By Glenn Ellis
COVID-19 has turned the lives of every man, woman, and child on the planet upside down, and continues to sweep around the world with a vengeance. Here in the United States the virus particularly vicious, as we watch in horror as it become crystal clear it’s not going anywhere for the foreseeable future.
To date, the best understanding in the medical and scientific field is that transmission and spread of COVID-19 will not slow down until 50 to 70 percent of the population is infected. One prominent epidemiologist sums it up by saying, “We will be dealing with this forever.”
The U.S. declared a national emergency in mid-March, and here we are almost six months later; the death toll continues climbing and the human toll of the virus in America has just passed 160,000 lives lost, with all indications that we will most likely exceed 200,000 deaths by the end of this year.
I know, some of you are reading and saying, “Doesn’t this guy know that we are on the brink of a COVID vaccine?” Sure, we might have a vaccine soon, but many experts are already stating with confidence, “some communities are not ready to accept it.” Well, I belong to one of those communities, and let me tell why I believe they are right.
The majority of people with little, or no, experience nor insight to the lives of members of these communities, automatically default to the U.S. Public Health Syphilis Study at Tuskegee. Well, the issue is much deeper than that.
We make a huge mistake of resting all of our attention and focus on attributing the mistrust and suspicion on vaccines and Blacks on that one atrocity; there are a plethora of factors.
Perhaps (in the interest of time and space), these “factors” can best be summed up by an article in the Journal of Healthcare for the Underserved, “Several factors that affect the participation of African Americans in studies have been identified including elements of study design, logistical problems, low levels of health literacy, sociocultural factors, and specific attitudes that hinder research participation. Mistrust of academic and research institutions and investigators is the most significant attitudinal barrier to research participation reported by African Americans.”
All of the issues and conditions that have disadvantaged poor and communities of color in this country, are the very things resulting in the disproportionate burden that Black people all over this country are experiencing with COVID. Discrimination; healthcare access and utilization; occupation; education, income, and wealth gaps; and housing: All, according to the Centers for Disease Control and Prevention (CDC) are associated with more COVID-19 cases, hospitalizations, and deaths in areas where racial and ethnic minority groups live, learn, work, play, and worship. Researchers at the CDC found that 47 percent of U.S. adults have an underlying condition strongly tied to severe COVID-19 illness. By middle age, 50 percent of Blacks have hypertension, and 70 percent of retirement-age Blacks.
U.S. Food and Drug Administration data shows that Blacks, Latinos, Asians, and others are underrepresented in clinical research in the U.S. According to U.S. Census data, Black or African Americans represent 13.4 percent of the U.S. population, yet make up only 5 percent of clinical trial participants. The disparity is even greater for those of Hispanic or Latino origin. They represent only 1 percent of clinical trial participants.
If the FDA approves any drug or treatment, it will be prescribed for people of all different ages, genders, races, and ethnicities; so, it is essential that data reflects the effectiveness and potential side effects for all groups. So, if we are not included in the clinical trial, how in the world are we supposed to know that it’s safe and effective for us? How do we make an informed decision?
Lastly, I have to address the issue of rationing. Who will even be offered the opportunity to get the vaccine first? How will we give priority to different groups or communities whose case load and death rate indicate that they are most vulnerable and deserve to be vaccinated first? In an ideal world, the elderly, Black and Brown communities, and essential workers. The overwhelming majority of the “essential workers” in this country are members of Black and Brown communities. Going to work, therefore, could mean being exposed to a virus that disproportionately targets those “essential workers” with underlying health conditions.
The social and structural factors that make Black and Brown people, in this country, especially vulnerable are long-standing and historical. What makes it all so frustrating and tragic is that some of the things that could have fixed them were not done…ever!
Let’s do what’s necessary, and for once focus on health literacy, equitable distribution of healthcare; and full inclusion and retention in the clinical research for COVID-19 vaccines.
I’ll end with this. Health spending totaled $74.6 billion in 1970. By 2000, health expenditures had reached about $1.4 trillion, and in 2018 the amount spent on health had more than doubled to $3.6 trillion. Yet, only one in 10 adults in the United States are health literate. Only about half of Americans say they would get a COVID-19 vaccine; 40 percent of Blacks say they won’t, and 32 percent of Blacks say they are unsure. That represents 70 percent of all Black people. We deserve to be able to make informed decisions about our health care, just like everyone else.
Glenn Ellis, MPH is a Visiting Scholar at The National Bioethics Center at Tuskegee University and a Harvard Medical School Research Bioethics Fellow. He is author of Which Doctor? and Information is the Best Medicine. For more good health information visit: www.glennellis.com
