Op-Ed: Trust in Covid vaccine needs to be earned for Blacks and Latinos after decades of mistreatment

Dr. Torian Easterling is the New York City Department of Health’s first Deputy Commissioner and Chief Equity Officer

For any vaccination program to succeed, there is one essential element: people’s trust in the vaccine and the institutions that administer it. Confidence in the Covid-19 vaccine is as precious as our vaccine supply. But after decades of racist disinvestment and medical mistreatment, Black and Latino communities have every reason to be skeptical.

A recent CDC poll on vaccine hesitancy showed disappointing — albeit not surprising — results. In September, 56% of Black Americans said they would get vaccinated, and by December — after the FDA authorized the Pfizer and Moderna vaccines for emergency use — this percentage dropped to 46%. In comparison, 70% of white Americans responded that they intend to get the vaccine in December. Another survey by the Kaiser Foundation found a similar trend among Hispanic Americans, that only 42% want to get the vaccine.

But more revealing in these polls is exactly why Black people and Latinos are reluctant to get the shot. The main reasons included concerns about side effects, that the vaccine was developed too quickly, and many said they don’t trust the government.

Clearly, there is work to be done. To earn the trust of Black and Latino New Yorkers, we have to be inclusive, reach out to communities, listen to voices, values and opinions. The onus cannot be on the individual. It has to be on the institutions and public health leaders to treat people with respect, so they have a reason to trust and make informed decisions. Think of it as wrapping our arms around communities and making them know, we got them.

 In recent months, I have attended dozens of listening sessions with community groups, faith leaders and local health care providers in Black and Latino communities. We have discussed misperceptions and fears about the Covid-19 vaccine, and how decades of racism and poor treatment by the medical community have led to mistrust.

When Black, Latino and white medical experiences are compared, the contrast is unsettling and it starts literally from the moment we are born. There are, as we know, persistent and intolerable disparities in maternal health outcomes.

Alas, the disparate treatment continues into adulthood. People of color are less likely to receive the same level of treatment for anything from palliative care to management of chronic conditions. There is also unequal access to high-quality health care and often hospital segregation in many large cities.  

In my own conversations with New Yorkers, confidence in government and medicine have been a persistent theme. And while they are painful, they give us a chance to move to a place of healing.

Last summer, we heard the call for change when Covid-19 hospitalizations and deaths illustrated how racism affects health, and the murder of George Floyd laid bare structural racism in our country. The movement led the health department to declare racism as a public health issue and the city to form the Taskforce for Racial Inclusion.

Now we are keeping this commitment in the city’s vaccine rollout. To build trust in the vaccine, New York City unveiled an equity plan rooted in 33 neighborhoods with high Covid-19 case and fatality rates, as well as historical inequities, such as disease burden and crowded living conditions.

Our central theme is community-centered outreach, at the neighborhood level. Townhalls and webinars lay out information about the safety and efficacy of the vaccine, but empowering people to make their own decision has to be done in small groups with trusted voices. That is why we are partnering with hundreds of community-based organizations to be trusted messengers. We must meet people where they are — on the phone, at home, online or door-to-door — in the languages New Yorkers speak. Communication must be — and has been — open, honest, and clear.

We are also using data to inform our work. We sent out a letter to health care providers across the city encouraging them to collect and report Covid-19 vaccine recipient’s race and ethnicity to the citywide immunization registry. We publish race and ethnicity data on Covid-19 testing and positivity, and we just added ZIP code level data.

We want to know who is getting the vaccine and where there are gaps, so we can bring the vaccine to the right places. As vaccine supply increases, we are collaborating with community partners to identify the best locations for people to be vaccinated and also ensuring linkages to resources and services. Already the majority of our city vaccine sites are in the 33 priority neighborhoods, but we are scaling up and prioritizing communities with longstanding inequities who need the vaccine the most.

As we move forward in our vaccine rollout, racial equity will remain our most steadfast, core value. We know that in order for our vaccination strategy to succeed, we have to name racism, take responsibility, and do the work necessary to instill trust and confidence into everyday people.

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