Medical Examiner

Black Doctors Explain How to Overcome Reluctance Toward the COVID Vaccine

To get patients to trust immunization, give them reason to trust the entire medical system.

A vial of the Moderna vaccine and a photo of a Black man with his head in his hands.
Photo illustration by Slate. Photos by Joe Raedle/Getty Images andIgor Vershinsky/iStock/Getty Images Plus.

The doctor was attentive and the exam room was pristine, even if I did have to wait eight hours to get there. Two nights before, when I’d rushed to the emergency department with a swollen arm and a painful cyst, the room in which I was treated gave me pause. It had had bloodstains on the floor, along with what looked like excrement, but when I asked the nurses about it, they brushed me off.

I’d always assumed that whenever a situation presented itself where I wasn’t being treated properly by a doctor that I would raise hell. But I didn’t. When the people with medical degrees emphasize that something isn’t a big deal, it’s hard not to trust them. Even when I wondered why the antibiotic dose they gave me seemed lower than I’d gotten for other, less serious conditions, I still trusted the medical professionals.

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But now, as the new doctor was changing my dressing, she informed me that I had been underprescribed antibiotics and was at risk of becoming septic. The realization that I’d been facing such negligence and disregard for my well-being changed my whole sense of what to expect, and what to fear, from the medical establishment. My new distrust bled over into nearly every interaction I’d have with a doctor afterward—and it colored my feelings about whether or not I would want to receive the vaccine for the novel coronavirus.

Even while news reports described how vaccines were going to change the course of the pandemic, I was planning not to get immunized myself. In spite of my knowledge of Black people’s historic medical mistreatment, I’d never been afraid of vaccinations before. My great-grandmother, who raised me, made sure I had every immunization for which I qualified. Her persistence was rooted in her own experiences of almost dying from mumps as a child, as well as her not having the same access to quality health care as white folks. It was another way of protecting me. I stayed up to date on my vaccinations when I aged out of her care and, recently, got my flu shot and tetanus booster. But following my poor experience in the emergency room, anything I wasn’t familiar with regarding medicine sowed doubt.

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COVID-19 has hit Black communities particularly hard, and the two vaccines authorized for emergency use, from Pfizer/BioNTech and Moderna, could save lives. But generally, Black folks face more barriers to vaccination and don’t receive treatment as frequently as their white peers. Along with the historical record and personal experiences of medical mistreatment, this tends to guide one’s health decisions away from taking part in immunization campaigns. In October, nearly 50 percent of Black Americans said they would not get vaccinated for COVID-19, citing safety concerns and distrust of the medical establishment, according to a survey published by the Undefeated and the Kaiser Family Foundation. Since then, confidence has increased slightly; a subsequent survey published in December found that 62 percent of Black Americans were willing to receive the vaccine. (President-elect Joe Biden has announced a vaccine rollout plan that intends to address hesitancy and barriers to immunization.)  

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What can be done about vaccine reluctance? I interviewed five physicians who deal with health disparities in the Black community to ask how they intend to address the subject among their patients and what broader strategies may be effective. Each doctor mentioned the more commonplace run-ins patients have with medical providers who treat them differently because they’re Black. And they discussed how history—such as the U.S. Public Health Service survey at Tuskegee and the story of Henrietta Lacks—informs both the present-day wariness Black patients have toward doctors and the provider actions that provoke uncertainty.

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The doctors I spoke with all expressed concern that the responsible institutions, such as the Food and Drug Administration and the Centers for Disease Control and Prevention, aren’t doing enough to reach Black communities with credible information. Explaining the safety data will be of particular importance. Many of the physicians who spoke with me mentioned patients wanting to find out how the vaccine affects others before they are willing to take it. “They’d rather wait and see what happens and make sure other people don’t have a bad reaction before they volunteer,” said Dr. Lisa Cooper, the director of the Johns Hopkins Center for Health Equity. “They don’t want to be the ones that are being ‘experimented on,’ or ‘being guinea pigs.’ We hear that a lot.”

“Different things bring people to vaccine hesitancy. It’s not really one size fits all in terms of what the concerns are that folks have,” said Dr. Marcella Nunez-Smith, the co-chair of President-elect Joe Biden’s COVID-19 advisory board and incoming chair of the White House health equity task force. “A mistake people can make is saying that for many communities of color there’s some anti-vax sentiment [and] that that gives us guidance. And I think that’s erroneous for most people.”

But Black health care providers are familiar with this skepticism, as well as outright refusals to take common vaccines. They’ve been navigating Black patients’ justifiable distrust of public health initiatives, medicine, and medical products for years. If anything, the hesitancy surrounding the COVID vaccine is an extension of a routine discussion happening in the exam room. Each walked me through a hypothetical conversation with a patient who is willing to be vaccinated any other time but isn’t feeling it for COVID-19.

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“Start by just listening and acknowledging what’s going on,” said Dr. David Malebranche, an internal medicine doctor. “That’s the first step: sitting down, being humble—regardless of your race and if you’re concordant with your patient. But for those of us who are Black and also seeing Black patients it’s really important because, in Black communities, people trust us more than they do their non-Black physicians.”

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When a patient walks into their doctor’s office and has a seat on the exam table, the hope is that the physician engages thoughtfully, thoroughly, and personably—especially when whatever decision is made could have a significant impact on their health. If the patient is a bit worried about a vaccine, explain how vaccines work in basic terms, demystify the side effects, and explain the risks of not getting the vaccine. Doctors could also point the patient to reputable individual resources, or share if they’d recommend the shot to one of their family members. If a patient lets their doctor know that they aren’t generally against vaccinations, get granular and ask about their specific concerns about this one, and reassure them that they probably aren’t the only one who feels this way. If the speed of the vaccine development process has someone on edge, walk them through the safety data.

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And always make it clear that hesitance based on prior bad experiences with medicine is valid.

Listening to the patient’s concerns—and acknowledging the reasons why they aren’t trusting of medicine—is paramount, the doctors said. Establishing a personal connection helps as well, since research won’t be enough to convince each patient. Cooper tells patients if she’s received a vaccine herself, in order to establish an open line of communication. Research has shown that these trust-building methods not only make patients more open to receiving treatment but result in more patients staying in care afterward.

“I tell them more about what I’ve learned over time and how research has changed over time to protect people more,” Cooper said. “And how there are many people like myself, and other scientists and physicians of color, who have done a lot to uncover the disparities in care.”

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She added: “There are so many safety provisions in place now where the kind of thing that happened with the Tuskegee syphilis experiment could just not happen in this day and age.”

I didn’t come into this story seeking to have my mind changed. But having access to a number of Black physicians, who were willing to entertain my questions, has given me the chance to develop a new understanding of vaccine safety processes. The same access that I’ve had in order to change my mind about receiving the COVID-19 vaccine is what institutions should afford to everyone.

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Public fear became more salient as the vaccine emerged as the most quickly developed in history. It’s both a sign of what is possible in science, and how institutional barriers persist. Without the relevant context, “Operation Warp Speed,” the name used to describe the effort, gives the perception that corners have been cut for the sake of getting people vaccinated quickly.

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In reality, the acceleration was due to years of prior research and an abundance of resources thrown at the process. Institutions have failed to make this clear—and three doctors I interviewed admitted that they had to do quite a bit of reading to understand the fast pace as well—or to fully acknowledge why their speeded-up process might make patients uneasy.

Building confidence in the vaccine is going to be necessary in convincing Black folks who are on the fence about being inoculated. It’s important that people don’t feel as though they’re being sold a vaccine on its own, explained Nunez-Smith, but instead understand that this is the best exit out of the pandemic. Trusted messengers who exist within and outside of the medical establishment—such as members of faith-based organizations, barbers, and other folks who are already known to people—can aid in closing the disconnect between government entities and Black communities.

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“There’s a role for Black health care professionals to really be front and center in this conversation in a way that we haven’t been in a long time,” said Dr. Uché Blackstock, an emergency medicine physician and the founder of Advancing Health Equity. “If you haven’t seen us, now you really need to see us. There are enough of us out there where you can have us on the news, on virtual town halls, on Facebook live, doing Instagram stories. We really need to be out there because our patients obviously trust us more. We also know what it’s like to be a Black person living in this racist country, and I think many of us would be willing to take the vaccine.”

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Safety data for both vaccines is encouraging. Efficacy rates for Pfizer/BioNTech’s and Moderna’s vaccines are 95 percent and 94.5 percent, respectively. (Efficacy is an estimate of how well the vaccine will work in the general population based on results seen during a clinical trial.) If you have a true exposure to COVID-19 after receiving one of these vaccines—meaning you’ve been within six feet for more than 15 minutes of one or multiple people who are infected—then there’s a really good chance that the vaccine would protect you from experiencing severe disease.

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During Moderna’s trials, only 30 people experienced severe disease and one of those folks died. All 30 were in the placebo group. No one who received the vaccine experienced severe COVID. In trials for Pfizer/BioNTech, 20 people experienced severe COVID and 18 of them were in the placebo group.

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Safety data will continue to be collected for the vaccines via multiple monitoring platforms, which will alert health officials of any adverse events and allow the public to have a better understanding of the vaccine. “I want to reassure people that the safety data collected on vaccines is not only collected during the trial and approval process, but also prospectively, in real time, after vaccines go into production, dissemination, and use in the general population,” said Dr. Rhea Boyd, a pediatrician and public health advocate.

Negative reactions to vaccines are rare, serious adverse events are even less likely, and anything adverse would occur relatively soon. (Cooper said any reactions to a vaccine would usually occur within the first week, not months or years later.) There are side effects, however, that could be mistaken as a bad reaction to the vaccine when really it’s your immune system doing exactly what the shot intends for it to do.

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“You might have soreness where you get the shot. That’s normal. What we’re trying to do is get your immune system revved up to fight this thing if it sees it in the future,” explained Nunez-Smith. “Your body doesn’t know that. Your body thinks it’s seeing it now. … So you might get a little bit of fever. You might feel a little unwell.

“If people know to expect that,” she said, “then I think we’ve done a better job in communication.”

Changing people’s minds is, in the end, not a single action, but a process. I’d listened to the doctors and absorbed their case for getting the vaccine, until I thought I was probably going to do it. Soon after, when the vaccine arrived, the fact that it was happening safely solidified my decision.

I signed up to receive my shots, as soon as they’re available to me.

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