An Ohio medical center's chief diversity officer discusses the origins of mistrust and strategies to overcome vaccine hesitancy.
As the coronavirus pandemic enters its second year, reaching the Black community has emerged as one of the daunting challenges of vaccinating as many Americans as possible.
Survey data indicate that COVID-19 vaccination hesitancy is high among Black Americans. A survey commissioned by the National Foundation for Infectious Disease found 51% of Black adults were not planning to be vaccinated for COVID-19. A survey conducted by the Urban Institute found 49% of Black adults said they were unlikely to get vaccinated, with 28% who said they probably would not get vaccinated and 21% who said they definitely would not get vaccinated.
HealthLeaders recently spoke with Leon McDougle, MD, MPH, chief diversity officer at The Ohio State University Wexner Medical Center in Columbus, Ohio, to get his perspectives on vaccination hesitancy among Black Americans. McDougle is president of the National Medical Association, the country's largest and oldest national organization representing African American physicians and their patients. He is also past chair for the Association of American Medical Colleges' Group on Diversity and Inclusion.
HealthLeaders asked McDougle about the origins of COVID-19 vaccination hesitancy among Black Americans and how healthcare providers can address vaccination hesitancy in this population. The following is a lightly edited transcript of that conversation.
HealthLeaders: Why is there vaccine hesitancy among Black Americans?
Leon McDougle: When it comes to vaccine hesitancy, we need to be careful not to place the blame on Black Americans themselves. We must acknowledge the history of the medical establishment's treatment of Black patients and the trauma that has caused. A revealing example is the Tuskegee syphilis study, in which public health officials worked with the Tuskegee Institute to study impoverished Black men who had syphilis, leaving them without treatment for the disease so that researchers could study its progression in the body over 40 years.
Even today, we know that many of the health disparities among people of color are a direct result of unconscious bias and racism. A 2019 study, for example, shows that Black women are considerably less likely to receive standard treatment for heart attacks than white women. When you or members of your community have experienced this kind of unequal treatment, it's understandably difficult to take the word of strangers in white coats who want you to try a vaccine that has been developed unusually quickly.
HL: What can physicians do to address vaccine hesitancy among their Black patients?
McDougle: Physicians need to earn the trust of their Black patients in the spirit of mutuality by having conversations with patients that are not dominated by the healthcare provider—understanding the perspective of the patient is key. Those in the Black community can be assured by knowing that they were adequately represented in the COVID-19 vaccine trials. Independent groups of scientists and physicians, such as the National Medical Association COVID-19 task force on vaccines, are providing extra vaccine reviews on their behalf.
Importantly, transparent communication must include listening to individual concerns and acknowledging that vaccine hesitancy, especially in the Black community, is valid. This pandemic and the COVID-19 vaccine are unprecedented, and it is reasonable and understandable to have questions.
Safe, convenient, accessible vaccination sites must be established to ensure that certain communities of color are also able to get the vaccine easily when they are ready.
Leon McDougal, MD, MPH, chief diversity officer at The Ohio State University Wexner Medical Center in Columbus, Ohio
HL: What steps has Ohio State Wexner Medical Center taken to address vaccine hesitancy among Black people?
McDougal: Among Ohio State's many health equity and anti-racism initiatives are efforts specifically designed to address COVID-19 vaccine availability, accessibility, and misinformation. Our Anti-Racism Action Plan includes periodic Roundtables On Actions Against Racism (ROAAR)—public panels that bring together institutional and community leaders and are led by the Ohio State Wexner Medical Center's Health Equity Steering Committee. Our most recent ROAAR addressed these health disparities and other race-specific issues laid bare by COVID-19.
A multifaceted COVID-19 Vaccine External Education Committee at the Ohio State Wexner Medical Center develops consistent, educational, accessible messaging targeted specifically to our most vulnerable communities, while providing transportation to vaccine sites and assisting with neighborhood-based, mobile vaccine distribution. Recent examples are public service announcements that aired during the Super Bowl, featuring a diverse group of Ohio State Wexner Medical Center staff who shared their personal reasons for getting vaccinated.
Recently, we also opened a dedicated vaccination site on Columbus' Near East Side, central to the city's neighborhoods that typically have the fewest resources available to them. Patients and community members in targeted ZIP codes can receive their COVID-19 vaccine at a closer, more convenient site at Ohio State's East Hospital, in addition to the option of traveling to Ohio State's mass vaccination site at the Jerome Schottenstein Center.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Physicians need to earn the trust of their Black patients by having conversations with patients that are not dominated by the healthcare provider.
Transparent communication must include listening to individual concerns and acknowledging that vaccine hesitancy, especially in the Black community, is valid.