By Melba Newsome

There is cautious optimism among public health officials that a vaccine to combat the novel coronavirus that has turned the world upside down might be available by the end of the year. A vaccine to combat COVID-19 is the best chance we have to end the pandemic and return to something resembling normal life. But what happens if a significant number of people refuse to be immunized?

In an Aug. 14 NPR/PBS NewsHour/Marist poll, 71 percent of Americans say the coronavirus is a real threat but only 35 percent say they won’t get vaccinated.

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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said herd immunity, where enough of the population is immune to stem the spread of infection, is less likely if only two-thirds of the population were vaccinated.

That concern is shared by health officials across North Carolina. Family practice physician Lisa Reed, said between 5-10 percent of families in Buncombe County don’t get routine vaccinations such as those against measles. That number has been even higher during the pandemic.

Reed worries that this vaccine hesitancy in Asheville and the surrounding community will be even greater for a coronavirus vaccine, resulting in a dramatic impact on herd immunity.

“As a tourist town that relies very heavily on people coming here to enjoy our mountains and everything else that we have to offer, it is really unfortunate that we could be a place that isn’t able to offer safety in a community that is protected from future outbreaks in this coronavirus.”

The growing distrust of vaccines

Concerns about immunizations predate the coronavirus pandemic. Over the past decade, early-childhood immunization rates have been slipping, leading to the worst measles outbreaks since the disease was declared eradicated 20 years ago. The World Health Organization lists vaccine hesitancy as one of its top 10 global health threats.

Doubts about an erstwhile COVID-19 vaccine are particularly acute in the African-American community. A recent Axios poll found Blacks were significantly less likely than whites to take a first-generation coronavirus vaccine, with only 28 percent of the Black respondents saying they would get a shot, compared to 51 percent of white respondents. Black respondents in the poll were also less likely than whites or Hispanics to get an annual flu shot.

A July report from the Center for Countering Digital Hate found that falsehoods about a COVID-19 vaccine have been prevalent on social media sites for months and have grown direr over time. Most prominent were “anti-vaccination entrepreneurs,” people who sell or profit off of vaccine misinformation.

Vaccine on a tray with swabs and a Band-aid. Photo courtesy: SELF Magazine/ American Academy of Pediatrics via Creative Commons
Photographer: Heather Hazzan; Shot on location at One Medical.

Vaccine hesitancy

When federal health authorities repeatedly tout Operation Warp Speed, the $10 billion public-private partnership that is driving much of the research into a COVID-19 vaccine, they inadvertently elevate one of the public’s biggest concerns of the vaccine–the rush to create it.

William Rivers, a Charlotte construction manager, is not opposed to vaccines but when asked if he will get the coronavirus vaccine, his answer is emphatic.

“Hell, no! Not the way they’re rushing this thing out,” he said. “Who knows what might happen to you down the road. You might grow a third leg or something!”

An intense global effort is underway to develop this vaccine and certain steps that usually take years such as securing funding and getting approvals for the trials, have been eliminated for expediency.

When talking about the historic mistrust of the medical system among many African Americans, Rivers mentions the Tuskegee syphilis experiment. In 1932, the U.S. Public Health Service recruited 600 poor Black men in Macon County, Alabama to participate in the “Tuskegee Study of Untreated Syphilis in the Negro Male,” with the promise of free medical care.

At the time, there was no known treatment for syphilis. But even after penicillin emerged as an effective treatment 15 years later, the researchers withheld the drug and continued to monitor the progression of the disease in the men. They watched as the men died, went blind, became psychotic or experienced other severe health problems due to their untreated syphilis.

Prioritizing immunizations

The Tuskegee experiment also epitomizes the fear many Blacks harbor of being denied critical care while the wealthy and prominent go to the front of the line. The ongoing clinical trials might provide a window into the future prioritization. Both Moderna and Pfizer say diversity is a priority for the Phase 3 trials, given COVID-19’s impact on Blacks and Latinos. But the first Phase 1 Moderna trial included 45 people; 40 were white and two were black.

This lines up with historical data that shows Black, indigenous and people of color (BIPOC) are less likely to be included in clinical trials for disease treatment. Blacks make up about 13 percent of the U.S. population but on average 5 percent of clinical trial participants. For Latinos, trial participation is about 1 percent on average, though they account for about 18 percent of the population.

A hospital building in Ashboro which belongs to Randolph Health and is about to be sold to another company
Photo credit: Randolph Health

One thing is clear: When a vaccine does become available, there won’t be enough to go around. So, who goes first? If accessibility is perceived to be unfair, it could only heighten mistrust among certain groups. Questions about whether race should be a factor have sparked a contentious debate within the Advisory Committee on Immunization Practices (ACIP).

Dayna Bowen Matthew, dean of the George Washington University Law School and an ACIP consultant on vaccine distribution, told the New York Times that racism should be directly addressed in the distribution plans.

“It’s racial inequality—inequality in housing, inequality in employment, inequality in access to health care—that produced the underlying diseases,” Bowen Matthew said. “And it’s that inequality that requires us to prioritize by race and ethnicity.”

Building trust

Lavanya Vasudevan, assistant professor of family medicine and community medicine at the Global Health Institute at Duke, said vaccine opposition is the logical progression of the divide over lockdown procedures.

“We are having trouble convincing people to adopt very simple behaviors like wearing masks and physical distancing. Convincing them to accept a vaccine will be even harder,” says Vasudevan at a media briefing on July 22.

National and state health officials are engaged in a high stakes game of whack-a-mole to combat the conspiracy theories and correct misinformation.

“We are behind here,” National Institutes of Health leader Francis Collins told CNN. “We haven’t done a good job of getting [coronavirus vaccine] information out there.”

“The best strategy is to invest in communication. Communicating early, communicating often, communicating through trusted entities,” says Vasudevan. “If it’s on the national level, it feels more distant. And relaying the importance of vaccines is critical. Vaccines are our best shot to ending this pandemic.”

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Melba Newsome is an award-winning freelance writer with more than 20 years' experience reporting on news and features. Her feature credits in many prominent publications including the New York Times, Bloomberg...