Nature: Community power can boost vaccine uptake

In our correspondence article in Nature, we argued how medicine and technology must reckon with historical racism or else we run the risk of the vaccine worsening the COVID-19 pandemic disparity. We provide our expanded arguments here.

By Renee C. Wurth and Herman Saksono

With death counts from COVID-19 mounting ever higher, all eyes are on the recently-approved vaccines to save us. But these vaccines may not help everyone equally. Vaccine hesitancy among Communities of Color — a result of histories of racism and marginalization — can widen health disparities during the COVID-19 pandemic.

At first glance, the vaccine appears it will be equally beneficial. The two frontrunner vaccines have tried to make clinical trials more demographically representative, and the government has even proposed priority access of that vaccine for racial and ethnic groups at higher risk. Yet, as recent polls reveal, demographically representative trials and proposed access do not make up for the deep history of racism that eroded the trust of Black Americans.

Simply put, equitable clinical trials and distribution policy alone cannot fix the fractured relationship between the world of science with Black Americans.

With the long history and continued codification of anti-Black racism in medicine, the vaccine feels riskier than the disease. In reference to the infamous Tuskegee study, one survey respondent stated, “the federal government has injected a vaccine to black people in the past which turned out to be a death warrant for black men.”

To prevent the pandemic disparity from widening more, there needs to be a direct acknowledgment of historical racism that has harmed and seeded mistrust for Black Americans.

By acknowledging the history of racism in medicine, we can advance to the next steps of promoting vaccination. Health organizations, which have historically sided with the status quo, must start to share more decision-making power in the work of health promotion. This includes giving Communities of Color more control in health promotion — recognizing that they hold the knowledge of effective health messaging.

Giving communities more decision-making power in health promotion has many upsides when compared to the failures of previous national health campaigns. More community control allows for culturally appropriate messaging that can be promoted by familiar faces. When people in the community, especially local healthcare providers, create new social norms by advocating and educating about vaccines, acceptance goes up.

At the heart of communities is a sense of shared identities built upon shared histories of social interactions. Stories and art often take center stage, embodying emotions and liveliness to convey important messages in ways that statistics cannot. Storytelling can provide a trusted source of information — as shown in a study where Black American breast cancer survivors effectively used their stories to encourage other women to get screened. This is true for other health interventions, from promoting smoking cessation to managing hypertension and diabetes.

The sharing of these stories and expressions is best done in person, whether that be at the community health center, church, or local events. So how can we tether vaccine success to something that relies on a pandemic impossibility? Technology companies can play a role in remedying racism in health. Yes, technology by itself may not be a solution to the inequities of the pandemic, but communities have already found creative educational tools that are “virtual-friendly”.

Communities are experts at innovative messaging. The community of Black nurses and doctors curated a YouTube video message called Love Letter to Black America, through which they educate on vaccination while directly addressing concerns caused by shared injustices. The health promotional mediums of creative writing, drawing, and painting are already commonly used by Communities of Color and can easily be shared digitally. Whether it be American Indian youth making comic books about the risk of smoking, or Latinx teens designing fotonovelas to educate about vaccination, art has proven a valuable tool for promoting health within communities.

Community designed interventions not only create health promotional materials, but they also strengthen their social fabric in the process. Thus, to play a role in mitigating health disparities, technology companies and health organizations must collaborate as equals with Communities of Color, which involves sharing the decision-making power in health promotion. Technology companies cannot merely bear the gift of interventions without investing in the communities. Rather than creating technology for communities, allowing communities to take the lead in co-creating novel technological innovations ensures health technologies do not widen health inequalities.

The vaccine’s effectiveness will not be determined solely in the lab. New technology does not erase the harm caused by the racist employment of old technology. It will depend on our ability to address the past and give power to communities to support their future.

Renee C. Wurth, Ph.D., (@rwurth) is a population health scientist. She received her Ph.D. from Northeastern University and conducted her postdoctoral training at the T.H. Chan School of Public Health at Harvard University.

Herman Saksono, Ph.D. (@hermansaksono), is a digital health equity scientist. He is currently a postdoctoral fellow at Harvard University’s Center for Research in Computation and Society. He is a Fulbright alumnus and received his Computer Science Ph.D. from Northeastern University.