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How one city is building vaccine trust in Black and Latinx communities

Since vaccines don’t guarantee vaccination, one New Jersey city is on a quest to overcome residents’ longstanding distrust.

A Covid-19 testing facility in Camden, New Jersey, on December 9.
Jose F. Moreno/The Philadelphia Inquirer via AP
Fabiola Cineas covers race and policy as a reporter for Vox. Before that, she was an editor and writer at Philadelphia magazine, where she covered business, tech, and the local economy.

The need for widespread vaccination against Covid-19 is urgent — experts say about 60 percent of people need to be vaccinated to see the vaccine’s effect on the disease that has claimed the lives of more than 300,000 Americans. But the country must first surmount a considerable challenge: convincing many everyday Americans, not just skeptics, to get vaccinated.

This challenge will be doubly tough in Black and brown communities, where the coronavirus has disproportionately decimated families and where distrust of government and medical institutions remains high.

In November, Pew found that Black adults are “much less likely to say they would get a vaccine than other Americans.” Only 32 percent of Black adults say they would definitely or probably get a vaccine, compared with 52 percent of white respondents, 56 percent of Hispanic respondents, and about 72 percent of Asian respondents, according to Pew. Similarly, the Kaiser Family Foundation’s December vaccine monitor found that Black Americans are among the most hesitant when it comes to the vaccine — 35 percent say they definitely or probably would not get vaccinated — because they don’t trust vaccines in general or are worried they might get Covid-19 from it. The same report found that about half of Black adults are not confident that they were considered in the vaccine development process; over a third of Hispanic adults say the same about their needs being considered.

Distrust of government and institutions is rooted in a long history of state-sanctioned malpractice. One of the most infamous examples is the Tuskegee Study of Untreated Syphilis in the Negro Male, conducted by the US Public Health Service. From 1932 to 1972, researchers lied to around 600 Black men about their participation, telling them they were being monitored for “bad blood” when they were actually being studied to understand the impact of syphilis in the human body. The government also intentionally withheld penicillin (which was discovered as a reliable cure for syphilis during the course of the study) from the men who suffered and eventually died of the disease.

The distrust is also a response to a well-documented history of not being taken seriously by doctors and being undertreated for pain due to medical racism. It’s hard to repair trust that’s essentially never been earned — enslaved Africans who were brought to America endured centuries of medical exploitation.

Though the Kaiser monitor summarized Black and Hispanic attitudes as largely hesitant, it did find an inkling of hope: With each monthly accounting of attitudes, more members of each group say they will get the vaccine than say they will not, suggesting that vaccine hesitancy can be reduced with more information. Researchers are confident that communication and clarity about the efficacy and potential side effects of the vaccine can go a long way to change attitudes.

This outlook is already in effect on the ground in Camden, New Jersey, a city that is about 92 percent Black and brown and where one in every 14 residents has been infected with the coronavirus. There, the health department has launched an on-the-ground effort in which a team of ambassadors has been tasked with knocking on as many doors as possible to persuade residents to take the vaccine. According to Camden County health director Paschal Nwako, people’s attitudes about the vaccine have already changed since the team knocked on the first door in November.

“We’ve had individuals who open their door, then close it back on the first day. Then on the next day, they open the door and listen to us for a minute, then close it. Then the next day, they open their door and engage us for five minutes,” Nwako told Vox. “It’s not easy, but we stick with them because we know it’s the only way we can get the community the right information.”

Nwako talked to Vox about the challenges and opportunities ahead with getting Camden residents to take the vaccine. Our conversation has been edited for length and clarity.

Fabiola Cineas

Camden City has the highest infection rate in the Greater Philadelphia region, with 5,583 cases of coronavirus as of December 11. For comparison, Camden has nearly twice as many cases as the neighboring and largely white Cherry Hill neighborhood, though they have about the same number of residents. Why is this happening in Camden?

Paschal Nwako

In Camden, much of the population lives in multigenerational housing. There is also higher density housing in Camden. There are pockets of essential workers that could have been exposed to the virus in their front-line jobs, like people that work in restaurants and grocery stores. There are also undocumented populations who are worried about reaching out for public health information. So if there are people who live in close quarters, like families that live in one-bedroom or two-bedroom apartments, it’s easier for the virus to spread. In Cherry Hill, people are able to spread out. The positivity rate we are seeing comes from people congregating together because they are family-oriented. That’s why around the Thanksgiving holiday, we were telling the community to stay within their own bubbles.

And now, we are seeing more cases in people ages 30 to 42 on average; during the first wave, from March to June, it was people ages 65-plus. But while we are seeing more positive cases in younger people, these people aren’t ending up in the hospital or dying in the same way people died during the first wave.

Fabiola Cineas

The Pfizer vaccine is already in use at Camden’s Cooper University Hospital downtown. What does this mean for the city?

Paschal Nwako

The vaccine is being administered to health care workers at Cooper Hospital during the first phase. They are looking at vaccinating 8,800 employees and expect to take up to a month to do that. Right now, we are in phase 1a, which is health care workers and long-term care residents. From there, we go to phase 1b, which are other essential workers — police officers, firefighters, EMT and EMS workers, people who work in jails, as well as people who work in dental offices, pharmacies, restaurants, supermarkets, and warehouses doing food distribution. These people are essential because without their services like food and health care, we cannot provide what citizens need to survive.

Then we go to phase 1c, which are adults ages 65 and above and all adults with high-risk medical conditions. And then we go into phase 2, which is the general public and should happen sometime in March.

We know that there is vaccine hesitancy, especially among minorities. We have to work hard to make sure that we partner with Camden City residents to disseminate Covid vaccination information in the county, targeting minorities — Hispanics, African Americans, and also faith-based communities in Camden City.

Fabiola Cineas

Studies have shown that Black Americans are among the most hesitant on the vaccine primarily because they’re worried about side effects and also don’t trust the development process. Why is this the case, and have you noticed this kind of reasoning among Camden residents?

Paschal Nwako

Vaccine hesitancy is a barrier among minority populations because of the history in these communities of the testing of medications and vaccines on them in the past. That’s a problem. We are training ambassadors in the community to convince the rest of the community that the vaccine is safe to take.

But while we know there is hesitancy, we expect that to change now that the vaccine is here. People are going to see people like them taking the vaccine. So if we were to give that survey again, we expect the number of people willing to take the vaccine to increase.

And bear in mind that by the time we get this vaccine to the general public in Camden, the number of people that will have taken this vaccine will have increased tremendously. And without side effects between now and then, people will be more willing to take the vaccine. Just like every other product that is new on the market, there will be a hesitancy. People will eventually feel more comfortable to start using it.

Fabiola Cineas

The same Kaiser Family Foundation study revealed that there’s also a fear that there won’t be equitable distribution of the vaccine, that there might not be enough vaccines for certain communities. Is this a fear you’ve come across while on the ground? And what is the county doing to make sure this isn’t a reality?

Paschal Nwako

There’s no such fear here. Everyone will be going through New Jersey’s vaccine scheduling system. It is open to the public, all New Jersey residents, and doesn’t discriminate. Everyone has to sign on and just choose a site. We have ample vaccines that will be coming through from Moderna, and we expect to get more from Pfizer, and also AstraZeneca down the line in March, when they get their emergency use authorization from the FDA.

Fabiola Cineas

Can you say more about the role these vaccine ambassadors are playing in the community? Why did the health department choose to launch this initiative, and what’s the impact been so far?

Paschal Nwako

People are sometimes confused about what they read or hear on the television. So when somebody in their community calls them on the phone, or sends them a text that will end up with a phone call to discuss the vaccines with them, that is more effective.

Since there are high-density living spots in Camden City, if we go into a building and stay in the lobby, we are able to engage people when they come down and get on and off the elevators. We can talk to them briefly there. Then when we get up to the second floor, 10th floor, 12th floor to have more conversations standing 10 feet apart, people are more responsive having seen us in the lobby. That person will be more open to speaking with you than a person who has not seen you before.

That strategy has been working because we are engaging with them by giving them masks, telling them where to go to get tested for coronavirus, and how to social distance.

So far, we have knocked on 52,646 doors, made 57,802 phone calls, sent 37,858 text messages, and conducted 991 wellness check shifts throughout the city.

Fabiola Cineas

Wow! And you’ve also been conducting a vaccine study. What have you been asking residents, and what do you hope the survey can help your team do?

Paschal Nwako

We ask them if they have taken a vaccine before, how they feel about taking vaccines, whether they feel like vaccines can prevent diseases, the side effects they have had in the past when they took a vaccine, and how they feel about the Covid vaccine coming down the pike.

We plan to use the information from this survey for a health education campaign in the community to build trust for the vaccine. We already have health educational materials that we are floating around Camden City. We’re giving it out to the churches that usually send it out to their members or when they come in on Sundays. Information packets are located at the front of churches for people to collect, for example.

Moderna informed us that an African American woman was the lead in producing the Moderna vaccine. So that will help reduce the anxiety and fear in the community over the efficacy of the vaccine.

Fabiola Cineas

What do you think the rest of the country can learn from what your team is doing in Camden around vaccine hesitancy?

Paschal Nwako

We know that it’s better to deal with communities when you are right there with them. If we go door to door, it means that we are right in the community and it means that we are engaging with them right there on the street, in front of their homes. And then we stick with them.

What we are also seeing is that the community needs employment — this is the highest want and need. People don’t want the government to hand them over money. They don’t want them to hand them over food. We have provided them with food, sometimes four times a week with the food bank we provide. They know where to get food. We provide them with masks and all the information they need to get tests and to take the vaccine, and they say, now what? We need a place to go work. Camden was hit with high unemployment as a result of the pandemic. [In April, Camden’s unemployment rate jumped to 15.1 percent from under 5 percent in March 2020; the unemployment rate was 7.1 percent in October, the latest month for which data is available.]

Fabiola Cineas

As we close out a year that has been very tough for Camden residents, what brings you hope as we move into 2021 for administering the vaccine in Camden?

Paschal Nwako

The best hope is that we expect that the end is in sight. But we also know that a vaccine does not equate to vaccinations. Having vaccines but not vaccinating is no good. The good news is, though, that we expect the hesitancy to reduce by March. When the community sees that people are not developing any side effects or dying suddenly because of the vaccine, they will be open to taking it.

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