My annual routine of recommending the flu shot to my patients is now more critical than ever before. But when I asked one of my patients recently about getting the flu shot, she said:
“No, not really. I’m worried it will give me the flu and make me sick.”
I listened and shared some information about the flu vaccine’s benefits and how preventing hospitalizations due to the flu would help us fight surging rates of coronavirus. Later on, I asked her how she felt about the vaccine against coronavirus and whether she would take it.
“Absolutely not doc, I’m worried the government may poison me.”
I’ve had similar conversations with patients since then. At their core, these conversations underscore one important value that seems to be missing: trust.
As a society and a medical profession, we must continue building trust within our communities and our patients. Without trust, we face an uphill battle in defeating COVID-19.
In a recent poll by Pew Research Center, 49 percent of Americans said they would not take the vaccine if it were available. Vaccine hesitancy was named one of the top 10 global health threats by the World Health Organization in 2019. While the causes are likely multifactorial, they include the growing anti-vax movement and memories of history’s dark days, among others. In particular, African Americans have historically been subjected to medical experimentation without their consent since colonial times.
One of the most famous examples is described in the book The Immortal Life of Henrietta Lacks. Cells taken from a black woman with cervical cancer, without her knowledge, were used in medical breakthroughs. The woman herself, Henrietta Lacks, was never cured and ultimately died of cancer.
The irony is that despite these valid historical concerns about medical research practices, African Americans are at least 3 times more likely to die of coronavirus than white people, according to data analysis by the Brookings Institution. This makes Black people more likely to benefit from a scientifically-vetted vaccine to prevent coronavirus than other members of the population. And yet, without trust, we face an uphill battle.
As Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, recently said in a podcast, “We have this thing called operation warp speed, which is counterintuitive to building trust. You don’t build trust with people rapidly. It takes time.”
To me, building trust involves at least three key components.
First and foremost, we need to ensure that we have a safe, effective, and affordable vaccine against COVID-19. Despite Pfizer’s promising news about its vaccine based on interim analyses, we are awaiting full transparency of the data and a thorough review by the Food and Drug Administration. In particular, it would be helpful to know whether the vaccine was safe and effective in populations at higher risk for severe forms of COVID-19, including the elderly and those with specific medical comorbidities. Having this research and evidence will help build trust.
Second, we need to build community partnerships by communicating with local leaders and bringing together a coalition to disseminate trusted information about a future vaccine. A Parkland Hospital and UT Southwestern Healthcare Ambassador program engages teens from underserved populations to educate and build trust within their communities. Recently, the ambassadors coordinated a free drive-up flu shot clinic in Pleasant Grove, vaccinating hundreds of people. Engaging teen ambassadors now helps build a local connection and will lead to a more energized and trusting community when the vaccine against COVID-19 arrives.
Third, having a personalized, simple, and effective communication strategy could be the difference between high vaccine uptake and a lackluster acceptance. While the strategy should be tailored locally, there are some important messages to communicate. For example, many vaccines against COVID-19 may require more than one shot and waiting a certain amount of time between doses.
It may seem daunting to talk of building trust given the polarized political landscape and ongoing misinformation about the coronavirus. However, trust is a foundational pillar of health care, and it’s worth the investment for patients like mine.
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