WASHINGTON – Confronted with widespread distrust of government in communities of color, the Trump administration is turning to historically Black colleges and churches for help to alleviate fears about the coming coronavirus vaccines and promote them to a population that has been at high risk during the pandemic.
Surgeon General Jerome Adams, who has been leading the effort, said the federal government must “validate and acknowledge peoples’ legitimate fears” to build trust in a vaccine.
“Many people of color have good reason not to trust the government or the health care system, and we’ve got to remember that while a lot of the framing is often political, and there is no doubt that there is a higher level of distrust for this administration, it goes back well beyond or before this administration,” Adams said in an interview with McClatchy.
Many Black Americans have been distrustful of government health programs since the public learned of a decadeslong federal study of syphilis that intentionally misled and mistreated Black study subjects, a scandal known as the Tuskegee experiment. That study, which began in the 1930s and lasted into the 1970s, led to new federal regulations that require transparency and oversight in scientific research.
The revelation that cells were harvested from Henrietta Lacks, an African American woman who died of cancer in 1951, and cloned without her knowledge or her family’s consent to create the HeLa cell line – which has formed the basis for decades of medical research – has also fueled skepticism in the Black community of medical research and experimentation.
In a recent study released by the COVID Collaborative, the NAACP and UnidosUS, only 14 percent of Black respondents said they trust that a vaccine will be safe and 18 percent said they mostly or completely trust that a COVID-19 vaccine will be effective.
Adams said that his office had been holding weekly calls with faith leaders of all religions and that he had personally reached out to prominent members of the Black community, including gospel singer CeCe Winans, to educate them on the vaccine and to request that they promote it to others.
“We now know that something like Tuskegee will never happen again in this country, because you have lots of oversight,” Adams said. “And then we have to engage again with trusted partners, because for some people, it doesn’t matter what I say as long as I’m a representative of the federal government. And it doesn’t matter which administration I’m under, they’re still not going to trust me.”
Two vaccine manufacturers have submitted applications to the Food and Drug Administration for emergency approval, and several Trump administration officials have said that the first of these vaccines could be approved for use as soon as this week.
The FDA’s initial analysis of the first vaccine submitted for emergency use, produced by Pfizer, found the medicine is equally safe and effective regardless of race, age or weight, the agency said Tuesday. A vaccine advisory committee will meet on Thursday to independently review the findings, and emergency approval of the vaccine could come within days.
The second vaccine submitted for emergency approval, from Moderna, was made using a similar biological process, and over 30% of its advanced clinical trial volunteers were Black or Latino, according to clinicians involved in setting up the trial.
Adams said he has held a weekly call with those two companies and Johnson & Johnson and AstraZeneca to ensure that trial participants were representative of minority communities.
The White House also encouraged Black leaders in calls to ask members of their organizations to volunteer for vaccine and therapeutic trials.
In the effort to build confidence in the safety and effectiveness of a vaccine, Adams said that he has visited historically Black colleges and universities (HBCUs) to meet with health professionals and contacted Black fraternities and sororities that make up the National Pan-Hellenic Council, also known as the Divine Nine, about raising awareness among their membership about the importance of becoming vaccinated.
“In many cases they will do something because their sorority president says do it, even if they won’t do it because the surgeon general says to do it,” Adams said.
From the earliest days of COVID-19 vaccine development in March, top officials at the National Institutes of Health knew that minority representation would be critical to the success of the vaccines.
The group that organized the advanced clinical trials, known as the COVID-19 Prevention Network, pursued several strategies to recruit minority volunteers – and to ensure transparency for communities that have been historically skeptical of federal public health programs.
“Since the very beginning of this process, there’s been inconsistent public health messaging regarding the pandemic in general,” said Dr. Stephaun Wallace, director of external relations for the COVID-19 Prevention Network. “There’s a plethora of misinformation about COVID-19 circulating in communities, and politics has completely overlapped with this process, and complicated the messaging and, I think, the trust for many people.”
“Communities of color have a right to be a bit skeptical of what’s happening,” he continued. “But it’s an opportunity for the medical establishment and researchers to do better in terms of engaging communities so that the research enterprise can be more trustworthy.”
The core of their strategy was to ensure that minority groups were represented at every step of the vaccine development and testing process.
All clinical research sites across the country were required to have community advisory boards that reviewed study materials and helped recruit vaccine trial volunteers.
Expert panels were convened comprised of scientists of color who had experience engaging with their communities, and were responsible for reviewing any scientific and ethical questions that arose at each research site. The network also convened community working groups that included local activists “to ensure that eyes are on the entire process,” said Wallace.
In order to reach the greatest number of people, Wallace and his colleagues relied on Black churches and the well-established network of experts and activists working to confront HIV/AIDS to build confidence and trust in their COVID-19 response.
Those networks already have the hard-earned trust within these communities necessary to build vaccine confidence, said Rev. Edwin Sanders, leader of the COVID-19 Prevention Network Faith-Based Initiative and founder of the Metropolitan Interdenominational Church in Nashville.
“When this moment of need came along, in terms of enhancing our ability to reach populations that are being most disproportionately impacted, one of the things that we learned during our HIV work is that the faith communities were clearly a vehicle by which we could engage persons who have the trust and who have the avenues to speak to and address their communities,” Sanders said.
Sanders said that HBCUs could help reach young Black Americans through social media with reliable vaccine information.
The greatest mistake public health officials could make, Sanders said, is “just showing up when things are spiraling out of control.”
“One thing we learned is that there is no quick fix,” Sanders said. “It’s important to have relationships within the communities that are being impacted so adversely.”
The Trump administration is aiming to vaccinate 20 million Americans this month, beginning with front-line workers and elderly Americans in nursing homes and assisted living facilities.
Adams said that as the availability of a vaccine progresses, HBCUs will also be an important component of the federal government’s distribution campaign.
President-elect Joe Biden has said that an early priority of his administration will be to make sure communities of color, which have been disproportionately impacted by the coronavirus, have equitable access to a vaccine when widespread distribution begins.
“Delivering large amounts of the vaccine to the Walmarts and other major drug chains does not get you into a lot of these neighborhoods. And it doesn’t guarantee that it gets around. So we got a lot of work to do,” Biden said last week, calling the virus a “mass casualty” event for minority populations.
Black leaders interviewed by McClatchy said that trust in a vaccine, not access, is the hurdle the new administration should be most concerned about. While it was helpful that former President Barack Obama volunteered to be vaccinated on camera, it would be meaningful to the Black community if incoming Vice President-elect Kamala Harris made the same commitment, they said.
Harris said before the election that she did not trust President Donald Trump and would take a vaccine only if it came at the recommendation of a public health professional such as Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. In a CNN interview last week, she said she would “of course” take the vaccine after priority groups such as front-line health care workers have received it.
“She needs to do it. She can’t leave it up to Obama. She’s going to be the vice president, and she needs to step into the role,” Star Parker, founder of the conservative Center for Urban Renewal and Education, said. “She should be the first one out there. Obama can’t clean this one up for you. She’s the one who said it.”
A spokeswoman for Harris declined to comment.
Adams said that politicization of the vaccine had been unhelpful. Without mentioning Harris directly, he said, “You had politicians saying they wouldn’t trust or take a vaccine. You had politicians, also, I think, making remarks about a vaccine that suggested that the process could be rushed all around.”
“We had politicization of this. And my hope as surgeon general is that we can help people focus on the process, and not the politics, understand that it’s safe, and we can create some momentum for uptake.”
Trust in the vaccine development process steadily declined nationwide over the course of the summer as Trump publicly pressured government agencies and drug manufacturers to have them ready by Election Day.
Overall, public confidence reached a low in September, with half of Americans polled saying they intended to get the vaccines once available. That has risen to over 60% since additional information was released on the results of the advanced trials.
Michael Bars, a White House spokesman, defended the administration’s efforts to boost vaccine confidence, noting that the National Institutes of Health announced in September a $12 million grant for outreach and engagement efforts in ethnic and racial minority communities. “President Trump’s Operation Warp Speed has continually emphasized that distribution of a safe and effective vaccine should be targeted to protect the health and safety of vulnerable Americans disproportionately affected by the virus,” Bars said.
Padonda Webb, interim executive director of the student health center at North Carolina A&T State University, said that there is inherent distrust in the Black community of a vaccine and of the current administration, including the Black surgeon general.
Webb said in an interview that she participated in a virtual forum with Adams and a small group of HBCUs last month during which participants stressed that local Black community leaders such as college chancellors and faith leaders should be tapped to build vaccine confidence.
“You could probably take these vaccines to the neighborhood and would have limited people that would actually take them,” she said.
Biden has formed a coronavirus advisory board that is guiding his policy response throughout the presidential transition. He has also announced his intent to nominate Vivek Murthy to the position of surgeon general, and asked Fauci, a current coronavirus task force member, to be his chief medical adviser.
Adams said that while he had received no outreach from Biden’s team, he intends to work with “anybody” who has a plan to address the pandemic’s disproportionate effects on communities of color now and in the future.
“My plan is to continue what I committed to do, and that’s to continue working hard to protect the American people, and the politics will sort itself out,” he said. “But right now I’m focused on doing my job until someone tells me that I can’t anymore.”
