By Debra Furr-Holden, Michigan State University
Dr. Anthony Fauci and other national health leaders have said that African Americans must take the COVID-19 vaccine to protect their health. What Fauci and others failed to state is that if African Americans don’t take the vaccine, the nation as a whole will never achieve herd immunity.
The concept of herd immunity, also known as community immunity, is pretty simple. If a significant portion of the population or herd becomes immune to the virus, the entire population has acceptable protection. Immunity can occur through natural immunity to personal infection and recovery, or through vaccination. Once a population has reached herd immunity, the likelihood of person-to-person spread is very low.
The big lie is that of omission. Yes, it is true that African Americans will benefit from the COVID vaccine, but the full truth is that the country needs African Americans and other populations with lower reported COVID-19 vaccine acceptance rates to take the vaccine. Without increased acceptance of the vaccine, we have little chance of community-wide protection.
I am an epidemiologist and health researcher who has been researching the African American community for 20 years. Much of my work focuses on strategies for increasing community engagement in research. I see a significant opportunity to improve COVID vaccine adoption in the African American community.
Perform coronavirus math
Approximately 70% of the people in the US must take the vaccine in order for the population to achieve herd immunity. Whites make up about 60% of the US population. So if every white person got the vaccine, the US would still fail to achieve herd immunity. A recent study found that 68% of whites would be willing to receive the COVID-19 vaccine. If these estimates are correct, we would get 42%.
African Americans make up more than 13% of the American population. However, if up to 60% of African Americans refuse to take the vaccine, as a recent study suggests, it will be difficult to hit the 70% threshold likely to be required to achieve herd immunity.
Latinos make up just over 18% of the population. One study suggests that 32% of Latinos could opt out of a COVID vaccine. Add up the 40% to 50% rejection rates among other population subsets and herd immunity becomes mathematically impossible.
Further exacerbating the problem is that mass vaccination alone does not achieve herd immunity, as the effect of COVID vaccines on preventing virus transmission remains unclear. Ongoing preventive measures are likely to be needed to stop the community from spreading. As opposition to fact and science continues to grow, the need for credible information dissemination and confidence building around vaccines becomes increasingly important.
My research offers some possible explanations for lower vaccination rates in blacks. Historical mistakes such as the Tuskegee Syphilis Experiments, which ended in 1972, have been instrumental in increasing blacks’ distrust of the health system. In another case, Henrietta Lacks’ “immortal” cells were divided without her consent and used in medical research for more than 70 years. The most recent application includes COVID vaccine research, but her family has not received any financial benefit.
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One of Dr. A study conducted by Giselle Corbie-Smith at the University of North Carolina identified distrust of the medical community as a prominent barrier to African American participation in clinical research. Another peer-reviewed study by Corbie-Smith found that distrust of African Americans is significantly higher among African Americans than among whites.
In the modern health system, too, African Americans are treated disproportionately unequally. These experiences of bias and discrimination fuel the problem of vaccine reluctance and suspicion. In April 2020, Massachusetts reported lower priorities for hospital admissions and life-saving interventions for COVID-19-related illnesses among African Americans. As a result, Massachusetts changed its guidelines, but the USA lacks data and transparent reports on this phenomenon.
The current reporting of vaccine importance may seem numb to those in a community wondering why their health is so important now at the vaccine stage. Black health did not appear to be a priority during the first wave of the pandemic when racial disparities emerged in COVID.
Questioning the scientific process
Perhaps Operation Warp Speed even had the unintended effect of reducing vaccine acceptance in the African American community. Some wonder why vaccine development for HIV, for which there is still no FDA-approved vaccine, has not been adopted so quickly. As of 2018, AIDS-related disease has killed an estimated 35 million people worldwide. People of the same color and other socially vulnerable population groups are still disproportionately affected.
If African Americans were honored and recognized in these COVID vaccine talks and said “We need you” instead of “You need us”, perhaps more black people would trust the vaccine. I encourage our nation’s leaders to consider radically changing their approach. You need to do more than point out the few black scientists involved in developing COVID vaccines or make a spectacle of prominent African Americans who are receiving the vaccine.
These acts alone are unlikely to be enough to gain the confidence needed to increase vaccine adoption. Instead, I believe that our leaders should embrace the core values of justice and reconciliation. I would argue that establishing the truth must be at the forefront of this new narrative.
There are also several leverage points along the supply and distribution chains as well as in vaccine delivery that could increase diversity, equity and inclusion. I would recommend giving minority and women-owned companies fair and mandatory access to contracts to bring the vaccine to communities. This includes procurement and purchase agreements for the freezers needed to store the vaccine.
Minority health workers should rightly be called back to aid vaccine administration. These non-publicly discussed topics could be transformative in building trust and increasing vaccine adoption.
Without a radical shift in the conversation about real COVID justice, African Americans and many others who could benefit from the vaccine will get sick instead. Some will die. The rest will be marginalized by a system and a society that have not valued, protected, or prioritized their lives equally. I think it’s time to tell the truth, the whole truth and nothing but the truth.
Debra Furr-Holden, Assistant Dean of Public Health Integration, Michigan State University
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