The COVID-19 pandemic highlighted stark racial inequities in the U.S. healthcare landscape, disproportionately killing and harming Black Americans. Compounding increased exposure to the virus, decreased access to healthcare, and inequitable resources was that Black Americans were more hesitant to get the COVID-19 vaccine when it first became available, according to the Centers for Disease Control (CDC). Black community leaders developed initiatives to overcome this hesitancy and in doing so, have transformed the way that Black Americans receive healthcare.
To better understand vaccine hesitancy, the AmNews spoke with Dr. Simon Haeder, a professor of public health policy at Texas A&M who conducts research on the topic. According to Haeder, hesitant individuals are those “who have concerns about vaccinations that may then trigger them to either delay or outright refuse vaccinations.” Haeder’s research has shown that vaccine hesitancy is not a single defined concept, but rather an overlap of many differing attitudes toward vaccines.
Complicating this is the fact that different vaccines provoke different degrees of hesitancy in the public, and different communities have different opinions on these vaccines. For example, with COVID-19, political affiliation strongly predicted whether someone would receive the vaccine, “but, if you go into other things like polio vaccines, acceptance is very high and those predictors are very, very different.”
Past is prologue
Vaccine hesitancy did not begin with COVID-19, but like many other problems, the pandemic exposed what was already hiding beneath the surface. Haeder said that “it was always there … there was always a subgroup of people who were hesitant or concerned about vaccinations, but I think social norms, as well as requirements, have suppressed [these concerns] for a very, very long time.”
Vaccine hesitancy in the Black community is largely based on past experiences with the biomedical establishment. After decades of mistreatment by public health professionals, medical institutions, and scientists, there is legitimate concern about how these institutions view Black Americans.
According to Roxanne Spurlark, a Doctor of Nursing Practice who was working in a Chicago safety net hospital during the pandemic, this negative history has created a perception of hostility toward the Black community. “These are perceptions, and the perceptions are the reality when it comes to the community,” Spurlark said.
The history that Black Americans have experienced and the perceptions it has created even more barriers to accessing healthcare, in a community that research has shown was already disproportionately affected by the disease.
(Source: NY State Dept. of Health)
As COVID-19 vaccines became available, governments were quick to implement vaccination mandates. “We know the best way to increase vaccination rates are vaccination requirements … especially when it comes to things people can’t avoid, like having a job or a K–12 education,” Haeder said.
However, historically, imposing mandates on Black parents has done little to overcome perceptions of antagonism between the Black community and the public health sector. Initially, Black Americans were less likely to receive the COVID-19 vaccine than white Americans, according to a CDC report.
Breaking barriers
If mandates are not that effective in getting Black Americans to get vaccinated for themselves or their children, what works? In a study, Spurlark and her colleagues examined the barriers that prevent Black Americans from vaccinating and proposed solutions to overcome those barriers.
One of these solutions was to work with trusted community leaders. “[Black Americans] wanted to see that the people that they trusted were doing it,” Spurlark said. “It is not a secret that in the Black community, the only thing that is owned is the church, so if you can get your church leader to present and take the vaccine, most of them will follow their church leader.”
One such faith leader was Rev. Dr. David K. Brawley, lead pastor at St. Paul Community Baptist Church in Brooklyn. As the pandemic began, Brawley and other pastors “discovered that we are a front-line entity. Churches are front-line and faith institutions are a front-line entity that has to be involved at this level … One thing that we had to offer was space. Our institutions had spaces that we could offer for testing and then eventually for vaccinations.”
When Brawley received the COVID-19 vaccine, his vaccination was filmed by Doctors Without Borders, and he publicly encouraged others to get vaccinated.
“When I was first vaccinated … I had a deep concern for [my congregation members’] mental health and well-being, but also, I needed some advice and guidance from them, from the front lines” he said. Brawley spoke with his congregation, which included a number of healthcare professionals. He emphasized the role of the congregation in discussing the vaccine and making the decision to get vaccinated together: “It was not a hierarchical decision in any way — it was definitely under the advisement of people within our own congregation who had more understanding about what was happening than I did.”
For the community, by the community
The community-level response initiated by churches like St. Paul Community highlights a crucial and continuing development in the relationship between Black Americans and healthcare. Pastors like Brawley are using the relationships created during the pandemic to address other health issues within their congregation. “Given where [St. Paul Community is] located, and being the epicenter of diabetes and hypertension and other chronic diseases, we want to turn that narrative around,” said Brawley.
Many of the resources to support these endeavors come from Choose Healthy Life, a collaboration of Black churches — including St. Paul Community — that was launched to address the crises caused by COVID-19. It has since expanded, and Brawley explained what is revolutionary about this new approach: “During the pandemic, you came and got tested, right? Then you came to the church, and you got the vaccination. Now you’re coming to the church, and now you can get blood work done. Now you can go to the church and now you have referrals [to physicians].”
In New York City, 20 churches of different denominations are part of Choose Healthy Life. Reverend Jacques DeGraff, the NYC clergy leader for Choose Healthy Life, explained the vision that the program has for the Black community: “When you talk to our community, health is sometimes interpreted as ‘not being sick,’[but] we actually want to move to wellness.”
To do this, Choose Healthy Life has partnered with Quest Diagnostics to create a “blueprint for health.” On “Wellness Wednesdays,” community members can go to churches or other community locations and, in addition to vaccinations, receive individualized health assessments. This blueprint allows community members to seek out healthcare professionals with knowledge in hand and on their own terms. “That empowers individuals who may not have a physician, or they may be negligent about their own situation,” said DeGraff.
For healthcare workers like Spurlark, normalizing community-based healthcare is also crucial preparation for the future rather than being complacent now that the pandemic is over. “It’s not if it happens it happens again, it’s when,” she said.
Key to this preparation is to separate the association between community-based healthcare, such as mobile clinics or health fairs like “Wellness Wednesdays,” from the trauma and chaos of the pandemic. “Through these normal events, community health providers “[are] becoming a trusted representation. Now, if something happens … those people become known and trusted.”
While things are changing for the better, now is not the time to stop. “The only way to keep the momentum with it is to create the opportunity for education and restorative justice in between [events like the pandemic],” Spurlark said. Through recognizing past harms to Black Americans, government and public health officials can support the developing community health initiatives in Black communities.
“We need resources,” Brawley added. “We need the resources, and the leadership can come from within the community, as Choose Healthy Life has proven.” Ultimately, Brawley said, “Healthcare cannot be done to us. It has to be done with us and through us.”