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Racial disparities create obstacles for Covid-19 vaccine rollout

“Without considering racial equity, we deepen the cracks that systemic racism has already created in our health care system," a health advocate said.
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LOS ANGELES — Despite the potential for a vaccine within weeks, distrust of the medical community by Black and Latino people, who have been disproportionately affected by Covid-19, remains high as elected leaders and public health professionals work to prioritize its distribution.

Fueled by a dark history of medical experimentation and unequal access to care, people in Black and Latino communities struggling with high Covid-19 rates are among those least likely to get vaccinated, health advocates say. Overcoming systemic racism and the collective trauma associated with it will be paramount as officials rush to distribute vaccines to hard-hit communities, they warn.

"The people who need it the most are the same who don't trust it," said Sernah Essien of Universities Allied for Essential Medicines, an international advocacy group working to ensure equitable vaccine access. "Without considering racial equity, we deepen the cracks that systemic racism has already created in our health care system."

The message is being heard at the highest levels.

A top adviser to President-elect Joe Biden said Tuesday in an interview with The Associated Press that addressing the racial disparities cannot be overlooked as the nation continues to battle the coronavirus, which has infected more than 14 million people in the U.S. and killed 276,388 as of Thursday, according to NBC News counts.

This report is part of NBC News’ in-depth coverage on the “Race for a Vaccine,” a network-wide, week-long series airing across all programs and platforms, including NBC Nightly News, TODAY, Dateline NBC, MSNBC, and NBC News NOW.

Dr. Marcella Nunez-Smith, an expert on health care inequality at Yale University, said testing and vaccine programs must consider fairness and equity along with safety to be truly effective.

“We cannot get this pandemic under control if we do not address head-on the issues of inequity in our country,” she said. “There is no other way.”

Several states say they intend to prioritize communities of color when a vaccine becomes available.

California Gov. Gavin Newsom said last month that Black and Latino residents who have been disproportionately affected should be among the first to be inoculated. New York Gov. Andrew Cuomo echoed those remarks while speaking in a Manhattan church on Nov. 15: "We know that our Black, brown and poorer communities have fewer health care institutions. Their communities too often have health care deserts."

According to the Centers for Disease Control and Prevention, race and ethnicity are risk markers for other underlying conditions that affect overall health outcomes, including access to medical care and exposure to the coronavirus at work.

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Rates of hospitalization and death from Covid-19 among Blacks, Latinos and Native Americans are two to four times higher than for whites, according to the CDC.

Black and Latino people also report higher levels of vaccine hesitancy and distrust compared to white Americans, according to a recent survey by the COVID Collaborative, a coalition of national experts on health, education and the economy.

Fewer than half of Black adults said they would definitely or probably get coronavirus vaccines if they were free. Just 18 percent said they would definitely get vaccinated regardless of the cost, according to the survey. Among adult Latinos, 66 percent said they would get free vaccines, and 31 percent said they would definitely get vaccinated.

The findings were more troubling when it came to the question of trust. Just 14 percent of Black adults and 34 percent of Latinos said they trust vaccine safety, and three-quarters of both Black and Latino respondents said they are less likely to get a vaccine approved for emergency use by the Food and Drug Administration, according to the COVID Collaborative.

The findings present an additional challenge to an already overburdened health care system, said Vickie Mays, director of the Center on Research, Education, Training and Strategic Communication on Minority Health Disparities at UCLA.

"Disparities beget disparities," she said. "It's not just a matter of pre-existing conditions. People who live in dense areas, where the sidewalks are very small, they don't have the luxury of keeping 6 feet distance."

Mays is one of several researchers at UCLA who created a predictive model identifying populations in Los Angeles most at risk of becoming infected with the coronavirus. The model, which can be applied to other cities, uses four indicators that can increase a person's vulnerability to the coronavirus: pre-existing medical conditions, barriers to health care, environmental characteristics and socioeconomic challenges.

The researchers found that people living in urban centers and in multigenerational households are more likely to become infected than people living in more affluent neighborhoods with large single-family homes and the ability to work remotely.

Mays, who was an early HIV/AIDS researcher, said many of the disparities experienced today in Black communities during the pandemic mirror what she witnessed in the 1980s.

When the AIDS epidemic peaked, messaging and outreach efforts were targeted to men who had sex with other men. Intravenous drug users were not an early focus, which meant an entire category of people who were susceptible to infection knew little about it.

"When you have an epidemic, you have layers of science," she said. "People of color came very late in the process, especially in California."

As a result, Black men in California continue to have the highest rates of new HIV infections, she said, adding that lessons learned during the AIDS crisis could have been used in the pandemic.

"Not only were there lessons that should have been learned, but if we had learned those lessons well, then we would be doing better today," she said.

Across California, which had reported more than 1.2 million confirmed coronavirus cases as of Thursday, communities of color have been ravaged by Covid-19.

Los Angeles County surpassed 400,000 confirmed cases this week, and infection rates remain highest in densely populated urban neighborhoods, public health officials said. Some of the lowest rates of infection appear to be in wealthy coastal cities, like Malibu, that are segregated from the rest of the county by geography and socioeconomic status.

"It's not an accident that Black and brown people have been disproportionately affected by the pandemic," said Priti Krishtel, a co-founder of the Initiative for Medicines, Access & Knowledge, an international nonprofit that campaigns to make pharmaceuticals accessible and affordable. "Structural racism is embedded in our health care system."

One of the most egregious examples was a 1932 study of syphilis in Black men. Called the Tuskegee Study of Untreated Syphilis in the Negro Male, it was undertaken by the U.S. Public Health Service with the stated aim of learning more about the disease and eventually justifying a treatment program for Black men.

Decades later, in 1972, a news report found that men who participated in the study had been misled about its purpose and were denied treatment, which caused needless pain and suffering. Even when penicillin became widely used to treat syphilis in 1947, it was not offered to the test subjects.

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An advisory panel later concluded that the Tuskegee Study was "ethically unjustified," and a $10 million settlement was reached in 1974. President Bill Clinton formally apologized to the subjects and their families in 1997.

The damage inflicted by the Tuskegee Study and ongoing health care disparities, including lack of access to affordable medical care and to expensive pharmaceutical drugs, continues today as Blacks and Latinos remain leery of potential vaccines, advocates say.

People living in the U.S. without proper authorization have the added fear of being reported to authorities and deported. That mistrust has been amplified by the Trump administration's former family separation policy and ongoing anti-immigrant rhetoric, said Rita Carreón, vice president for health at UnidosUS, a national civil rights and Latino advocacy organization.

"These anti-family policies that have been in place kept our communities away from the health care system," she said.

In Long Beach, California, Mayor Robert Garcia, who lost his mother and his stepfather to Covid-19, in September launched a first-of-its kind mobile testing program, which sends health care workers into hard-to-reach communities. The mobile clinics offer free coronavirus tests provided by medical professionals who speak the language of the communities they are visiting.

The program can conduct about 300 tests a day, Garcia said, and he hopes to use the mobile model to help distribute a vaccine to the communities that need it most.

"This can't just be a government effort," he said, adding that the city will partner with community-based organizations to increase outreach and education efforts even before a vaccine becomes available.

"We have to make sure this is all through an equity lens," he said. "The last folks that should be vaccinated are NBA players and billionaires."

This report is part of NBC News' in-depth coverage on the "Race for a Vaccine," a network-wide, weeklong series airing across all programs and platforms, including "NBC Nightly News," "TODAY," "Dateline NBC," MSNBC, and NBC News NOW.