Nicole Cardoza Nicole Cardoza Nicole Cardoza Nicole Cardoza

Understand representation in vaccine trials.

Happy Sunday!

Today marks our weekly review of the racial disparities of COVID-19. It's important to remember that this virus doesn't discriminate. But our systems do. And we're trying to respond swiftly to its catastrophic impact while reckoning with our deep history of oppression and harm. Today's topic – the fight for representation in vaccine trials – is a good example of this. As you read, consider how much our mistakes from the past affect our ability to respond equitably in the present – and its implications for the future.

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Nicole

TAKE ACTION

  • Support the Black Doctors COVID19 Consortium, which is building trust in their community by offering free COVID-19 testing in Philadelphia, New Jersey and New York

  • Respect the racial and historical context that may make people wary of a vaccine

  • Consider: how may your racial identity influence your perception of vaccine trials? What privilege(s) may have helped you build trust in the healthcare system?

GET EDUCATED

The U.S. is moving at an unprecedented pace to create a vaccine to respond to COVID-19. The Trump administration has dubbed these efforts “Operation Warp Speed,” with the hopes to deliver “initial doses of a safe and effective vaccine” by January 2021 — shortening the development time from years to months (NPR). More recently, Trump has hinted that a vaccine may be ready by the election (what a coincidence), which is highly unlikely. And part of that is because of a lack of representation in testing groups.

350,000 people have registered online for a coronavirus clinical trial, but only 10% are Black or Latino, according to Dr. Jim Kublin, executive director of operations for the Covid-19 Prevention Network (CNN). An additional 8% represent Indigenous communities. This isn’t nearly enough, considering over half the COVID-19 in the U.S. have been in the Black and Latino communities (CNN). And beyond that, 1.3% of reported cases are from Indigenous groups, despite only representing .7% of the population (CDC). 
 

In fact, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, expressed his desire to see non-white communities enrolled in coronavirus vaccine trials at levels at least double their percentages in the population, which would mean 66.4% of participants need to identify as "Black or African American, Latin, American Indian, and Alaskan Native” (CNN). Scientists, doctors, and advocates are urging both pharmaceutical companies and the government to increase their efforts to enroll a diverse group of volunteers.

As we discussed in last week’s newsletter, communities of color have a deep distrust of the U.S. health care system, and for good reason. 

📰 Read more about the history of medical violence against communities of color >

Also, the U.S. (and other parts of the world) have a long history of using people of color as trial subjects for vaccines. Thomas Jefferson tested what would become a successful smallpox vaccine on enslaved people before extending it to his family (Smithsonian). A British doctor serving as a plantation physician in rural Jamaica subjected enslaved people to trial tests without consent (Futurist).

As a result, people of color are historically underrepresented in clinical trials of new drugs, even when the treatment is aimed at an ailment that disproportionately affects them (ProPublica). Data from the FDA shows that Black people are the least likely to participate in drug trials – and that participation by people of color decreased between 2018 and 2019 (Outsourcing-Pharma).

“The absence of significant participation by Black patients creates not only a hole in the data, but can contribute to less effective treatments with little data on the impact on that specific population.”

Dr. Valerie Montgomery Rice, president and dean of the Morehouse School of Medicine, via Governing

One outreach effort includes reaching out to historically Black colleges and universities, encouraging students to participate in the trials, and engage medical staff and students in the process. Advocates believe this can grow trust in the community and encourage more Black people to join (NYTimes). Here’s an example of a letter from Xavier University. But this initiative, paired with efforts to increase testing across campuses, is garnering mixed feedback (Twitter).

📰 Read why it’s essential to have more representation of people of color in research >

Also, the  COVID-19 Prevention Network, a group created by the National Institute of Allergy and Infectious Diseases, created an advertising campaign urging Black and Latino people to get involved. The ads center the voices of essential workers, grandparents, food industry workers, and other groups within communities of color that have been disproportionately impacted by COVID-19 (NBC News).

📰 Read more about the impact of COVID-19 on essential workers, the elderly, and workers in the food industry.

And leaders from the communities are doing their part to build trust. A group of faith-based leaders has joined together to enhance trust and engagement with people of color (Newswise).  And the Navajo Nation has announced its participation in a Pfizer-BioNTech COVID-19 vaccine trial on a patient-volunteer basis (Indian Country Today).

“I would encourage people, but I know everybody won’t. It’s like ingrained in the mindset of Black people when you consider the syphilis injections. Black folks don’t want to be guinea pigs and we have been. Even in light of that, if the data is transparent, if the information makes sense, if the research is credible, then I think we can overcome that particular fear.”

Rev. Kenneth L. Samuel, senior pastor of Victory for the World Church in Stone Mountain, via Governing

Regardless of the accelerated timeline for finding a vaccine, there’s “no shortcut” to authentically engaging communities of color for trials, emphasizes Dr. Dominic Mack of Morehouse School of Medicine in Atlanta (NPR). It will take a long time to repair a history of discrimination and harm, but that work has to start now.

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