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In minority communities, doctors change their minds about vaccination

Like many black and rural Americans, Denese Rankin, a 55-year-old retired accountant and receptionist in Castleberry, Alabama, did not want the Covid-19 vaccine.

Ms Rankin was worried about side effects – she had seen stories on social media about people developing Bell’s palsy, for example, after being vaccinated. She thought the vaccines had arrived too quickly to be sure. And she feared that vaccinations were another example in the government’s long history of medical experimentation on blacks.

Then, one recent weekend, her niece, an infectious disease specialist at Emory University in Atlanta, came to town. Dr Zanthia Wiley said one of her goals while making the trip was to talk to her friends and family at their home in Alabama, getting them to hear the truth about vaccines from someone they know, someone. ‘one that is black.

Across the country, black and Hispanic doctors like Dr Wiley are speaking to Americans in minority communities who are often wary of Covid-19 vaccines and are often suspicious of officials they see on TV telling them to get the vaccine. Many reject public service announcements, say doctors, and the federal government.

Although acceptance of the vaccine is increasing, black and Hispanic Americans – among the groups hardest hit by the coronavirus pandemic – remain among the most reluctant to roll up their sleeves. Even health workers in some hospitals have refused vaccines.

But insurance from black and Hispanic doctors can make a huge difference, experts say. “I don’t want us to benefit the least from it,” Dr. Wiley said. “We should be the first to get it.”

Many doctors like her now find themselves not only urging their friends and relatives to get the shots, but also posting on social media and conducting group video calls, asking people to share their concerns and offering advice. reliable information.

“I think it makes all the difference,” said Dr Valeria Daniela Lucio Cantos, infectious disease specialist at Emory. She has hosted town halls and online immunization-themed webinars, including one with black and Hispanic employees of the university’s cleaning staff.

She thinks they’re listening, not only because she’s Hispanic and speaks Spanish, she said, but also because she’s an immigrant – her family is still in Ecuador. “Culturally, they have someone they can relate to,” said Dr. Cantos.

Many of those who hesitate to get vaccinated are mainstays of health in their own families. Ms Rankin, for example, helps take care of Dr Wiley’s grandmother, who is blind, and her grandfather, who cannot walk. Ms Rankin looks at Dr Wiley’s mother, whose health is fragile. And she is the single mother of three daughters, including a 14-year-old daughter who still lives at the home.

“If my aunt were infected my family would be in dire straits,” said Dr Wiley.

Dr Wiley met Ms Rankin, her daughter and mother in the living room of a brick ranch house on a quiet street – socially remote and wearing masks. Dr Wiley answered questions and explained the science behind the vaccine.

No, she said, the vaccine is not made from live coronaviruses that could infect people. No, just because someone was vaccinated and got sick doesn’t mean the vaccine made them sick.

And yes, the vaccine has been tested on tens of thousands of people and the data scrutinized by scientists with nothing to gain and everything to lose by pushing it prematurely.

Dr Wiley told them she was looking forward to being vaccinated herself.

Dr Virginia Banks, an infectious disease specialist in Youngstown, Ohio, who is black, understands the community’s long-standing distrust of the medical establishment.

But she has seen too many people – and not all of them elderly – suffer and die in the pandemic, she said. And Dr. Banks worries about her own risks when caring for patients. “I feel like I’m playing Russian roulette,” she says.

So she tells stories to those who are reluctant to get vaccinated, like that of a patient she recently treated, breathless. He asked her, “Am I going to make it out alive?” She told him she didn’t know.

“We have to tell these stories” to black Americans, she said. “And it has to come from someone who looks like them.”

“My friends and family say, ‘Even if the risk is one in a million, I’m not taking it,’” she added. “I said, ‘I understand your distrust, but this is beyond Tuskegee. It’s beyond “The Immortal Life of Henrietta is Missing.” We are currently in a pandemic. We have to trust science. “”

Dr Banks stresses the ripple effects of individual decisions: “If you don’t take this vaccine and it’s safe, we’ll be wearing masks for a while. If you want to get your life back, if you want to get back to normalcy, you have to rely on trusted messengers like me.

Dr Leo Seoane, an intensive care doctor at Ochsner Health in New Orleans who is Hispanic, has already been vaccinated. When he started talking to his friends, family and other members of the community, virtually everyone said they would not get the shot.

They were concerned that the vaccine was developed too quickly, that it was not safe, that it was not effective, or that it could infect them with the coronavirus. Now, after a gentle persuasion, “for one person, they’ve all changed their minds.”

But few believe that it will only take one or two conversations with a trusted doctor to convert vaccine skeptics into believers.

“When they started talking about the possibility of a vaccine in April, I said, ‘Not at all,’ said Phelemon Reins, a 56-year-old federal government employee. He was wary of the rapid development of vaccines and knew all too well the history of the mistreatment of blacks by the medical system.

“The Trump administration has done nothing to make anyone trust anything that comes out,” he added. “I reject everything they say.”

But Dr Banks, a friend, made him rethink his reluctance. “At the end of the day, it will be people like her that I will depend on,” Mr. Reins said. “I believe her.”

“How to convince the African-American community?” he said. “They might need people who look like him.”

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What does Joe Biden owe to black communities?

In effect, they ask President Biden to take inspiration from candidate Biden. In the primary and general elections, and under pressure from activists who portrayed Mr. Biden as an artifact of the political past, his team adopted a plan for black Americans called “Lift Every Voice,” which would seek to cut incomes. blacks and whites. gap, expand educational opportunities, invest $ 70 billion in HBCUs, and rethink the criminal justice system and policing.

Mr Biden’s selection of Vice President-elect Kamala Harris, the first black woman on a major party ticket, has been – with the encouragement of the campaign – seen as a symbolic affirmation of those commitments. Former President Barack Obama, the country’s first black president, had to assure white America that he would be president for all races. But Mr Biden has repeatedly asserted that black communities will receive special attention in his administration.

Black political leaders believe that the biggest obstacle to Mr. Biden’s commitment to tackling systemic racism is his own instinct for compromise, bipartisanship and deference to Washington’s idea of ​​civility. Mr Biden has consistently reaffirmed his belief that Congressional Republicans will work with his administration in due course, though some of them continue to question the legitimacy of his victory and President Trump shows no signs of slacking off. its hold on the party base.

“Bipartism is how the president-elect and vice-president-elect plan to get things done from day one,” said Ramzey Smith, spokesperson for Mr. Biden’s transition team. “They made it clear that in order to tackle the systemic inequalities that black Americans have faced for generations, it is imperative to work on the other side and engage with all groups to achieve a consensus that does not compromise nor our principles and our priorities. . “

Some black leaders who met Mr Biden and Ms Harris during the transition were frustrated by the sentiment, according to several people familiar with the talks. Mr. Biden, the leader of the Democratic Party, is one of the few Democrats who believe that Republicans who reflexively opposed all of Mr. Obama’s actions and were slow to recognize Mr. Biden’s legitimacy are just ‘an aberration.

Leaders are asking him to consider unilateral action like executive orders to implement his agenda, saying the horse trade in Washington has rarely prioritized the needs of black communities. Mr. Biden has been steadfast: Republicans will come.

“We’ll see if he’s right, and we’ll see very soon,” said Sherrilyn Ifill, chair of the NAACP Legal Defense and Educational Fund Inc., who met with the Biden transition team. “If he’s not, we’ll see him very soon as well.

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Will the most affected communities receive the coronavirus vaccine?

It’s an idea that may never have been tried in large-scale vaccine distribution: Citing principles of equity and justice, experts insist that people living in communities hardest hit by the pandemic, which are often made up of black and Hispanic populations, get some of the limited first supply of coronavirus vaccines set aside just for them.

A committee of experts advising Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, is studying the idea. But as it becomes more focused, its underlying concepts and execution need to be further defined, and the approach may then face legal and political challenges, even as the medical system grapples with it. the logistical obstacles expected from the distribution of new vaccines.

The group that formulates the allocation plan is the Advisory Committee on Immunization Practices, which is made up of medical or public health experts who advise the CDC on schedules for providing immunization schedules for diseases such as flu or chickenpox.

He will discuss a variety of ethical issues at his next meeting on Friday, but members say he will not vote on a final proposal until a vaccine receives full approval or authorization for use. emergency response from the Food and Drug Administration, probably weeks or months after now. There are currently four vaccines in late trials in the United States

The plan currently under study is largely based on several proposals, in particular that drawn up by the National Academy of Sciences.

Dr. Helene Gayle, co-chair of the committee that designed this framework, noted that the issue facing her committee was racism, not race. Racism leads to social vulnerability, she said, with people in low-paying jobs putting them at higher risk of infection and living in overcrowded neighborhoods and households.

“Health inequalities have always existed, but right now there is awareness of the power of racism, poverty and prejudice that amplifies the suffering and the health and economic hardship imposed by this pandemic,” said Dr Gayle, former infectious disease specialist. at CDC who is now President and CEO of the Chicago Community Trust.

These impacts are seen in the way some groups, including people living in crowded neighborhoods with jobs such as caregivers – situations that tend to apply more often to people of color – become ill and die in a much higher rate than the rest of the population.

Dr Eboni Price-Haywood, director of the Center for Outcomes and Health Services Research at Ochsner Health in New Orleans, said she often showed the public a map of New Orleans that depicts areas of low income housing where people depend on public transport, where there are an increased number of multigenerational households with a grandparent as caregiver and where the density of poverty is high.

The map, she said, “overlaps with a predominance of black households.”

If the CDC committee follows the National Academy’s framework, 10 percent of the total amount of vaccines available would be reserved for people in hard-hit communities.

Their report says that because racial and ethnic groups, including blacks, Hispanics and Native Americans are disproportionately affected by the pandemic, “Alleviating these inequalities by explicitly addressing the higher burden of COVID-19 suffered by these populations is a moral imperative of any fair vaccine. allocation framework. “

“I see this as a seismic shift,” said Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania. “We cannot go back to the allocation of color blind.”

But the priorities go beyond those of the hard-hit neighborhoods.

The CDC committee suggests a framework that divides the American population into four broad groups for the allocation of vaccines when stocks are insufficient. A vaccine would be administered in stages.

The first phase offers a vaccine to health workers, a large group that makes up at least 15 million people and includes low-paid workers, such as nursing assistants and housekeepers in retirement homes. These groups are often overlooked in healthcare worker discussions, noted Stanford University committee member Dr Grace Lee.

“Most people think of doctors and nurses, but we rely on a whole team of people to care for patients and to run our health systems,” she said.

The potential second phase is made up of essential workers who are not in health care, a group that includes teachers. This also includes people living in shelters and homeless prisons and the staff who work there. And that includes people with health conditions that put them at high risk and people over the age of 65.

There are around 60 million essential workers who are not in health care – and it will be difficult to decide who among them will take priority without knowing how each vaccine candidate performs, Dr Lee said.

Subsequent phases include people with lower and lower risk levels until the final phase, which includes all people who have not received vaccines in previous phases.

But any initiative to integrate justice and equity in the distribution of a vaccine against the coronavirus raises difficulties.

It’s not even clear that hard-hit communities who are heavily black would want extra doses of a vaccine just for them, said Ellis Monk, a Harvard sociologist who studies race, inequality and health.

“Given the history of the American medical establishment,” he said, many African Americans have “a healthy skepticism about potentially being guinea pigs.”

The framework of national academies that the CDC is considering has favored an index, the Social Vulnerability Index, to decide which communities are hardest hit by the virus. It was designed to help allocate federal aid during hurricanes and other disasters.

The index is based on socioeconomic status, household composition, race, ethnicity, language, housing and transportation.

Committee members have said repeatedly that they want to make sure that communities that score high on the social vulnerability index have access to the vaccine.

But the Social Vulnerability Index is not the only measure being considered, said Dr. Beth Bell, a committee member at the University of Washington in Seattle.

The problem is that different indices can have very different consequences. And any allocation plan that explicitly includes race as a criterion could be subject to legal challenge, recently wrote Dr. Schmidt and colleagues in the journal JAMA.

Another measure, the Zone Deprivation Index, uses social indicators of health, such as overcrowding, to identify communities with greatest need, but does so regardless of race.

The difference between the two indices leads to large differences in allocation, says Dr Schmidt. When the first two phases of vaccines are distributed, an additional 1.7 million doses would be offered to black and Hispanic communities, mostly more disadvantaged, using the vulnerability index preferred by national academies than the index of deprivation, he and other colleagues reported in another article.

The difference in the number of people who received the vaccine, noted Dr. Schmidt, is greater than the population of Philadelphia.

“Normally, we invent scenarios like this for teaching purposes,” said Dr Schmidt. “But for better or worse, that’s pretty much the real picture.”

In principle, using equity and justice as a factor in vaccine delivery is laudable, said Dr Michael DeBaun, vice president of clinical and translational research at Vanderbilt.

But, he said, what if it turns out that a priority vaccine for hard-hit areas with predominantly black residents turned out to have serious side effects? What if these effects could have been predicted if clinical trials had included more people of color?

This impact “would be devastating for confidence in the CDC and public health,” said Dr DeBaun.

Acceptance among people of color will also depend on the political climate and “who is in power,” Dr Monk said. Trump administration officials have repeatedly tried to silence or override career scientists at the CDC and the FDA, fueling skepticism that the vaccines are being rigorously tested, he noted.

Dr Price-Haywood said acceptance of a vaccine must be seen in the larger context of the distrust of many blacks in the medical establishment. It also translates into a reluctance to participate in clinical trials, with people wondering “Is anyone doing experiments on me?”

“On top of that,” she says, “you get the feeling that ‘everything is speeding up’, and that ‘you did it too fast’.

Another potential problem will be the reactions of the different states, which will be the ones distributing the vaccines using the CDC’s guidelines.

The allocation proposal “is based on the premise that people who for generations have been underserved and disadvantaged should have a head start if we can afford it,” said Dr Matthew Wynia, ethicist and infectious disease specialist at the University of Colorado. But, he said, the leaders of some states can refuse.

“We have a very diverse country with different perspectives on what is right and in particular what is right for long underserved communities,” he said.

There are no easy answers, said Dr Schmidt.

“Getting the perfect super-duper could be an illusory ideal,” he added.