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Mistrust of Health Care System a Barrier to African Americans Getting COVID-19 Vaccine: Experts

Mistrust in health care system, an obstacle for African Americans to get vaccinated

The State of California is leading the nation in its response to the pandemic, however, there is still a long way to go in terms of vaccination: certain sectors still doubt its effectiveness, especially among African-Americans, a community that has been, paradoxically, one of the most affected by COVID-19. 

This situation is not due to chance, as African Americans have compelling reasons not to trust the nation's health care system, and that includes vaccinations, experts said during a media briefing organized by Ethnic Media Services.

During her participation, Kim McCoy Wade, director of the California Department of Aging, detailed that older adults continue to be the sector of the population with the largest share of deaths from the disease.

In this regard, he noted that there are marked differences, because while about three-quarters of the older adult population have received their first vaccination, "the most striking gaps are appearing in communities of color, particularly the African-American community, where less than half of the community has been fully vaccinated."

COVID-19 vaccination rates remain disproportionately low among African Americans nationwide. In California, although increasing, 48 percent of this community remains below the state average.  

Oliver Brooks, M.D., of Watts Healthcare Center, agreed that African Americans have a lower vaccination rate than the majority of the population. "That's true across the state and across the country."  

According to the Department of Aging, the case rate in California is 5.7 cases per 400,000 African-Americans and in the 5.5 percent of those over 65 years of age the mortality rate is 7.1 percent compared to 5.5 percent of the entire older population with COVID-19.

He explained that the rate of COVID-19 is 7 to 8 times higher for those who are not vaccinated. "The point is, if you don't get vaccinated, you're more likely to get COVID, to die from it, to be hospitalized from it, and theoretically to spread it to other people. So I want to make the case that it's imperative that you get vaccinated."

He added that because of COVID-19, life expectancy has been reduced by two years for African Americans, while it has been one year for all other Americans. "People are dying, getting sick, and with longer cases, more in those who are not vaccinated." "The point is that it's relevant to get vaccinated."  

African Americans say they are more likely not to vaccinate because they are worried about missing work, not having sick leave, and having to pay for vaccines, which means a general concept of access, "so, some of those who don't vaccinate, it's not because they are anti-vaccine."  

Lack of trust in the health system before COVID-19

"The African-American community has been mistreated by the health care system for as long as we have been in this country," Dr. Brooks pointed out.

The expert pointed out that during the slavery era, medical schools in the north of the country invaded and took bodies from the cemeteries of slaves and took them to medical schools to use them as cadavers in their anatomy classes. While in the early 20th century black women were forcibly sterilized in the South and other areas of the United States.

He explained that, according to studies, African-Americans are less likely to receive cardiac studies and procedures, in addition to receiving restrictions on medication, and less treatment for pain when there are other injuries such as femur fractures.

"I want to be clear that distrust of the medical system is valid. So when we address doubt about vaccines, which is the case, we have to not be dismissive."

It is a decision based primarily on distrust in the vaccine and distrust in the healthcare system, in the medical delivery system. 

I think the most important thing is repetition. We need to hear the same message over and over again: the vaccine is safe and effective. There is no conspiracy.

Looking at the history of African-Americans in order to understand

"I think we have to look at the history of African Americans over 400 years to realize that we have from cradle to grave more chronic diseases, we die faster, we're sicker. And this was a perfect envelope for a virus like COVID-19," Michael Lenoir, M.D., an allergist and pediatrician, said at the time.

The expert explained that one of the reasons mortality rates in the African-American community were so high to begin with was because they started out with compromised community immunity. "But it's clear that African Americans have been suspicious of vaccines for a long time."

He recalled the Tuskegee, Alabama, experiment, where hundreds of African Americans were denied proper treatment for syphilis and tricked by introducing substances that caused many of them to die. "That has triggered suspicion of all vaccines."

"So for well before the last two or three years here in Northern California we had to argue with black parents, about all the vaccines. And it was only until vaccines were mandated by the state of California that that discussion really stopped."

In that regard, he noted that older African-Americans were much more open to the discussion of vaccines than younger people. An example of this, he recounted, was that he recently decided to survey 15 of his patients who were in his office with their children and asked how many of them had been vaccinated, and only 2 of the 15 had been immunized.  

"That's when I started to realize that this is going to be much harder than I thought. Because the people who doubt vaccines now are very much like the variants of the virus: they are tougher, more resistant, more entrenched, and they have reasons that they believe to be true, consequently, it's harder to convince them to get vaccinated."

He added that these individuals are reinforced by friends and peers, in addition to social networks such as Clubhouse, Instagram, Ticktock, Facebook and Twitter, among others.

In this sense, he pointed out that the messages disseminated through these networks are confusing for many people, which "has generated a great deal of creativity to the imagination".  

Some of the excuses the African-American community has for doubting inoculation is that, he said, on the one hand, they wait for God to tell them when to get vaccinated, and yet another is that they say they know three people who died from vaccination.

In addition, he detailed that they are concerned that the vaccine was launched too quickly to the market, or that they consider that they are injecting something that in a couple of years will deteriorate.  

"I think all the messaging that we've done has been creative. I think the state of California and people like their organizations have been very creative in trying to get a message out about how good vaccines are and how important they are, and so I think it's going to be a one-on-one discussion between trusted messengers and vetted people in our community that convinces people to get vaccinated," he stressed.

Faith and science, the road to salvation

The Rev. Steven Shepard of St. Paul's African Methodist Episcopal Church in San Bernardino, California, experienced firsthand the virus that causes COVID-19.

"Yes, I had COVID. I was at death's door and didn't want to get the vaccine because of some of the issues that both doctors have discussed, the experiment and some of the other issues that we, as black people, deal with, not only the historical background of the Tuskegee experiment, but how we are treated every day, when we go to doctors' offices or emergency rooms that leads us to be hesitant to get treatment and vaccination." He said.

But, he added, historically the black church has served as the epicenter for positive change in the community. He recalled that in 1793 in Philadelphia, Pennsylvania, the church was on the front lines of the fight against yellow fever, and this time may be no exception.

"I felt it was my job when I was discharged from the hospital. One, was to make sure our community had the right information. The Bible tells us that our people perish for lack of knowledge. I was so caught up in what happened in the past, I didn't take the time to realize the science behind it and those behind the vaccine, and when I found out and did my research, I found out that those things that scared me in the past shouldn't worry me now."

Second, he said he wanted to make it possible for members of his community to go to a trusted place to get vaccinated, to make it easier for them and to send the same message from African-American doctors, scientists, and the African-American health community: "vaccines are safe."

And third, he said, he wanted to bring hope, help and healing to an underserved community suffering from health disparities.

So, and in conjunction with organizations, they came up with a plan and started vaccinating people. "In fact, we still have people who want, who call, who want to get vaccinated because, one, they trust the trusted messenger of the church; two, because it was a nice environment to come and get vaccinated; and three, because we're all looking at the same song. We may be singing in different parts, but we're all singing the same song."

A story to move dozens

Alva Brannon, a parishioner of the same church, knows what it is like to be afraid of vaccines and distrustful of the country's healthcare system, but she changed her mind.

Brannon was a product of the Tuskegee Institute study. "My father was one of the young men, unknowingly, and of course he was not treated. He wasn't aware. So when I was born I contracted syphilis. The family didn't recognize or know this until I was 7 years old when I lost my vision. I was completely blind from age 7 until I was 15 when I had a corneal transplant and regained my sight."

In the face of this, her family always said no to vaccinations. "I remember I had to get a court order to get a smallpox vaccination, because they said it would rot your arm off and because it made a big blister. That's how convinced I was." 

Alva has three children, five grandchildren and seven great-grandchildren. They were not vaccinated. She always believed that anything they wanted to get to the African-American community was a bad thing. "Why do they want to give it to us first? Why do they want to give us this vaccine?" she questioned all the time.

In addition to her age, Brannon has comorbidities: pulmonary hypertension, high blood pressure and diabetes. When she went to her pulmonologist's appointment, he told her she would be vaccinated, but she refused.

The doctor warned her that if she acquired the virus it was likely to kill her, but she remained reluctant. Until her daughter told her about Johnson & Johnson's one-dose vaccine. 

"Two days later, we got the call from the church I'm a member of, they were giving the Johnson & Johnson one, so I took it as a sign from God, and that it was time. So my daughter was the catalyst and signed us up at that time. I eventually got vaccinated."

Today his entire family is vaccinated, except for one of his grandchildren who suffers from severe allergies so his doctor recommended against it. They got vaccinated, he said, because in addition to avoiding getting seriously ill, it helps to avoid going to the hospital.

"Because normally as an African-American, the one time you go into critical condition, in my experience, you go to the ER and they send you home telling you to take a couple of aspirin and drink lots of fluids."

Stories like this one are added to those of others, who today have changed their minds and have listened to science, beyond those who do not have correct information or who have simply decided to turn a deaf ear without giving a chance to advance the welfare of their community.

You may be interested in: COVID-19 Vaccine for 5- to 11-Year-Olds Safe: Pfizer

Pamela Cruz
Pamela Cruz
Editor-in-Chief of Peninsula 360 Press. A communicologist by profession, but a journalist and writer by conviction, with more than 10 years of media experience. Specialized in medical and scientific journalism at Harvard and winner of the International Visitors Leadership Program scholarship from the U.S. government.

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