Dr. Ryan Neal, division head of hospital medicine at Houston Methodist, said this trend of hesitancy could partially be attributed to some historical issues of trust in the medical community embedded in African American culture.
There will always be some suspicion from the African American community when governmental direction meets with recent medical science research and the pharmaceutical industry, he said.
“And I think, based on our history, that is sometimes warranted,” he said. “There’s caution from the perspective of, ‘Is this safe? Am I going to be unduly affected? Should I really be taking it? Can I trust what my political leaders are saying I should do?’”
This stems from unethical health care treatment of communities of color, said Ryane Jackson, vice president of community benefits for Houston Methodist. She cited the “Tuskegee Study of Untreated Syphilis in the Negro Male,” a 40-year study by the U.S. Public Health Service in which, starting in 1932, hundreds of Black men with syphilis were misled about their treatment and left untreated, according to the Centers for Disease Control and Prevention.
While some Black Americans, Neal said, will register for the vaccine as soon as they are able to, many will need additional assurance of the vaccine’s safety and efficacy, and others still will refuse to get vaccinated no matter what.
However, Neal said he is hopeful for the potential for herd immunity if at least 80% of the population ultimately decides to move forward with the vaccine. Those with certain comorbidities and those who work in occupations where they are exposed to lots of people on a regular basis are at a higher risk level when it comes to COVID-19, he said.
“People who work in public transportation, people who work in public access facilities where they have to deal with people one-on-one, people even in the food services business have to consider themselves high-risk because of exposure,” he said. “[They] should be looking at their first available opportunity to get the vaccine. I don’t think any one [vaccine] is better than the other—I think whichever one you can get first is the one you should take.”
Issues of access
The COVID-19 pandemic has also illuminated preexisting health care access issues among communities of color, the poor, the underinsured and the elderly, among other groups, Neal said.
Residents of the Houston region who live further outside the Loop or who were not connected to major health care hubs, such as Houston Methodist, Memorial Hermann, Kelsey-Seybold and Baylor St. Luke’s, may have missed out on early vaccine distribution opportunities, he said.
“They were sort of left out on the periphery trying to get this vaccine—even if they were in Phase 1 and eligible,” Neal said. “You see that as one point of accessibility, but where this reverberates even larger is the fact that these are the same people who can't get in for regular visits to a primary care physician.”
Barriers, such as insurance and transportation, have long been factors that disenfranchise certain populations from equitable health care opportunities, Neal said. When it comes to communicating important messages about vaccines or public health strategies, Jackson said, language can be a major obstacle in the Latino community.
Houston Methodist officials learned early on in the pandemic that certain phrases, such as “social distancing,” do not necessarily translate well in Spanish, so they shifted their focus to using simpler terms, such as, "Stay 6 feet apart from others,” Jackson said.
According to data from Harris County Public Health, the county’s population is 44% Hispanic, but as of March 17, only 29% of the department's vaccine distribution has been to Hispanic individuals.
Jackson said undocumented residents may be fearful of visiting major hospitals but are more likely to trust their smaller community clinics, so Houston Methodist has also leveraged partnerships with those agencies in vaccination efforts.
Another layer of complication that has become apparent during the vaccine rollout is inequity in communities' access to technology. Neal said not everyone has access to a computer or the tech savvy to navigate websites where vaccine registration is taking place—especially the elderly population.
Neal said because the vaccine remains unattainable for so many marginalized individuals who are often at the highest risk for COVID-19 complications, Houston Methodist has taken several measures to expand access.
“We sometimes underestimate just how hard it is for a 75-year-old lady who doesn’t drive to find someone to take them for an appointment where they might have to wait in line for hours,” he said. “If you don’t have family, if you don’t have somebody who’s available, it’s not as easy as most of us [who] drive anywhere we want, go anywhere we want [and take that] for granted.”
Addressing disparities
Jackson said her team is making targeted efforts not only to educate communities of color about the efficacy of the vaccine but also to help make it more accessible for those who face barriers.
The hospital system is partnering with many organizations, such as historically Black fraternities and sororities, the Latin Women’s Initiative, the Houston Food Bank, federally-qualified health centers and religious groups, to identify vaccine-eligible individuals.
For example, church leaders are holding “Sunday Signup” events in which they inform their congregations about how important the vaccine is in protecting themselves and others. Because faith plays a pivotal role for so many Black Americans, Jackson said, this has been an effective way to get people comfortable with the vaccine.
“All groups of people, regardless of your race or ethnicity, find value in their faith, but I do think there’s some historical rootedness in the African American community and in the Latino [community] with truly following the advice and feedback of their faith leaders,” she said.
Individuals who sign up will either receive a text to register themselves or call a designated phone number to have a Houston Methodist representative register them. They can also indicate transportation needs—which Jackson said about 10% do—and the hospital system can coordinate rides to appointments through a third-party company called ModivCare.
Christie Griffin-Jones is a member of North Houston-based Fallbrook Church, just one of the dozens of organizations that has partnered with Houston Methodist. She said she believes the partnership will help thousands get vaccinated.
Griffin-Jones, who has a professional background in the health care industry herself, said she has spent a lot of her personal time helping seniors from low-income and minority populations access the vaccine and offering reassurance and dispelling myths about it.
“When you’re coming from the north side of town, you may get an appointment at NRG, but you just don’t have access to get there,” she said. “I know that there is some truth to Blacks having hesitancy and just the willingness to be vaccinated, but on the other end, there is a large number of African Americans that want to be vaccinated that just don’t have access.”
