Adedolapo Adeleke on the need to build community trust.
“I am not taking the vaccine, I do not trust it. I think it’s too soon to have a vaccine.” This was the response I got when I asked a friend if they were going to take the COVID 19 vaccine. This reluctance to receiving the vaccine has not only been echoed by friends, but other members of the black community on social media platforms.
The pandemic has shown a lot of disparity in healthcare with members of black communities dying disproportionately in comparison to members of white communities. However, with a vaccine that could significantly reduce mortality, there is still a high level of reluctance amongst many in the black communities to taking the vaccine. I noticed a major difference in response between my black and white friends when asked about the vaccine. This made me think about the reasons members of the black community were so opposed to it, despite it being part of the solution for the reduction of mortality. The concerns raised by friends and on social media platforms originate from a lack of trust in the government, researchers, health care professionals and pharmaceutical companies. In order to understand the origin of uncertainty and scepticism, we must understand history.
In the past, vulnerable black and brown communities have been targeted by racist health policies and clinical experiments. An example of this injustice is the Tuskegee experiments conducted to treat men for “bad blood,” a local term used to describe several ailments, including syphilis and anaemia. The study was conducted without informed consent and lack of transparency. The participants were made to believe they would receive free medical care and treatment. Medication to treat these men was withheld and more than two dozen men with untreated syphilis died and approximately 100 died of complications related to the disease (CDC, 2020). These men were unable to give informed consent because there was a lack of research integrity and lack of transparency from the medical community and scientists. This example shows how a particular ‘race’ of people were treated very poorly when taking part in a clinical trial. Another example is how pain management is dealt with. A study by Hoffman et al (2016) shows black patients are systematically under treated for pain and less likely to receive pain medication when they are in pain. These disparities remain prevalent in gynaecology and obstetrics with black women four times more likely to die from pregnancy related causes than white women. (MBRRACE-UK, 2020).
At the beginning of the pandemic on the 3rd of April 2020, two French doctors discussed using Africans as clinical trial subjects. The head of intensive care at Cochin hospital in Paris, said: “If I can be provocative, shouldn’t we be doing this study in Africa, where there are no masks, no treatments, no resuscitation?” “A bit like it is done elsewhere for some studies on Aids. In prostitutes, we try things because we know that they are highly exposed and that they do not protect themselves.” (BBC News, 2020) The above quote shows a continuing attitude in favour of using Africans and black people as clinical subjects with no regards to their well-being. Using people as clinical subjects because they don’t have the ability and resources to protect themselves is ethically incorrect and magnifies the long timeline of medical injustice from people in positions power to give medical care.
Lack of credible and accurate information also adds to the unwillingness and reluctance to receive the COVID-19 vaccination. Withholding valuable information or not disclosing all necessary information to the public creates scepticism which leads to distrust and unwillingness to take medical experts’ recommendations. Engaging members of the black community will depend on whether members of this community not only trust that the vaccine is safe and effective, but also believe that the medical organisations and pharmaceutical companies making the vaccines are trustworthy. Clinical researchers, medical experts and pharmaceutical companies must provide convincing evidence to overcome the extensive historical experience of unequal treatment and prove that they are, in fact, trustworthy.
An example of confusing information are the changes made to the time frame of vaccination. The second dose of the Pfizer vaccine was supposed to be administered 21 days after the initial dose, however due to limited supply and trying to vaccinate as many people as possible in a short period of time, the second dose has now been changed from 21 days to 12 weeks (Mahase, 2021). The medical community or governmental leaders have not given much explanation to the public regarding why this change occurred. Without a comprehensive explanation, the distrust and confusion continues to build in the community.
Scientific communication and the dissemination of information to the general public must be improved. In current times, social media allows anyone to craft their own narrative about science and publish it to an audience of millions. The dissemination of unverified information through the media and other social media outlets, has caused confusion, mystified the vaccine, created fear and a lack of trust. In order to stop misinformation, high quality research must be made easily available and written in ways that would be understood by the general public.
There are some black led outlets which have encouraged the uptake of the vaccine, such as social media platforms, black community organisations and faith organisations. Recently, on a social media platform called clubhouse there were discussions had regarding the vaccine. Clubhouse is an international social networking app based on audio-chat. Users can listen in to conversations, interviews and discussions on various topics. Scientists, doctors and health care professionals explained the function, efficacy and effectiveness of the vaccine. Members of the black community asked questions directly to health professionals who had no affiliation to the government and questions were explained thoroughly till it was understood. The misinformation people had prior to the interactive session were corrected, the vaccine was demystified and fears were eased.
Faith organisations and black community organisations have worked hard to dispel mistrust of the vaccine in black communities. This has been done by faith leaders bringing health professionals from within communities to address concerns and answer questions. This has encouraged more people to get vaccinated. The East London Mosque, which serves the largest Muslim community in the UK, hosted a pop-up vaccination centre to help counter mistrust of the vaccines. In north London, a Jewish GP and a Muslim GP opened a mobile vaccination unit, visiting places of worship, community centres and private homes to increase uptake of the Covid jab among faith groups (Sherwood, 2021). Black community organisations such as CAHN (Caribbean and African health Network) also provide accurate resources for members of the community. These endeavours have positively impacted the uptake of the vaccine. The reported hesitancy for vaccine uptake in black or black British adults has been halved from 44% to 22% which exemplifies the impact of community engagement (Crew, 2021).
Has the reluctance to take the covid-19 vaccination been justifiable? In my opinion, it has been. It is important to acknowledge the discrimination and medical injustice that are still frequently met in society and to learn from it. In order to achieve population immunity through vaccination, it is important all concerns and scepticisms are addressed appropriately. Trust plays a vital role in relationships between health care providers and patients. Health care professionals should focus on building trust through transparency and the disclosure of credible information. Black community and faith organisations have played a significant role in developing appropriate trust.