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Brian: Brian Lehrer on WNYC. You might be familiar by now with these apparently contradictory statistics. Black Americans are being hospitalized for COVID-19 at more than triple the rate of white Americans, and yet the Black population of the United States is more skeptical of the COVID-19 vaccine than other populations.

According to a December poll by the Kaiser Family Foundation, in other words, taken this month, 35% of Black adults surveyed said they definitely or probably would not get vaccinated compared to about a quarter of the rest of the public.

The Centers for Disease Control says communities of color are a critical population to vaccinate, but what actionable steps are states taking to make sure people of color aren't overlooked and are brought into the fold as much as possible?

Joining me now are Caroline Chen, healthcare reporter for ProPublica who's been focusing on vaccines, and Dr. Georges Benjamin, Executive Director of the American Public Health Association. Caroline's article about this in ProPublica is titled Vaccinating Black Americans Is Essential. Key States Aren't Doing the Work to Combat Hesitancy. Welcome to WNYC, Dr. Benjamin, and welcome back, Caroline.

Dr. Georges: Hey, Brian, how are you?

Caroline: Hi, thank you so much.

Brian: Listeners, we want to open up the phones right away to our Black listeners. Are you skeptical about the COVID-19 vaccine? Why or why not? Maybe you and family members and others have thought that maybe you don't trust or they don't trust how quickly the vaccine was created, or maybe more to the point that the historic and present relationship of the medical profession to Black Americans leaves you suspicious, or someone you know, suspicious from the outset.

What sort of conversations are you having in your circles about the vaccine? What kind of conversation are you having in your own head? If you support the effort, what do you think public health officials should do to ensure that communities of color get the message?

We do have the Executive Director of the American Public Health Association, Dr. Benjamin here. 646-435-7280 is our phone number for anyone who wants to answer any of those questions. 646-435-7280, and make your doubts, your strategies, your questions, or anything else heard. You can also tweet @BrianLehrer but again, the phone number is 646-435-7280 for Black Americans on this. 646-435-7280.

Dr. Benjamin, let's start with you here. You've been examining the issue of vaccine hesitancy within our Black community since before the pandemic. Of course, this issue goes back in history. For those who don't know, can you walk us through why there is a historical mistrust of the medical system among communities of color, and how much it is really a present mistrust so we don't just talk about something like the Tuskegee experiment?

Dr. Georges: Sure. Well, you go back to slavery when African Americans were often treated in experiments, both medical- just medical experiments, as well as early research experiments, of course, without their permission. You go to Tuskegee, where an idea of a natural history study on syphilis went awry when not only did they properly inform the people that were in the study. By the way, they were all African American men, but they did not get treatment when the treatment became available.

Now, there was a national apology by President Clinton when that happened, but-- I mean, afterwards, but you have continued to have real historical injustices in research. Although now, understand, there's been a lot of things that have been put in place to try to prevent that from happening.

Those are history. The issue today, of course, is that historical issues are one thing, but current mistreatment continues to occur. African Americans and Latinos and Native Americans, basically, communities of color are often continued to be mistreated within systems, disrespected, assumed not to have doctors.

When we think about this, there are really four things that happen in the healthcare system that create disparities. Access to care, differences in the quality of care received, differences in health-seeking behavior, cost, and a whole range of social activities that prohibit you from getting the care that you need. That has also played out even in this current pandemic. A lot of those things will continue to play out, including vaccine hesitancy.

Brian: Caroline, you're writing your PhD, injustices on confined to the past. Do you want to add anything to what Dr. Benjamin just said and how it connects specifically with vaccine hesitancy for COVID-19?

Caroline: Yes, sure. I wanted to quote Dr. Bisola Ojikutu, who is an infectious disease physician at Mass Gen, who has been at a lot of town halls lately. I think she put it so well, she said that from the very beginning, Black and brown people aren't really part of the enterprise of research. Quoting her here, she said, "They think so few people look like us in research, industry, and academia." These are all parts of vaccine research.

She said, "Why should we trust that someone at the table is thinking of our interest?" When it comes to vaccine hesitancy, she said, "A lot of people aren't necessarily buying into wild conspiracy theory so they are out there." She said, "They're asking very reasonable questions. When we talk about vaccine hesitancy, we aren't necessarily saying that anybody's anti-Vax, they maybe are asking questions like, 'Hey, how did you produce the vaccine so quickly when it normally takes so long, so I might want to just wait and see. I want to make sure that there are no side effects.'"

This is a very reasonable objection. The problem is that, as you said right at the top of the show, communities of color are being hit so hard by COVID that there is this anxiety to make sure that they get the vaccine quickly. For some people, particularly those who are essential workers, they might not really have time to just wait and see for months and months, even though they might understandably want to.

There's this urgent need to overcome hesitancy to help them understand the data, help them really understand what safety and efficacy there is with these vaccines, even though their hesitancy is very reasonable.

Brian: Before we get to some callers, Caroline, talk about the premise of your latest article on vaccinating people, the subhead is Key States Aren't Doing the Work to Combat Hesitancy Among Black Americans. What would that work look like?

Caroline: Yes. My colleagues, Ryan Gabrielson, Topher Sanders, and I looked at some of the state plans. We looked at 10 states that have the highest number of Black population and each state has had to send their plans to the CDC. There are some states including Texas, Georgia, and Illinois, that don't even acknowledge that hesitancy among Black residents, or among communities of color is an issue that they'd have to overcome.

There's no mention of this as a key issue at all. There are other states that do at least acknowledge that this is a barrier, but there isn't much detail as to what are we going to do to combat this? It seems to be leaving a lot to either local nonprofits, or to national nonprofits to do this work, and so we found that concerning. We called a bunch of these states and said, "Hey, what are you going to do?" Again, Texas, Georgia, Illinois didn't even respond to our request for comment, which was unfortunate.

Because, as you said right at the top of the show, we know this is an urgent issue. The CDC has flagged this as an urgent issue. When we talk to a lot of experts, the president of the AMA, Dr. Susan Bailey, for example, said that this is something where you ideally want to be able to talk to a trusted caregiver. We know that most of the time, people want to go to their doctor or to someone that they know and trust to really be able to ask all their questions, to be able to walk through the data.

To be able to make sure that physicians, whether it's their family care provider or someone that they know and trust, or whether it is partnering with the church community, any other trusted figure in the community has all of the information, and we've been moving very fast. We've just authorized two vaccines to have all that information that can then be disseminated into the community is really important right now.

Brian: Dr. Benjamin, for you as Executive Director of the American Public Health Association, would you add anything to that as best practices for getting past vaccine hesitancy in Black America?

Dr. Georges: Yes, I think we should have been spending the last couple months basically explaining people what a vaccine was, as Caroline said, how can we produce it so quickly, and, by the way, it has been produced very quickly but the actual research steps were never skipped, but we haven't explained that to people.

We've done a lot of studies to document which something that every one of us could have told folks what they would have found about that hesitancy, that hesitancy wasn't a secret, and so it should have been built very proactively and all the plans and that does mean talking to trusted messengers. That means getting people that look like the populations that we want to get vaccinated to get out and talk about the vaccine. That means giving them the facts so that they can adequately and accurately communicate that information.

I think the issue about having people of color at the table, one of the more interesting facts is that, at least, the Moderna vaccine, an African-American woman was a major researcher and leader of that effort to actually produce that vaccine. I knew that, but that was not common knowledge until fairly recently.

Brian: Let's take a phone call. Shawnee in St. Albans, Queens, you're on WNYC. Hello, Shawnee. Thank you for calling in.

Shawnee: Hi, Brian. Good morning. I just want to lay out that for many Black people, America is a disease that we're having to carry. America is a disease. Meaning that aside from all the historical points laid out by your guests, the idea that there are certain narratives that assume that our bodies are intrinsically inferior, both medically and psychologically. I can remember sitting in as undergrad in psych classes where professors would talk about how our IQ is lesser than other communities, and I would raise the point that it was systemic racism that led to these inaccuracies in an inherently culturally and racially skewed test.

It's often that our bodies are often seen as intrinsically inferior and so we recognize, as Black people, that were we not in this location, we would not be at risk. We see that schizophrenia rates are higher in this country than they are in many other African countries.

We see that this issue of, again, intellectual inferiority, this myth is propagated and so we recognize that the liability is living in this country, not necessarily-- and the irony is that we have to bear the brunt of taking the vaccine.

I see also-- I don't know if we've also brought up the fact that the studies that Black feel less pain, these are issues that are very much related to the fact that America is the culprit and so why I should have to then bear the brunt of carrying something in my body, just from being in this location, to me, it's just a travesty.

Brian: Let me ask you to make that connection one step more. Accepting everything you've said about the racist history of perceptions, and even teaching about Black people in this country, why do you then wind up with Black people are now being asked to bear the brunt of the vaccine, as opposed to being asked to get vaccinated same as anyone else because white people are also being asked, Latino, Asian people are also being asked to get universally vaccinated?

Shawnee: I certainly see that it's not a coincidence that the first person that was vaccinated was a Black woman here in Queens, a nurse. There is an effort to promote publicly that we should be the example it has said. Just based on our history, I'm going to be skeptical because if the phrase goes, if America gets a cold, Blacks get much worse. If we're looking at places also-- There's also suspicion and skepticism in Africa as well towards this vaccine. In South Africa, we're hearing new stories about it as well.

This is beyond just the States. This is very much a multi-national effort to-- We have examples of birth control being studied on in South Africa and in the '80s and situations happening arising where women were sterilized because of it. We know that it's a concerted effort but that doesn't mean that I'm not going to take it. Ultimately I recognize that there's as a Black person, what is the agency that I have in this country over my own life? We see that with George Floyd.

I hear you that we're all having to get it, everyone's having to get it, but often the ramifications hit our community the hardest. We have not seen how this vaccine is going to affect us 20 years from now, 10 years from now, so it's hard for me to say that everyone is going to be affected the exact same way because of, again, how our bodies have borne the brunt of racism.

Brian: Shawnee, thank you so much for all of that. Please keep calling us. Dr. Benjamin, do you want to react to anything in Shawnee's call?

Dr. Benjamin: Sure. I'm going to put my head on it as a physician. The first thing I always tell patients is I want to acknowledge the historical injustices that Shawnee articulated, she was quite eloquent in her articulation.

The challenge we have and the trade-off that many people of color are having to make is do I want to take a vaccine that at least in the short-term we've clearly shown to be safe and effective? Or do I want to get a disease that we know in the short-term will kill you?

That is a trade-off and people have to recognize that clearly 80% of the people that get the disease don't do okay, but that 15% to 20% that get the disease get very sick, and disproportionately they're communities of color.

Let's look at the numbers. We're twice as likely, and this is Black, Hispanic, and Native Americans, twice as likely to get COVID. Four times as likely to be hospitalized, and two-and-a-half times more likely to die. What I do is I try to give patients the facts and say you have a choice of taking a vaccine that will protect you.

I agree, we don't have 40 years of history with this vaccine, we have a few months, but everything we've seen says that it's safe and effective, and the risk that you're taking, because there was an adequate number of African-Americans in the study, the risk that you're taking is the same as the risk for whites, for the vaccine, as best we can tell, but your risk of getting the disease is highly out of proportion. At least from my probe, that's what I would tell my patients, and, of course, what I would tell my family is 'get the shot'.

Brian: Here's another doctor calling in. Dr. Kathryn Ireland in Rockaway you're on WNYC. Hello, Dr. Ireland.

Dr. Kathryn: Hi. I am a member of the American Medical Association and I'm a social media ambassador. I'm not a member of the National Medical Association, but I would like to highlight their COVID task force. What I'm seeing is that we are trying to get--

Brian: Do you want to distinction by the way, for people who are unfamiliar, the difference between the AMA, the American Medical Association, and the NMA, the National Medical Association, and why you bring that up?

Dr. Kathryn: Is that better?

Brian: Oh, yes, much better. Thank you for getting off your speakerphone.

Dr. Kathryn: Oh, it was my headphone, sorry about that. What happened is when we try to show all of the people not taking vaccines, we are not modeling the best way, what we need to do is model by setting up social norms and that is what we're trying to do by showing an African-American nurse, getting it at, unfortunately, a private hospital, Northwell. Too bad it wasn't a public hospital, but that's the way to go here.

One other way we can do that is by getting the police to wear masks, take the vaccine. Where I live it's predominantly white, predominantly police environment. Nobody wears a mask. When we're having things like George Floyd happening, we see none of the police are wearing a mask. We know that the police aren't going to be taking vaccines, and then we're trying to rail against that. That's not the way to go. The way to go is the way that we are now starting to go by showing that African-Americans are getting the vaccine, having the National Medical Association do an apolitical task force to show that this is safe and also amplifying stories like my own. I went to Promoter yesterday on 34th street as a patient and all of the staff and the security guards, all African-American that I encountered were so excited to get the vaccine.

We need to tap into and to highlight those stories, not that the police benevolent associations shows that police don't want to take the vaccine or wear masks, something like that.

Brian: Highlighting the positive on social media.

Speaker 1: Exactly, and showing that the way that we can save ourselves is within ourselves by highlighting the NMA taskforce, showing that an African-American medical group is taking the lead, taking the politics out of this and taking the range, and, as I said, I'm actually not a member of the NMA, but I applaud everything that they are doing.

Brian: Dr. Ireland. Thank you so much. Caroline, you want to piggyback on that?

Caroline: Yes, and I really applaud all the work of specific doctors, ones that I interviewed for my story, as you said, the NMA taskforce, and I just wanted to go back to the previous caller and just note how much is going on in her head and how much has been carried in the heads and the hearts of Black Americans as they weigh this decision. It's not just, "Do I want to take this vaccine?"

It's the historical injustices, the current injustices that's weighing on them, plus the position of, "Do I want to take this vaccine right now?" I think it's really important that doctors and members of this COVID task force in the NMA, these trusted voices that we've been talking about who are doing all this work to promote and overcome vaccine hesitancy be supported, whether that's giving them funding, giving them time so they can have extra-long conversations with their patients to answer all those questions.

This is the sort of thing that States can do or even local private doctor practices, give support to the Black and brown physicians in your community so that they can talk to their patients because they are the trusted voices. I think that's what I really hope will happen right now, because now is the time, we don't have time to waste.

Brian: Let's take another call. Gianna in Brooklyn, you're on WNYC. Hi, Gianna.

Gianna: Hi, can you hear me?

Brian: I can hear you fine.

Gianna: Fantastic. Hi, Brian. Longtime listener, so excited to be calling. My mother worked in pharmaceuticals and I trust the science and we'll be getting the vaccine when available to me, but mostly so I can hug my grandmother again, otherwise, and the Black woman was an auto-immune disease, and can't necessarily say I'm taking the vaccine because I trust the US health system.

One of our guests earlier in the month-- One of your guests, excuse me, earlier in the month and an earlier caller beautifully emphasized that while many resources were devoted to developing this vaccine hence it's relatively speedy availability of this trial did not have the benefit of time so we don't know long-term how it will affect others and you asked in the latter part of your question, what will it take in order to maybe convince people, Black people to take it.

I agree with many people who've spoken before a fair and caring treatment within the medical sphere. Generally, I'm going to turn the mortality rate for Black women that isn't the highest of the "developing world". If I don't trust my primary care physician to give a baseline care wellness checkup and provide me fair and equitable treatment, why would I let them inject something into me?

Like an earlier caller said, it would take trust in the medical system that should something adverse happen to me as a result of taking the vaccine, I would have to trust the medical system in this country would take care of me, which even as a person who is privileged to afford some of the best medical care, I don't trust or believe that that would actually happen being a Black woman.

Brian: Right and so it sounds like you're conflicted enough though, that you are going to take the vaccine, despite that lack of trust?

Gianna: Absolutely. I will be taking it because at the very least I am willing to sacrifice what might happen to me medically in order to prevent myself being a carrier and spreading it and I want to see my family again. I want to touch my family again.

Brian: Gianna, thank you very much. Here's a vaccine skeptic, Duke, in Jersey City, Duke, you're on WNYC, and let me apologize in advance we're running out of time in the segment, so we've got about 30 seconds for you.

Duke: Oh, wow. Hi, Brian. How are you?

Brian: Okay.

Duke: Okay. I'll go real quick. Oh, yes, I definitely would not be taking the vaccine. I think for myself, it comes down to trust and-- There's been basically one narrative pushed from beginning with this Coronavirus. Until I see Dr. Fauci, or--

Brian: He took it.

Duke: I know you've had Leana Wen on your program a few times or Sanjay Gupta. Until I see one of these doctors debating some of the other doctors who have another narrative about this, I'm not trusting anyone. I don't normally take a flu vaccine every year. I'm definitely not taking this one.

Brian: Duke, thank you. Caroline, for you as a media person covering vaccines, and I know you've got to go in like 30 seconds. What about that suggestion that there hasn't been enough debate, just a single media public relations push.

Caroline: Yes, I don't think it's a public relations push to me. For me, I think there aren't two sides to it because I think that would be actually a false narrative. For me, it's about the hard data. I don't think we should make up a false binary this side versus that side when it comes to data. I think what I actually encourage everybody to do is to look at the actual hard data for themselves and what you can do is you can Google Pfizer EUA. EUA stands for Emergency Use Authorization, Pfizer EUA fact sheet or Moderna EUA fact sheet.

Those are the fact sheets put out by the FDA about the two vaccines that are now available and those include information about the actual trials. What were the results of the trial? What were the side effects found there? It's really important that you look at the side effects so you know what to expect if you get the vaccine.

If you're a super hardcore nerd, you can actually look at the FDA's, you can look up FDA briefing documents, and that will look at what the FDA examined themselves, and the FDA is the only agency in the world that actually does its own analysis of the raw data.

They don't trust the pharmaceutical manufacturer’s analysis, they do their own analysis, and then you can peek through how they analyzed the data from the trial themselves and go into that into detail. That's my stance on it. I don't just take whatever Pfizer or Moderna says. I will look at the data myself and I think that's really important for you to have come to your own conclusions. Don't trust Dr. Fauci, or whoever it is out there if you don't want to, you can look at the data yourself.

Brian: Caroline, you can jump off if you're on deadline and we'll wrap up the segment with Dr. Benjamin--

Caroline: Thanks so much for having me.

Brian: Thank you so much, Caroline Chen from ProPublica, doing great reporting on vaccines and vaccinations for months. Now, her latest article is vaccinating Black Americans is essential, key States aren't doing the work to combat hesitancy. Dr. Benjamin, last word to the last caller or anything else you want to say?

Dr. Georges: Yes, I appreciate his concern, and what I can say is that trust but verify. What I can say to the last caller is I did exactly the same thing that Caroline said. I went and pulled the report from the FDA and you can go to the FDA website and you can read the report and I read it myself.

Now, obviously, I can't look at the individual data sets, but I can read the report and I read it and it convinced me that the vaccine was safe and effective. I recommend that vaccine to folks, but I do recommend that people don't take my word for it. Check it out yourself.

Brian: Dr. Georges C. Benjamin, Executive Director of the American Public Health Association. Thank you so much for your time today, doctor.

Dr. Georges: Thank you, Brian.

 

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