening sessions and virtual town hall-style meetings. Physicians of color will be invited to speak so attendees can hear from “people who look like them in the medical field,” Anderson said. People of color who have participated in clinical trials also will be asked to share their experiences.
“Mainly what goes through my mind is I want people to live,” Anderson said. “I want them to be able to receive the things that will keep them alive, keep them healthy and keep them safe. And I want them to have peace of mind about it.”
For Dr. Reginald Eadie, president and CEO of Trinity Health of New England, which owns several Connecticut hospitals, the outreach is critical to ensuring there is robust buy-in to the vaccine.
In recent weeks, Eadie has had frequent conversations with leaders in the state’s African American communities to explain how the development process works and to address fears of receiving a shot that’s being rolled out in record time.
Eadie pointed to the Tuskegee Syphilis Study, a clinical study of untreated syphilis in Black men that began in the 1930s and ran through the 1970s, when referencing how mistreatment and racism in the medical industry has fueled mistrust of the system. The study, in which hundreds of Black men were promised free medical care but were instead left untreated so researchers could analyze the progression of the disease, is a notorious example of the unethical experimentation on people of color by U.S. public health agencies.
“African Americans have not forgotten about that,” Eadie said. “And so, as we find ourselves in the midst of having a vaccine that’s going to market in a fraction of the time it usually takes, it ignites some of those emotions that still exist in the African American community.”
During webinars, virtual meetings and phone calls, Eadie is trying to ease discomfort by describing the rigorous approval process the vaccine must endure and by highlighting the lack of side effects (drug makers Pfizer and Moderna say their shots have none).
In his role as co-chair of the state’s new COVID-19 vaccine advisory group, Eadie is also stressing the safety and efficacy of immunizations.
“Literally the day after the governor announced the advisory group, people randomly started calling my office, asking questions, providing recommendations and expressing their insecurities,” he said. “And now the scheduled conversations are coming almost daily. So my role as an African American physician, as a manager of our third-largest health care system in the state, and as co-chair of the advisory group, is to … put anxieties to rest by explaining how safe the vaccines are.”
“The bottom line,” Eadie said, “is the only way we as a country can get back to any degree of normalcy by this time next year is if we continue to practice social distancing, wear masks, practice good hygiene and participate in the mass vaccination program.”
Pfizer and its German partner BioNTech recently announced that their vaccine is 95% effective and asked the U.S. Food and Drug Administration to allow emergency use of the product.
State officials say Pfizer is expected to make 20 million to 30 million doses available in the U.S. by late December, of which Connecticut would receive 220,000 to 330,000.
Moderna has said its immunization is 94.5% effective. The company is expected to make 15 million to 20 million doses available in the U.S. by the end of December. Connecticut would get 165,000 to 220,000 doses from that first batch.
A third vaccine, developed by AstraZeneca and Oxford University, was found to be 90% effective in trial patients when given as a half dose followed by a full dose at least one month apart. It showed 62% efficacy when given as two full doses at least a month apart, the developers said. AstraZeneca has said it will seek early approval for the vaccine.
As outreach in communities of color ramps up, Tiffany Donelson, president and CEO of the Connecticut Health Foundation, said people in charge of those efforts should tap “trusted messengers” – community and faith leaders, workers with organizations that already have a presence in neighborhoods – to connect with residents.
Old wounds of mistrust in the health system were reopened during the pandemic as people of color had difficulty accessing testing and information, she said. And residents’ line of work – the high-risk, “essential” jobs such as those in nursing homes, retail and grocery stores – their underlying conditions such as asthma and diabetes, and their living conditions (people of color in Connecticut are more likely to live in heavily populated communities) put them at higher risk of contracting COVID-19.
The disparities have become starker during the pandemic. Black residents in Connecticut are 2½ times more likely to die from a coronavirus infection than whites when adjusted for age. The death rate for Hispanics is 67% higher than for white residents.
“That of course brings apprehension,” Donelson said. “People need to hear from trusted messengers who aren’t necessarily the folks in white coats or the researchers or the state. The state and the health care systems really need to consider partnering with organizations that are trusted messengers within the community.”
Beyond those initial conversations, Donelson said efforts should be made to maintain that trust – something community health workers could help with. Those employees bridge the gap between the health system and communities by addressing language barriers and erasing hurdles to medical care such as transportation and finances.
“Having health workers who are from the community, of the community, who understand the health care system and can do the education in a way that is culturally competent and would speak to the community – I think it’s going to be an ongoing need,” Donelson said.
Tekisha Dwan Everette, executive director of Health Equity Solutions, is planning a series of online listening sessions to engage communities of color. In preparation, she is drafting a list of key questions to get to the root of people’s fears. Those include: “What are your concerns about a vaccine? What do you need to hear? And what do you need to know to be comfortable with a vaccine?”
“I’m hoping to find out … if they’re never going to be comfortable with it, why?” Everette said. “And what is their actual plan to protect themselves from contracting the virus and to maintain their health?”
One significant concern she has heard already is people not wanting to be among the first or last to receive the vaccine.
“It’s a mixed concern,” she said. “We want to be sure, particularly for people of color, that we’re not going to be first in line for a faulty vaccine. [But] we don’t want to be left out or in the background.”
A day after the state’s vaccine advisory panel met in October for the first time, Sen. Douglas McCrory, D-Hartford, scheduled a virtual discussion on immunizations and trust in African American communities. Wizdom Powell, director of the Health Disparities Institute at UConn Health and a member of the advisory group, made plain the concerns arising from people of color.
“What we are bearing witness to, in terms of heightened levels of mistrust in Black and brown communities, is rooted in an unfortunate reality, and that is a history of medical malice and experimentation,” she said. “We are still dealing with those experiences in a real way. And I can’t imagine that the situation we find ourselves in today, having to roll out a new vaccine, isn’t ringing those historical alarms.”
McCrory said African Americans should not dismiss life-saving research. But people of color must carefully scrutinize the process before taking part in it, he added, and should be involved “at every level of implementation.”
“It’s extremely important that we know exactly what’s going on as a community. We want to be updated,” he said. “We want to know what percentage of our people are on these trials. We want to be informed because this has to, from a community standpoint, come from the bottom up.”