June 8, 2021 -- “The vaccine just hasn’t been out there long enough for scientists and doctors to really know the long-term effects of people getting the vaccine ... so I’m hesitant.”
That was 54-year-old high school mathematics teacher Wynne Stovall-Johnson 4 months ago explaining to WebMD why she decided not to get the COVID-19 vaccine.
The January story looked at vaccine hesitancy in the African American community. At the time, Black Americans, according to the CDC, had the lowest vaccination rates of any ethnic group, and a Kaiser Family Foundation poll found about 35% of Black Americans said they would not get the vaccine amid concerns about trust, safety, and the newness of the vaccines.
“It’s really an emotional thing. Trust is based on emotions, and I just don’t trust right now,” she said then.
But in April, she changed her mind.
“I realized that if I did not take the vaccine, I wasn’t going to be able to ever get back to doing my normal activities. So I realized that I really had no choice, that I would have to get the vaccine in order to go back to work.”
Still, it was not an easy decision, and she struggled with it right up to the day the needle went into her arm.
“The day that I was scheduled to get the first shot, the night before I had bad dreams about things that could possibly happen to me after getting the shot. I had a very sleepless night and I usually sleep well. I dreamt about the vaccine all night. I woke up feeling really uneasy about it.”
That morning, she talked to her husband and told him she didn’t want to get it. He understood but told her she should.
“I was just afraid, not of any immediate issues with the vaccine but just of not knowing the long-term effects.”
She also called a good friend in the pharmaceutical industry. In the end, it was her desire to get back into her classroom that tipped the scale, so she bit the bullet.
No so for Anthony Hardy Sr. Back in January, the 32-year-old Black man was adamant about not getting vaccinated even though he was considered high risk because he has obesity. He stuck to his guns. But in early April, Hardy, a main banker at Live! Casino and Hotel Maryland, started feeling sick at work.
“I could feel the symptoms Friday, Saturday. My body was wearing down,” he recalled. “I got there Sunday and I was sent home early because I was fatigued, I was sweating. I didn’t eat anything during lunch, I had a loss of appetite. I was tired. My body was tired.”
The following day he tested positive for COVID-19 and began quarantining in the family’s basement, away from his wife, two small children, and in-laws.
Hardy says his relatively mild symptoms lasted about 10 days, but he does not regret not getting vaccinated and has no plans to do so in the future.
“My job is offering incentives -- you get $100 extra if you show your vaccination card. My managers got vaccinated at work. Hell, no, I’m not getting vaccinated,” he said.
Hardy’s parents, siblings, and other family members have been fully vaccinated. His wife, who got the disease early in the pandemic, and his in-laws have not. For Hardy, it still comes down to a matter of trust.
“Where did the vaccination come from? What are you injecting me with? You’re trying to put something in my body that I don’t want to put in my body. I don’t trust it,” he said.
That lack of trust for many African American people comes from a long legacy of discrimination, exploitation, and mistreatment by the medical community. Most notably the Tuskegee Study, where Black men with syphilis were promised treatment, led to believe they were being treated, but were not. Many died, went blind, or developed other serious health issues. Then there is Henrietta Lacks, whose cancer cells were used for medical research by Johns Hopkins Hospital without her or her family’s knowledge and without financial compensation.
Kaiser Health News’ analysis of the CDC’s recent data shows only 22% of Black Americans have gotten a COVID-19 shot and that Black vaccination rates still lag behind white vaccination rates. Access, hesitancy, and structural inequities are all believed to play a part.
Georges Benjamin, MD, executive director of the American Public Health Association, says he’s not surprised by those numbers, but it’s complicated.
“There are a lot of people in the African American community that wanted to get vaccinated but they didn’t want to be first,” Benjamin says. “When people did focus groups and town halls in communities of color, they would say, 'You know, I have these concerns about safety and efficacy but the big issue here is I don’t want to be a guinea.'”
There has been a big push to deal with the hesitancy in those communities and gains have been made, Benjamin believes, but he says the distrust is still very real.
“There’s still rampant misinformation and disinformation, which is contributing to people’s concerns about getting vaccinated. They’re not getting the facts as they should and access to vaccination in those communities, there’s still many structural barriers that are prohibiting people from getting it even when they want to get vaccinated.”
“In retrospect,” he continues, “It turns out that the structural barriers was far more impactful than the hesitancy. IT systems were a mess. If you have to look at who we structurally were going to vaccinate early on, they were not places where there were lots of communities of color.”
To date, nearly 137,000,000 Americans, about 33%, have been fully vaccinated. Almost 170,000,000 have received one dose. Native American and Alaska Native people are being vaccinated at significantly higher rates than all other groups, including white people. However, the CDC’s data on race/ethnicity is only available for 57% of people who have had at least one dose and 61% for those fully vaccinated. So the information these numbers are based on is incomplete.
In a statement to WebMD, Katie Fowlie, CDC public affairs spokesperson, said:
“It’s important to know that the vaccine administration process is complex and requires strong cooperation and partnership with all parties at the jurisdictional, local, and federal levels. CDC is working closely with jurisdictions to ensure as much information is submitted as possible, and regularly provides feedback to states on data quality.”
The CDC, she said, provides weekly summaries that highlight priority issues and shares strategies for addressing specific issues, “including completeness of race, ethnicity and county of residence data reporting. This has resulted in improvements in reporting these data elements in several jurisdictions."
Benjamin believes the main failure was not doing things equitably.
“When we structured our vaccination plans, we didn’t put equity at the forefront,” he says. “The Biden administration has begun doing that for sure, but we knew that this was going to be a problem last fall and yet we didn’t think about -- we, I mean the universal we -- didn’t think about the fact that how are we going to get communities of color, particularly African Americans who seemed to be the most hesitant at the time, how do we get them vaccinated?”
Ultimately, he says, “We focused a lot on the hesitancy issue and not nearly enough on the structural issue, and yet we’ve always known the structural issue was there.”
Those issues include access to the internet and a computer to make online appointments, “and yet that’s exactly how we decided to get people to register right off the bat. And that created a structural inequity to begin with.”
Marcella Nunez-Smith, MD, chair of the White House’s COVID-19 Health Equity Task Force, says even though the data is not complete, progress has been made.
“There’s definitely been improvement since January in the quality of the data we have around race and ethnicity, and it’s important to note that, but it’s still not where it really needs to be,” she says.
“We did not let the fact that we didn’t have complete data stop us from designing a campaign centered on equity and making sure that the federal vaccination channels were going to be located in neighborhoods and communities that have been the hardest hit and are at the highest risk, and those initiatives have been successful in meeting their goal.”
Nunez-Smith says the key is to always work with trusted and trustworthy messengers and partners like community-based and faith-based organizations to meet people where they are. One of her goals is to remove structural barriers that are proportionately experienced by people of color and reach people that are close to saying yes.
“That’s what keeps me up at night -- that there might be people out there who want to be vaccinated and don’t know how to connect with vaccination,” Nunez-Smith says.
To help, the government has made walk-up appointments available in 20,000 pharmacies, partnered with Uber and Lyft to provide free transportation, and made sure people get paid time off from work to get vaccinated.
President Joe Biden has set an ambitious goal of vaccinating 70% of adults by the Fourth of July. As they push toward that goal, here’s what Nunez-Smith wants to impress upon the African American community:
“You know how diverse participation has been in clinical trials, which it has been, people need to know they can see themselves in the research that got us here, that there was representation in the scientists, in the policy makers around this, so just kind of getting that information out as well as making vaccination easy and convenient, that’s what we have to do, those are the strategies to move forward.”
One of the big challenges, she believes, is how politicized the pandemic has become, calling it extremely disappointing and disheartening. But she believes some people are still deliberating and can be reached.
“I believe some people are still deliberating, but we have seen confidence in the vaccine grow across all demographic groups in recent months,” she says.
“Our obligation is to make sure that we are very respectful, that we listen, we encourage them to talk to people that they trust like their health care provider, other community leaders that they know, but, you know, we are still hearing a fair amount about access issues, so we have to make sure. So the story I never want to hear is somebody who says, 'I want to be vaccinated, I just don’t know what to do or how to get that done.'”
Hardy does not regret his decision to forgo getting the vaccine. He says he’s more scared of getting pulled over by the police than getting coronavirus.
“I beat it. I beat it once, why can’t I beat it again?”
And after all the agonizing, Stovall-Johnson does not regret her decision, either. After teaching remotely since early December, she is now back to in-person teaching and feels comfortable being inside the building.
“I’m glad I got the vaccine because I do have a little more peace of mind in my day-to-day life. Since everyone in my small circle of girlfriends has been vaccinated, we all feel very comfortable getting together. This was not the case a few months ago.”