COVID-19 in Vulnerable Communities: Past Public Health Failures Threaten Successful Rollout of Vaccine Candidates

by Arsene Frederic Jr.

This spring, governors and local officials across the U.S issued executive orders to halt public gatherings and close non-essential businesses to reduce the spread of COVID-19. In a swift response, the Trump Administration convened Operation Warp Speed to facilitate and accelerate the development, manufacturing and distribution of COVID-19 vaccines, therapeutics and diagnostics.

Operation Warp Speed brings together various U.S federal agencies, government departments and private companies to develop therapeutics and treatments for the novel coronavirus. Rather than eliminating research steps from the traditional vaccine development timeline, steps have proceeded simultaneously, such as starting the industrial manufacturing of trial vaccines well before the demonstration of their efficacy and safety.

The viral outbreak of COVID-19 poses a challenge because 20% to 40% of the people show no symptoms, which can influence the perception of the severity of the virus. Healthcare infrastructure in the U.S. is a contested topic primarily due to its rising costs, and a prospective COVID-19 vaccine prompts more public hesitation.

Moderna, one of the companies furthest along in the U.S. race for a vaccine, received more than $1 billion in government funding to develop and produce its candidate and another $1.5 billion to supply it to the American public. However, the lack of Black, Latino and Native American trial participants—necessary to determine how well the vaccine works in these populations—slowed enrollment of its late-stage trial.

This concern motivated Walter M. Kimbrough of Dillard University and C. Reynold Verret of Xavier University of Louisiana to participate in a vaccine trial for COVID-19 and encourage students to do the same. “It is of the utmost importance that a significant number of Black and brown subjects participate so that the effectiveness of these vaccines be understood across the many diverse populations that comprise these United States,” the HBCU Presidents wrote in their letter to students.

However, the historical relationship between minority communities and the medical community is notorious for skepticism. Uneven healthcare infrastructure worsens the COVID-19 pandemic among vulnerable minority communities, and structural improvements are needed to address this concern. Further, the past decisions of government officials complicate the procurement of a COVID-19 vaccine and its dissemination across the American populace. 

For example, the chronic underfunding of the Indian Health Service posed obstacles to American Indians and their experiences with COVID. But through the C.A.R.E.S Act, the Indian Health Service received more than $1 billion in additional resources to prevent, prepare for and respond to the coronavirus pandemic. Restoring trust requires a committed public investment in healthcare for our most vulnerable communities.

Or this example: Following the passage of the Affordable Care Act, many American-born Latinos hesitated to sign up for coverage out of concern that Immigration and Customs Enforcement would access their medical history and use it to deport their undocumented parents. 

Henrietta Lacks, an African American woman, was the unwitting source of cells from a tumor biopsied during treatment for cervical cancer at Johns Hopkins Hospital in Baltimore, Maryland, U.S., in 1951. George Otto Gey then cultured these cells to create the HeLa cell line, which is still used for medical research. As was then the practice, no consent was obtained to culture her cells. Inconsistent with modern ethical standards, neither Gey nor Johns Hopkins University compensated Lacks or her family for the cell’s extraction or use. Restoring trust with Black communities means honest communication of past mistakes to ensure participants know their consent is required in government-funded research projects.

The Tuskegee experiment is often cited as a classic example of government officials committing ethical violations against minority communities, specifically Black communities. This clinical study observed the natural progression of untreated syphilis in African American men between 1932 and 1972. Doctors never treated the infected men with penicillin, which by 1947 had become the standard treatment for syphilis. The study continued without ever informing the infected men that they would never be treated. Surely, a vaccine would address the current coronavirus outbreak, but prioritizing efforts to restore trust between Black and minority communities is key to tackling persisting distrust.

Today, the face of the nation looks very different than it did 50 years ago. With the substantial increase in the nation’s minority population, perhaps the most salient change is that referring to people of color as “minorities” is no longer accurate. More importantly, race does matter, powerfully, for shaping citizen’s views of government officials, leading citizens to view these officials as unlikely to act in a fair, racially unbiased manner when making spending and hiring decisions. If researchers and government officials fully acknowledge how demographic shifts affect decision making and public health infrastructure, it could improve health outcomes for people of color moving forward.

The introduction of a COVID-19 vaccine would help our society adapt to the changes in our external environment, but it does not mean things would return to how they were before COVID-19. “It’s important for researchers to tap ‘trusted messengers’ in minority communities who can explain the importance of minority participation in clinical trials,” says Joseph Betancourt, a Puerto Rican who serves as vice president and chief equity and inclusion officer at Massachusetts General Hospital in Boston. “These messengers could include local politicians and activists, leaders in the faith community, community-based organizations, or minority physicians and health-care providers.” 

Without proactive government action to build trust, relationships and health infrastructure at the community level, our nation’s most vulnerable communities will disproportionately suffer from the impacts of the COVID-19 pandemic and future public-health crises. 

Featured Image Credit: unsplash.com/photos/L8tWZT4CcVQ

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