By Loanne O’Neal, The Undefeated
With the Food and Drug Administration likely to authorize two emergency use coronavirus vaccines within weeks, and more drugs in the pipeline, public health officials say 20 million Americans could be vaccinated by the end of 2020, and tens of millions more by spring.
The two-dose vaccines represent a potential turning point in the fight against COVID-19. The pandemic, which has stricken more than 65 million people worldwide, has killed more than 275,000 Americans.
But even with new cases surging, significant numbers of Americans have said they won’t get vaccinated. This is especially true for Black people, who have been disproportionately devastated by COVID-19.
A recent survey on race and health by The Undefeated and Kaiser Family Foundation found that while 34% of Americans overall say they are unlikely to take a vaccine, even if it is found to be safe, effective, readily available and free, half of Black people have no plans to take it.
It’s a horror show scenario that a coalition of Black health care groups is fervently trying to prevent.
Early on, these Black health professionals recognized “that we could not afford for our community to be left behind and left out of the political conversation that would uncover any additional risks associated with the vaccine,” said Morehouse School of Medicine president Valerie Montgomery Rice.
She was among the members of the Black Coalition Against COVID, which issued a Love Letter to Black America last month detailing their commitment to “helping create a vaccine that works for Black people.” Besides Morehouse, the coalition includes Meharry Medical College, Howard University, Charles R. Drew University of Medicine and Science, the National Medical Association, the National Black Nurses Association, BlackDoctor.org and the National Urban League. They’ve hosted a series of “Making it Plain” social media conversations and will be hosting one Dec. 8 with National Institute for Allergy and Infections Diseases Director Anthony Fauci at Facebook.com/BlackDoctor.org.
Rice spoke with The Undefeated about the coronavirus vaccine process and the life-and-death stakes.
This interview has been edited for length and clarity.
First of all, what is a vaccine and how does it work?
When you’re thinking about a vaccine, you’re thinking about something that is going to prevent you from getting the disease. The disease comes about because you have been infected with the virus, and the viral load has to get to a certain amount where you actually show the disease, meaning that you become symptomatic. Sometimes we may be exposed to a virus, our bodies produce antibodies and you don’t get the disease, meaning you don’t get symptomatic. But that doesn’t mean you weren’t exposed.
What a vaccine will do is cause you to produce an antibody response that shuts down the virus and you don’t get the disease.
Why are researchers so optimistic that the coronavirus vaccines will work?
When we’re talking about this first phase of the vaccine, we’re asking the question: Does it produce an immune response that will prevent you from getting the disease? The second part of that is: Does it cause enough of a response that even if you get the virus that you don’t get sick with symptoms of the disease and that you’re not infectious? Meaning that you can’t expose someone else to the point that they will actually get the virus, or get the disease.
If you get exposed to the virus that causes the COVID-19, it gets into your cells and multiplies. When it multiplies, that causes the infection and the infection is what causes the illness. You can produce an antibody against it, and it can shut down the virus from multiplying. You still got exposed, but you didn’t get the infection enough to cause an illness. The vaccines are showing about 90% effectiveness in causing your body to produce enough of an antibody that shuts it down so that you don’t get the disease, so you’re not getting ill.
That’s the first important part. The second part of it is, we want to know when my body is exposed to the virus and I have the vaccine, not only does it shut it down so that I don’t get ill, but that it doesn’t allow enough of the virus to replicate so that I can get someone else infected.
For a lot of people, this vaccine process has moved way too fast. Even the name of the public/private initiative to develop and distribute the vaccine, “Operation Warp Speed,” makes people feel like corners were cut and the drug might be dangerous. How should people think about that accelerated timeline when deciding whether to take a COVID-19 vaccine?
First of all, I think it’s so important that people recognize that ‘warp speed’ doesn’t mean that scientists skipped steps. They just did the steps concurrently. It usually takes a pretty long time for a vaccine – usually 10 to 15 years – to be developed. The first part starts with basic research. We were actually able to find the virus pretty quickly.
This was not the first time we’ve seen coronaviruses. Scientists were able to take that spiked protein, which is what allows the virus to enter into my cell, they were able to do the genetic sequence, and instead of that sequence being proprietary, meaning that somebody was trying to own it, China published it very broadly.
Then they said, ‘OK, if I put that sequence into a cell, does it produce antibodies? Does it cause replication of the virus in the cell? Then, do I see the spiked protein that I’m expecting, and I can get this immune response?’ Then they tested it in animals. Many of these things, with similar viruses, were already going on. They already had the models in place. So they were able very quickly to say, ‘OK, here’s the dose needed.’
The first dose is like a booster [to stimulate the immune response], and the second one acts as a confirmation to your body that OK, this is the right thing that we need to be doing. So they found they needed two shots within about 30 days. Normally all of this would be taking place in a sequential manner, but all of these were done concurrently. That’s what the warp speed was, but they did not skip any of those steps.
How can you be so sure researchers were being truthful?
First of all, the federal COVID-19 Prevention Network set up several panels, including a panel of Black scientists, which I’m on. They set up a panel of Latinx scientists, they set up a panel of physicians and scientists who take care of geriatric patients, they had one that takes care of patients in the VA system. They set them up individually and gave us access to the data from the clinical trials.
“My biggest fear is that our community will not participate in this process to change our outcomes.” — Morehouse School of Medicine president Valerie Montgomery Rice
We looked at the initial stuff that happened in the preclinical, in the animal studies, we got to look at the data from phase 1 and phase 2 that looked at dosing and safety, and then we got to look at the phase 3 trials as they were being launched. Not all of us were data scientists, like myself, or clinical scientists. There were people who were social scientists, so they were looking at it from one lens. They had people who were population health researchers, so they were looking at more of the social determinants about whether or not someone would consider taking the vaccine. They wanted to make sure that there were people who were not tied to the pharma companies or tied to the clinical trials.
They had us look at the consent forms. Are they written in a way that’s culturally sensitive and linguistically appropriate? We got to comment on all this, and we’re still doing it. There are still trials going on. And these meetings have been occurring every week since March.
With the long history of medical racism in the United States, the politicization of the response to the pandemic and the huge numbers of Blacks dead, Black communities’ distrust of health care systems and institutions feels insurmountable. What are you trying to accomplish with the Black Coalition Against COVID and its Love Letter to Black America?
First of all, we acknowledge the concern and the fear that our community has. And the Black Coalition Against COVID decided we wanted to have a national dialogue, and that national dialogue started about five town halls ago. We invited the head of the National Heart, Lung, and Blood Institute at the National Institutes of Health, we invited a leader in the vaccine trial assessment, and we invited doctors and community people who were actually participating in vaccine trials. We had about 30,000 people each time, and we would try to give short presentations that would address some of the most common questions. Never did we underestimate or try to dismiss people’s fears and the historical context those fears draw on.
The next thing we did with the HBCU [historically Black college and university] medical schools, we put forth a letter with the fundamental principles that were inherent to each of us individually and collectively that we were pledging to as we were all becoming sites for the vaccine studies. And we had clinical trials going on looking at patients who were COVID-19 positive who had sickle cell trait, or we’re trying to understand the impact of COVID-19 on kidney disease. We’re going to be following patients who have a history of cardiovascular disease. We talked about the principles of protecting the members of our community, listening to our community and ensuring that the information they got was culturally and linguistically appropriate.
We were confirming that any trial, whether a vaccine trial or clinical trial looking at therapeutics, that there was an agreement to participate and that it was voluntary. That there must be informed consent and that we will uphold, no matter what, to do no harm. Lastly, we wanted to make sure there was an equity lens to all of this and that we needed to ensure that people understood that the reasons we were being disproportionately impacted by COVID-19 was because of systemic racism and practices that have ensued for years and resulted in health disparities. From all of that evolved this Love Letter to Black America that we felt that we needed to write so that, again, our communities know that we see them, we hear them, we’re advocating for them and that we love them.
With so much distrust, how do you turn the tide, especially in such a short period of time?
I’m a straight talker and this is what I say to my people: ‘Look, a vaccine is going to be available probably by the middle of December and there’s going to be prioritization about who gets this first.’ For me, there’s no doubt in my mind that those who should get it first are health care personnel because they’re on the front lines. But right behind them, and concurrently, is essential workers, I’m calling non-health care workers. Those persons who are on the front line who have kept the functioning of America going – our teachers, our transportation people, our food and agriculture people, our police people, our firefighters, our people dealing with water and our waste, our manufacturing people. Then we have to be driven by data and science, and we know that the people who are next in line, who have the worst outcomes, are people who have two or more chronic diseases and they need to be next. Then we also have to include adults who are 65 and older. The allocation must be driven by science, that’s the first thing, and secondly, we don’t want to be left behind. If they do the allocation like it is outlined, then people of color will be highly represented.
How do you get the word out?
We’ve got to meet people where they are, and right now they’re in their home, mostly. There’s going to have to be TV, radio, how people are connecting in their church. Some people are only getting mail, spraying it down, but then eventually they open it. Then we say, ‘If I’ve got my 70-year-old who is afraid to come out, how do I do the truck for them to come get the vaccine, or do I get my mobile research van and take the vaccine to their home?’ It’s got to be a combination of things. A lot of our elderly are in long-term care and nursing facilities, so clearly we need to take the vaccines to those persons. Most people trust their doctors more than anything, so I believe the primary care doctor network should be a place where we clearly see an opportunity for people to get their vaccinations when they are going to the doctor.
What needs to happen in terms of health literacy and helping people understand the coronavirus vaccine?
I would urge us to make it simple. Morehouse School of Medicine got a $40 million federal grant and we’ve been developing linguistically and culturally appropriate materials to help people to get access to testing and educational material about COVID-19. So we’ve been working on people understanding the virus, understanding the disease – you see I talk about those separately – and then understanding testing, mask-wearing, hand-washing and distancing. Now we’re moving into developing materials for the vaccine.
What are your hopes and fears?
My biggest fear is that our community will not participate in this process to change our outcomes. I would not recommend this vaccine if I did not believe that it was safe.
My hope is that our community will believe that they have trusted messengers, trusted advocates, trusted entities at the table looking out for them. That they will express their concerns, but listen to the science and make the right decision to participate in us mitigating this virus.
Then I have one other hope: that we will learn that systemic racism and discrimination leads to health disparities and that we need ethical processes in this country that give everyone the opportunity to reach their optimal level of health. COVID-19 has shown us that the health disparities that have ensued were secondary to systemic challenges and discrimination for years that led to disproportionate amounts of chronic diseases in Black and brown people. That increased our vulnerability to this virus because we could not do the simple things to mitigate our risk – like watch our distance because we were essential workers, because of how we lived in density, therefore people got exposed more than they would have if they had been able to quarantine when they were COVID positive, or work from home. We could not do that the way other groups could. I need the light to stay shined on social determinants of health and how they influence people’s lives in multiple ways.