Building Trust: COVID-19 Vaccine Protection for the Black Community

Man seated with his daughter, wearing a wedding gown

Kesnel Lacossiere (left) attended his daughter Kenny’s wedding in September, after nearly dying from COVID-19 last spring. Now, father and daughter are both urging others to get the COVID-19 vaccine.

In the spring of 2020, Kenny Lacossiere was deep into planning her wedding when her 75-year-old father, Kesnel, got COVID-19. Always an active man, Kesnel, who drove a livery cab, deteriorated fast. Kenny brought him to Memorial Sloan Kettering, where he had been a patient the previous year for a thyroid tumor, and where she is a nurse practitioner.

Suddenly Kenny’s dream of her father walking her down the aisle turned into a prayer for his survival. A CT scan revealed Kesnel’s intense cough had ruptured an artery. He was placed on a ventilator for ten days and experienced multi-system organ failure. Kenny nearly gave up hope and, remembering her father’s wishes, signed a “Do Not Resuscitate” order.

“My father’s battle with COVID-19 was one of the scariest and most terrifying experiences of my life,” Kenny says. “I felt helpless watching him fight for his life.”

The pandemic has laid bare the tragic racial disparities in healthcare. Compared with white Americans, Black people are far more likely to contract the COVID-19 virus, be hospitalized for it, and die from the disease.

Yet, as the lifesaving vaccine rolls out, Black people are being vaccinated at a much lower rate than white Americans — in some states by less than half, according to one new analysis.

It’s a major challenge to overcome: Those who need the vaccine the most aren’t getting it — and they may be more hesitant to receive it.

Black adults are less likely than other groups to say they would get a coronavirus vaccine. A survey by the Kaiser Family Foundation found that Black adults are more likely than white adults (43% vs. 26%) to say they prefer to “wait and see” how the vaccine works for others before getting it themselves.

Why? The reasons range from distrust of the medical establishment to misunderstandings about the vaccine itself.

Wariness Toward the Medical Establishment

Kesnel in hospital bed

Kesnel was in such grave condition from COVID-19 that he suffered multi-organ failure and was placed on a ventilator for ten days. He pulled through thanks to MSK’s critical care staff.

Black people’s skepticism of the medical community is rooted in shameful episodes of US history. Among the most notorious is the Tuskegee experiment during the 1930s, in which Black men with syphilis were left untreated without their consent so that researchers could study the natural progression of the disease. In the 1950s, the cells of a Black cancer patient named Henrietta Lacks were harvested without her consent. The fact that these cells — which were named HeLa cells, after the first two letters of her first and last name — became the foundation for major medical advances has been overshadowed by the unethical way they were obtained. And as recently as the 1970s, Black Americans endured forced sterilizations in a dark chapter of eugenics.

Beyond outright medical exploitation, Black people have been denied the healthcare they deserve. “There is a legacy of bad decisions by politicians, public health officials, and physicians in this country that has created the perfect storm of inequities in access to healthcare,” says critical care medicine specialist Louis Voigt. “There are categories of individuals in America who have been shortchanged, including Black people in particular.”

For example, there are “hospital deserts,” where predominantly Black neighborhoods have no options for emergency or regular healthcare. Even when they have access to medical services, research shows they are offered fewer treatment options, get less pain management, and have worse clinical outcomes. These same obstacles to care make it more difficult for Black people to have access to the lifesaving COVID-19 vaccine.

“There is a component of racism in the medical establishment, even if it often is in the form of unconscious bias,” Dr. Voigt says.

The fact that only 5% of physicians in the US are Black compounds the general reluctance to trust official advice from the medical community.

Mistrust of the Vaccines

Given the medical misdeeds of the past, it is not surprising that many Black people are uneasy about whether the COVID-19 vaccines are safe and effective for them. How can they be confident the vaccines were adequately tested in all groups of people?

Studies of the vaccine were careful to include many different groups of people, says Dr. Voigt, adding, “Both drug makers included Black people in rigorous studies of people across a range of ages, gender, racial, and ethnic groups.”

In the study of the Pfizer-BioNTech vaccine, minority ethnic groups represented 17% of people in the trial. In the Moderna study, 20% of the participants were Hispanic/Latinx and 10% were Black. In the Johnson & Johnson/Janssen trial, 45% were Hispanic and/or Latinx; 19% were Black/African American; and 9% were Native American. All vaccines were equally safe and effective in all ethnic groups.

How to Ease Vaccine Fears

Local medical leaders are the most effective group for persuading Black people to get vaccinated, says Dr. Voigt. They must be transparent, listen, and respect the real fears that people may have.

He explains, “The medical establishment should apologize to the Black community — and the Latinx community as well — and say, ‘Yes, we got it wrong in the past. Bad things happened to you and your folks. Some of us participated in these events or turned a blind eye. You are still being denied access to quality healthcare. You are still marginalized — but we promise you that when it comes to COVID-19, following public health recommendations to wear a mask, practice physical distancing, wash your hands, and get the vaccine is the logical, safe, and scientific way of starting to fix these inequities.”

Opportunity for Change

Louis Voigt wearing a mask

Critical care medicine specialist Louis Voigt

Fortunately for Kenny, her father survived. She had a small wedding ceremony in late September — with her proud father in attendance. “Thanks to the amazing care he received at MSK, he lived to see that day,” Kenny says. “My family and I will forever be grateful. I can’t wait for COVID-19 to be over so I can go thank them in person.”

As a frontline healthcare worker, Kenny has already gotten the vaccine and is helping her father schedule his appointment. Translating for her father, who speaks Creole, she has this message from her father to anyone who might be hesitant: “He says people should know it’s going to help and protect them.”

Still, Kenny is shaken by her father’s close call.

“I don’t want any other family to have to experience what we did,” she says. “I encourage every Black person to get the vaccine as soon as they can.”

March 2, 2021

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