(TNS) — Jackie Gooden isn't against vaccines. The La Mesa resident works for Scripps Health, where she helps check in and schedule patients. She's religious about making sure her young son and daughter have gotten all their shots.
But this time feels different. Gooden, who is Black and Latina, wishes she could get clear answers to a few pressing questions about the push for a COVID-19 vaccine.
"What's the rush of getting this out? And what's the rush of getting communities of color (involved)?" Gooden said. "That's a big red flag."
Gooden's not the only one with questions, judging from interviews and focus groups organized by the county, UC San Diego, and the San Diego Refugee Communities Coalition. Those conversations revealed many people of color are concerned that science has been polluted by politics and isn't being explained to them clearly. Others worry their communities are being used for clinical trials without an assurance they'd have access to an approved vaccine.
These concerns are shared by people of all races, but they take on added weight for minorities. Medicine's history is marred by examples of researchers denying people of color life-saving treatments or using them to test risky procedures.
The mistrust forged by that history could upend efforts to defeat a pandemic that has claimed the lives of more than 255,000 Americans, including 966 San Diegans.
After all, a vaccine won't do any good if people won't take it.
Iniquities and Inequities
Any conversation about why many people of color are wary of medicine seems to lead back to the Tuskegee Study, in which the U.S. government monitored hundreds of Black men with syphilis from 1932-1972 without offering them treatment.
Dozens died. A few penicillin injections would have cured many of them.
The study is notorious, but it's just one part of a long, sordid history, says Dr. Rodney Hood, president and founder of San Diego's Multicultural Health Foundation.
"I get tired of talking about it, because we act like that's the only thing that happened to Black folks," Hood said.
That history includes the father of modern gynecology, Dr. J. Marion Sims, who performed surgery on enslaved women without anesthesia. It also includes the plight of Henrietta Lacks, a Black woman whose doctors used her cells for research without her knowledge. Those cells, taken from a biopsy in 1951, have grown into one of the most widely used cell lines in science, helping researchers develop vaccines against polio and human papillomavirus, which can cause cervical cancer. Lacks's family never received a share of the profits from these and other discoveries.
Even today, Black and Native American women are more likely to die in childbirth than other groups. Blacks and Hispanics who are in pain are less likely to receive treatment than White patients. That fits with research showing that many people — even medical students — think Black people don't feel pain as easily as White people, which is what Sims believed nearly two centuries ago.
"They're not taking care of us in terms of our health care," said George McKinney, senior pastor of Impact Global Ministries in Valencia Park. "We're not taken seriously when we have pain and discomfort, and that's documented. So those things add up to a distrust of the medical community and the government."
Racial and ethnic disparities have factored into the COVID-19 pandemic, too. Hispanics and Latinos, who make up a third of the county, account for roughly 60 percent of coronavirus cases. And Black and Latino San Diegans are three times as likely as White residents to live in areas with high unemployment and numbers of COVID-19 cases.
That's one reason researchers running COVID-19 vaccine trials have looked to enroll San Diegans living in these hard-hit communities, says Dr. Susan Little, who is directing two vaccine trials at UC San Diego.
"We want to make these research studies available to populations that are traditionally underrepresented in clinical trials," Little said. "Communities of color in particular have had higher rates of COVID, higher rates of hospitalization and, in some cases, deaths."
The trials' interest in enrolling minorities, however, worried Dr. Suzanne Afflalo, who spent 23 years as a family physician at Kaiser Permanente.
During that time, she feels like she treated practically every Black person in San Diego. But when an acquaintance asked if she'd spread the word about UCSD's upcoming COVID-19 trials, her initial reaction was, "Whoa, timeout."
"Big organizations come into the African American community, always want to accomplish something, gather data, go back out, use their data to get more grants, more federal funding. Never once has the community ever benefited from that," Afflalo said.
"I can't sign up for that in all good conscience. I'm here to actually protect my community from folks like you."
The trials have also drawn sharp criticism from community advocates. In September, the Chicano Federation said locating vaccine trial sites in the South Bay was yet another attempt to use people of color to test an unproven medical treatment.
And in recent press conferences, Shane Harris, founder of the People's Alliance for Justice, has demanded the county and vaccine developers release a racial and ethnic breakdown of San Diegans enrolled in COVID-19 vaccine trials. Harris also called on the county to give the public an opportunity to comment on the ongoing vaccine trials in a town hall.
"What I would have liked to see is a little bit more of a collaborative approach with the community and less of a 'Take this vaccine, try the trial, and tell us what happens to you,'" Harris said. "Now more than ever, our medical professionals need to deal with the racial history and the systemic bias."
Nick Macchione, director of the county Health and Human Services Agency, told the Union-Tribune that he'd be willing to join Harris in a virtual town hall to explain how the county would vet and distribute a COVID-19 vaccine.
A Shot to Build Trust
If you're looking for a quick fix to restore trust in medicine and government among people of color, think again, says Joseph Stramondo, a bioethicist at San Diego State University.
"What we need is a widescale shift in how the lives of people at the margins are valued by the government, by big corporations," Stramondo said. "I'm not sure there's any easy way out of that."
It won't happen overnight. But public officials and researchers are taking small, immediate steps to boost trust in how COVID-19 vaccines are being developed.
National City Mayor Alejandra Sotelo-Solis took one of those steps recently when she rolled up her sleeve for a shot as part of a local COVID-19 vaccine trial.
Sotelo-Solis is part of a study in National City testing a vaccine developed by Johnson & Johnson. As a third-generation National City native and Latina, she says she wanted to lead by example and show her community that she believes in science.
"My word means something. My work means something, to me and to my community. They trust me. And I don't want to violate that," Sotelo-Solis said, tearing up. "I want our community to be vaccinated when the opportunity does come and we have a vaccine."
Dr. Robert Gillespie, who joined fellow Black physicians Afflalo and Hood to found the county's COVID-19 Equity Task Force, is also participating in a vaccine trial for similar reasons.
But Harris is skeptical about the county relying on people of color as COVID-19 vaccine advocates, and he insists that direct community outreach is the key.
"What they fail to realize is that you can put a Black doctor or a Latino doctor in communities of color, but that doesn't mean that those people will trust them to go take a vaccine," he said.
Harris has said he is willing to sue or protest against vaccine developers that refuse to provide a breakdown of the race and ethnicity of San Diegans enrolled in their trials.
"Our communities deserve to get this information," he said. "Our communities will get this information."
The Union-Tribune reached out to the county regarding Harris's data request.
"We don't manage clinical trials," said Dr. Wilma Wooten, the county's public health officer. "So that is not data that we would have."
The U-T recently obtained the racial and ethnic breakdown of San Diegans participating in Moderna's vaccine study by reaching out to local trial sites. The biotech company reported Monday that its vaccine is nearly 95 percent effective in preventing people from falling ill with COVID-19, based on early results from an ongoing study.
Of the nearly 1,200 San Diegans who enrolled in the study, about 59 percent are White; 26 percent Hispanic or Latino; 7 percent Asian; 3 percent Black; 3 percent multiracial; and 1.4 percent Native American or Pacific Islander.
By comparison, the county is 45 percent White; 33 percent Hispanic or Latino; 13 percent Asian; 5 percent Black; 3 percent multiracial and 1 percent Native American or Pacific Islander.
The U-T also reached out to Pfizer — which recently reported that its vaccine is 95 percent effective — but the pharma company did not provide local participant data.
The other two local trials, sponsored by Johnson & Johnson and AstraZeneca, have not finished enrolling participants.
Little, who directs UCSD's trials for Johnson & Johnson's and AstraZeneca's vaccines, says her team has met regularly with opinion leaders, small businesses and community organizations to explain how the trials are being run. That includes Afflalo and other members of the COVID-19 Equity Task Force, as well as the San Diego Black Nurses Association.
What has been missing, she acknowledges, are opportunities for the public to directly question researchers about the trials, though she says there are plans to make that happen.
That sort of open, clear communication between scientists and the communities impacted by their research is exactly what McKinney thinks would reassure his congregation. He's got a unique perspective on the issue; in addition to being a pastor, he's the CEO of a biotech company, Better Life Technologies.
"Companies that are developing vaccines need to reach out to these communities," he said. "Which is not being done right now at all to my knowledge, not at all. It's somebody coming down and touting that, 'Hey, we've got this (vaccine),' like I'm Moses from the mountain and all of you guys should just line up and take it.
"That's not going to happen."
Members of his church aren't necessarily against a vaccine, he says. They simply want to know that the process is being driven by evidence, not politics, that the contents of a vaccine have been vetted, and that a vaccine would help people of color just as much as anyone else.
That's exactly what Gooden wants to know, too.
"I want to be able to look at the research and data and make a decision on if my family would benefit from it," Gooden said. "I am all for vaccination, but I am not for receiving something I know nothing about."
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