ST. PETERSBURG, Fla. — The Rev. Stephan Brown had been considering volunteering for a coronavirus vaccine trial when his doctor suggested it.
Brown is African American and has diabetes, a disease that puts him at high risk for serious illness if he becomes infected with COVID-19.
“I try my best to take care of myself and I want to be part of the cure,’’ said the Catholic priest, who shared his decision to volunteer for an AstraZeneca vaccine trial with his parish in a predominantly Black St. Petersburg neighborhood. “I didn’t want to sit around waiting.”
The coronavirus has disproportionately affected the nation’s Black residents, at least in part because of a high rate of underlying health conditions such as diabetes, heart disease and hypertension.
The COVID Racial Data Tracker, a collaboration of the COVID Tracking Project and Boston University Center for Antiracist Research, indicates that Black Americans are dying at 2.4 times the rate of white Americans. As of Sept. 17, at least 38,438 Black residents have died from the virus, accounting for 21% of coronavirus deaths where race is known.
In a recent column in The New York Times, presidents of the nation’s four historically Black medical schools urged pharmaceutical companies to increase recruitment of Black participants in their vaccine trials. They noted that in “clinical trials overall, African American participation hovers around an abysmal 5%, despite being 13% of the U.S. population.”
Such participation is critical in the quest to develop a coronavirus vaccine, said Dr. M. Monica Sweeney, professor emeritus in the School of Public Health at the State University of New York Downstate Medical Center.
“The importance rests with being able to say, once it is about to be released, first of all, is that they reached out to include everyone,” Sweeney said. “It would be important to be able to say we included people with diabetes, hypertension, obesity, that we included people with comorbidities, so that if we want to give it to people with comorbidities, we have included them in the trials.”
Dr. Rajbir Singh is director of the Clinical and Translational Research Center at Meharry Medical College, where a phase 3 Novavax trial for a coronavirus vaccine is expected to begin in October. “Diversity is important in clinical trials so that the work that we are trying to see is uniformly safe and effective,” he said. “When some population is not there, then you can’t make that statement.”
But attempts to enroll Black participants in the clinical trials will have to overcome a history of mistrust of the medical community among Black residents. A Pew Research Center survey conducted in the spring found that “Black adults are more hesitant to trust medical scientists, embrace the use of experimental medical treatments and sign up for a potential vaccine to combat the illness.”
The survey also reported that just 54% of Black adults said they would “definitely or probably” get a coronavirus vaccine. Yet 74% of Hispanic and white adults said that they would get the vaccine.
In Nashville at Meharry Medical College, one of the historically Black medical schools, president Dr. James E. K. Hildreth has decided to set an example by signing up for the Novavax study.
“I am going to be trying to convince people in minority communities that they should participate in a vaccine trial. I’m doing it to make the strongest statement possible, that I’m confident of the safety of the vaccines and I’m going to be in one of the studies myself,” Hildreth said.
“I’d much rather be involved directly in the science, but I actually think that my role as a trusted messenger, someone with deep knowledge of all this, might be more important. I’ve decided to focus on trying to explain the science, make people feel that science is accessible, and I believe that will make a huge difference in whether or not people accept the vaccines and are willing to participate.”
Meharry is advertising on television and radio and seeking feedback from community advisory groups. It is posting flyers at Target and Walmart stores, and it is turning to Black churches to boost its recruitment efforts for the study, which hopes to enroll at least 300 people.
“Community leaders like the pastors can play a big role and the leaders of the health departments, the leadership, like the political leaders. … These are the people who have good followers,” said Singh, one of two doctors leading the clinical trial at Meharry. “Educating the community is the most important part.”
The Rev. Eric Williams of Calvary Temple Baptist Church in Kansas City, Missouri, agrees, pointing to the experience of the congregation’s Calvary Community Outreach Network with HIV patients. Over the years, he said, the network was able to build trusted partnerships with universities and researchers.
“Those relationships have developed over time. … If I don’t trust you, I’m not going to allow you to poke and prod me,” Williams said, adding that he would advise those trying to recruit Black participants to turn to “the power of the pulpit.”
“Each pharmaceutical company needs to create those types of linkages with the people in the community,” he said.
Williams cautions, though, that the apparent speed in which potential vaccines are being developed may further erode Black trust. “You question whether they are being safely produced, and most of the folks I know aren’t willing to be guinea pigs,” the pastor said.
It’s an attitude firmly rooted in memories of the notorious Tuskegee syphilis trials that began in 1932. Hundreds of poor Black men in Alabama unknowingly were left untreated while under observation by the medical community. The trials were eventually halted in 1972. An apology did not come for a quarter century. “The United States government did something that was wrong — deeply, profoundly, morally wrong,” President Bill Clinton said in 1997.
Perhaps less well known was the unethical treatment of Henrietta Lacks, the young African American wife and mother whose cancerous cells were taken from her without her consent in 1951 and used for scientific research that continues today. Those cells have led to many medical breakthroughs, including the development of the polio vaccine.
Some Black leaders say Black citizens still are not treated the same as white citizens by the medical community, leading many Black citzens to be skeptical about treatment and reluctant to visit doctors.
“The engagement of African Americans with the health care community has been challenging in terms of being treated with dignity and feeling comfortable that you are getting the best medicine can offer,” Hildreth said. “There are really well done and rigorously done studies showing that there is implicit bias when you have African Americans interfacing with the health care system.”
Hildreth, a Harvard graduate and a Rhodes Scholar, added that African Americans seldom see research scientists and physicians that look like them, which contributes to “the unwillingness, especially in older generations of African Americans, to participate in clinical studies.”
That’s a “huge challenge” he said, “because those are the very ones who need the vaccine the most.”
At Meharry, Singh, who is responsible for patient safety and protocols established for clinical trials, said a central point is to ensure that participants are not harmed. Enrollees will be properly informed about the study and their rights explained, he said. They can opt out at any time. Participants will receive two dosages of vaccine or two dosages of placebo within a 21-day period and be monitored for side effects. The monitoring will continue for one to two years.
Sweeney, an author of the report, “America’s Inadequate Public Health Response to the COVID-19 Pandemic,” has advice on how the medical community should approach African Americans and other minorities about clinical trials.
“I would tell them to be upfront on all issues, that they can be honest about and the possible risks … let them know that this is very new, that the scientific community, the public health community, know very little about it,” said Sweeney, drawing on her experience as a former assistant commissioner for the Bureau of HIV/AIDS Prevention and Control in the New York City Department of Health and Mental Hygiene.
Brown, 56, the St. Petersburg Catholic priest, has two doctors in his family — his father is retired and his sister still practices. He has no trepidation about proceeding with the AstraZeneca trial, though it was temporarily halted because of a health concern in the United Kingdom.
“We shouldn’t live in fear, but rather be a part of a new direction toward healing. I trust what they’re doing,” Brown said. “I understand the abuse and the pain of the past and I don’t believe that what we are looking at right now with this pandemic and the trials is in some way seeking to use us as guinea pigs. I recognize the validity of science. As a person of faith, I believe that religion and science work together.”
Waveney Ann Moore recently retired as a staff writer for the Tampa Bay Times, where she reported on St. Petersburg neighborhoods and on religion for decades. Poynter researcher Caryn Baird contributed to this report. This is part of a series funded by a grant from the Rita Allen Foundation to report and present stories about the disproportionate impact of the virus on people of color, Americans living in poverty and other vulnerable groups.