Messaging around a Covid-19 vaccine must be delivered to African American communities without admonishment or pressure, according to health officials planning for its rollout in St. Louis.
The approach will be distinct from the messaging campaign that they’ve used for Covid-19 testing and prevention largely because Black communities are wary of vaccination efforts.
“We were very comfortable delivering a clear ‘call to action’ when it came to getting people to practice social distancing, use hand sanitizer, wear masks and so forth,” said Laurna Godwin, president of Vector Communications, which provides information about Covid-19 testing and prevention to minority communities.
“With the vaccine campaign, we’re going to just provide the information and let the people decide,” she said.
St. Louis officials’ efforts exemplify the decisions facing local health boards around the U.S. that will be on the front lines of promoting vaccinations to blunt the effect of the coronavirus, which has killed more than 800,000 people.
Federal officials also are working on a higher-level Covid-19 vaccination campaign, according to Surgeon General Jerome Adams. The Office of Minority Health is planning a $40 million campaign with the Morehouse School of Medicine to engage ethnic and racial minorities about the Covid-19 vaccine, Adams told the Senate Health, Education, Labor and Pensions Committee Wednesday.
Public Health Service officers are working with minority communities in “culturally competent ways” to increase acceptance of a Covid-19 vaccine and to ensure access when it becomes available, he said.
Local public health departments are using their forthcoming seasonal flu-vaccine campaigns to test out strategies for their own Covid-19 vaccination rollout, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
The Power of Choice
“Communities that we are engaging with are telling us, ‘We have the power of choice,’” said Bethany Johnson-Javois, CEO of Integrated Health Network, a St. Louis organization focused on reducing health disparities. “They’re saying, ‘Don’t tell us what we should or shouldn’t do. Provide us with the pros and cons and give us the respect of trusting us to make good decisions.’”
The Covid-19 pandemic has hit Black communities with disproportionate force. African Americans are more than twice as likely to die from Covid-19 as whites. Hispanics, Asians, American Indians, and African Americans are five times as likely to be hospitalized if they become ill, according to a recent report from the Kaiser Family Foundation.
Yet public health officials are concerned that a Covid-19 vaccine may still be a hard sell among Blacks.
The reasons come from history, according to Johnson-Javois. “You just have to think about the Tuskegee experiment and the case of Henrietta Lacks,” she said. “There’s a lack of trust in the health care system from people that have been used and targeted.”
The Tuskegee syphilis experiment was a notorious study conducted by the U.S. Public Health Service in which around 400 African American men with latent syphilis in 1932 were duped into participating and allowed to go four decades without treatment. Henrietta Lacks was an African American woman whose cancer cells, obtained from a biopsy in 1951, were used to create a cell line invaluable to medical research. Neither she nor her family were informed of or compensated for their use.
More recently, news of testing a Covid-19 vaccine in Africa sparked concern in St. Louis’s African American community, according to Angela Brown, acting CEO of the city’s regional health commission.
A clinical trial of Covid-19 vaccine began in South Africa in June, according to the international vaccine alliance Gavi. The group acknowledged that such trials are “a sensitive and potentially controversial issue” in light of misconduct by Western researchers in other vaccine trials in Africa and unethical experiments conducted in the U.S. on African Americans.
Black people in the U.S. don’t want to be left out when it comes to a vaccine, but they also don’t want to be pushed to the front of the line, especially if there are lingering questions about a vaccine’s safety, Brown said.
African Americans are “not interested in being the guinea pigs,” she said. “When we first heard about the idea of testing in Africa, we were like, ‘Oh my gosh.’ I don’t think there was an understanding about how that would impact people of color, with how we’ve been treated in health care and haven’t had access to health care.”
African Americans historically are more reluctant than white Americans get seasonal flu vaccines and keep up with other recommended shots, Brown said.
Preparing for Covid
Godwin and Brown created a coalition, PrepareSTL, to provide reliable information about Covid-19 to African American, Hispanic, and immigrant communities in St. Louis.
Community messengers associated with the group say they “are not comfortable with telling people what to do when it comes to getting a vaccine,” Godwin said. “The goal is to present reliable information and then let people decide.”
PrepareSTL uses community health workers and activists with ties in the community to offer information about Covid-19 and give feedback on messaging.
Earlier campaigns on virus safety included one-on-one conversations, fliers, events to distribute masks and other supplies, radio and TV spots, and social media campaigns.
St. Louis campaigners went where people were likely to gather—laundromats, hair salons and barbershops, convenience stores and pawn shops, Godwin said.
“We made sure that they had the proper PPE,” she said of the health liaisons. “We also let them know we respected their time and expertise by paying them,” including covering their Covid-related medical expenses if they contracted the disease.
Johnson-Javois said public health campaigns need to look beyond Covid-19. People “may not agree with you on what is the most urgent thing,” she said.
Some are dealing with grief from the pandemic, a chronic disease, or basic economic struggles. They worry about being evicted or owing back pay on rent when the public health emergency is over.
“It’s naive and disrespectful to just hammer Covid, Covid, Covid, when peoples’ reality is like, ‘I could walk outside and get shot,’” she said.