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Matter Of Trust: How community leaders and health officials are building vaccine confidence in minority communities

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WATERLOO, Iowa (KWWL) -- More than 929,000 Iowans have received at least one dose of the COVID-19 vaccine, but there are stark inequalities in who is getting vaccinated.

According to the Iowa Department of Public Health, just under 81% of the Hawkeye state doses have been given to white people as of Wednesday afternoon. Just over 1% of doses have been administered to Black Iowans. Nearly 15% of doses are categorized as unknown race, something Iowa-Nebraska NAACP health chair Jacquie Easley McGhee said is a product of the racial disparity due to vaccine hesitancy in the Black community.

"The mistrust leads people to believe if I report my race. I am getting a different vaccine," Easley McGhee said. "We have heard from individuals, saying that, that they do not want to give their race, because there is fearfulness that they will receive something that is not equivalent to the general population."

In communities of color, there is long-standing distrust of federal officials and, in particular, the scientific community. Easley McGhee said the hesitancy stems from systemic racism and historical trauma endured by the African American community.

Roger Lusala, the CEO of an Iowa City disability-services agency and a member of the Iowa City Human Rights Commission, took part in the Pfizer vaccine trial at the University of Iowa Hospitals and Clinics.

It is a two-year study conducted by UI doctors to research the vaccine. Lusala cited Pfizer's decision not to accept funding from the federal government as a big reason he felt comfortable enough to take part in the trial.

"That was important for me because I knew the government would not guide their study, and they also will not be tainted," he said. "As a leader in the African American community, I wanted to be an example since people in the black community are very reluctant to take the vaccine. You can't blame them. There's a lot of history there."

According to Pfizer and Moderna, roughly 10% of participants in both trials were black.

In early fall, an NAACP commissioned survey found around 45% of African Americans were not planning to receive the vaccine when it was available to them.

According to a more recent study released Tuesday by the Kaiser Family Foundation, around 20% of the US population is hesitant to receive one of the three COVID-19 vaccines.

"Who can blame them"

For African Americans, there is a deep rooted history behind the mistrust.

"There have been historical inappropriate actions involving African Americans it's related to health care and health care systems," Easley McGhee said. "African Americans who were slaves, being used for inappropriate medical experimentation and studies."

In 1932, the U.S. Public Health Service conducted a study at the Tuskegee Institute of syphilis in Black men. The 600 participants in the study were told they would receive experimental treatments. In reality, none of the participants were given any treatment, and the disease was allowed to run its course. The study lasted for four decades until the Associated Press exposed it in 1972.

In 1951, John Hopkins Hospital doctors cultivated the cells of an African American patient, Henrietta Lacks, for research without her family's permission. Lacks was treated at the hospital for cervical cancer and passed away from the disease shortly after.

The so-called "Hela cells" have been used in a handful of groundbreaking treatments with everything from groundbreaking experiments to develop treatments for cancer and HIV. Scientists also used the cells to study COVID-19.

"It is so important to understand the impact of history and and and why people feel the way they feel," Black Hawk County Health Department Director Dr. Nafissa Cisse Egbuonye said. "They have the absolute right to be concerned. But what I would say to individuals is that these vaccines have been proven to be effective."

The COVID-19 pandemic has disproportionately impacted the African American community. Easley McGhee said they are more likely to have underlying conditions and work in the front line, essential jobs that put them at high-risk for contracting the virus.

At the beginning of the pandemic, the data on race and ethnicity of those who tested positive for the virus wasn't publicly available. Officials with the NAACP eventually convinced the state to release it.

Today, the numbers don't highlight the disparity as they did in late April.

According to the U.S. Census Bureau, African Americans are up 4% of Iowa’s population, but they were 8.7% of COVID-19 cases. Latinos and Hispanics are 6% of the state population but accounted for 16.4% of the confirmed cases.

Simultaneously, in late April, white Iowans accounted for 73% of cases, though they make up 90% of the state's population.

"The pandemic ultimately ripped off a band-aid, so to speak, of the festering wounds of equity in the healthcare system," Easley McGhee said.

"We have to trust the science behind it."

As a community leader, Lusala wanted to set an example for his kids, his co-workers and his family.

"I wanted to step up and do it because to show them that the vaccine was safe," he said. "I am looking for my community. I'm looking out for those that I serve that don't always have the voice. So, I want them to get the vaccine."

Cisse Egbuonye said community leaders like Lusala could play a big role in increasing confidence in the vaccine, serving as a trusted messenger.

"They inform us on some of the best strategies and most effective ways to communicate with their community, and if there are any concerns, they shared that with us," Dr. Cisse Egbuonye said.

In Black Hawk County, Cisse Egbuonye said health officials spend a good deal of time looking at the vaccination rate in proportion to the demographic populations.

"It is data that we share with our partners so that they are also intentional about reaching vulnerable populations and populations that historically have fallen through the cracks," she said.

In their research, the NAACP has found local faith leaders, health care workers, and those who have already received the vaccine are among the most trusted messengers.

Prominent community members, including U.S. Vice President Kamala Harris, who received her vaccine publicly, have also boosted confidence.

"You need more prominent or visible individuals, but then also you balance that with people that you know your minister, your coworker, your colleague, your educators at your children's school, or faith leaders," Easley McGhee said. "The more people that you know in here and share these testimonies about the side effects, then I think the more we will get people to erase some of the hesitancy."

In Iowa City, Lusala is a member of the vaccine equity committee. It is made up of leaders from different communities who are working to build trust in the vaccine.

There are representatives from domestic violence organizations, churches, the Sudanese and Congolese communities, and others.

"This is all of us coming together and getting the facts about the vaccine, and all of us and then pushing it to our network," Lusala said.

The group meets with Johnson County Public Health officials every other week.

They're giving us the information and when is the next group getting vaccinated, what are the pros and cons of the vaccine, and the facts about the vaccine so then, our job is to push it to all out to our community," Lusala said. "The faith leaders are supposed to push it to the churches. We are supposed to push it to the immigrant community, the black community."

They have created messages in different languages to reach different immigrant communities.

"We are not going to put something in our body that we don't trust," Lusala said. "We want the community to trust the vaccine so they can be protected against this monster of a virus that we are dealing with."

Transportation and technology access are other barriers, but the NAACP, state leaders, faith leaders, and other groups have held large vaccination clinics and offered free public transport in Des Moines to help.

"All these things hopefully will mitigate any of the factors that have led individuals to I am not interested in the vaccine," Easley McGhee said.

For trusted messengers like Lusala, the convincing is not always easy.

"I know sometimes people are afraid about the side effect of the vaccine, and I always try to make them understand that we know that one of the side effects of COVID-19 is death," Lusala said. "My job is that when it's your turn. I want to make sure I get you to the finish line to cross that line."

Messaging Matters

In terms of convincing hesitant people in the African American community to get vaccinated, Easley McGhee said the NAACP has researched and learned it is important to target the messaging.

She said it should be based around the things you can look forward to once you are fully vaccinated.

For those over 65, being able to see their grandkids or going to church can be a big motivator. For those who are in the 40 to 48 range, the message is to get vaccinated so we can all return to a sense of normalcy.

"I don't mean just going back to bars and the things that you would normally think that people that each would feel a sense of normalcy, but having children back in school and feeling safe about having children back in school," Easley McGhee said. "Being able to feel safe going to soccer games and the normal things that we took for granted before March 2020."

There is some evidence that messaging is working. A new survey from the Kaiser Family Foundation says 55% of black adults nationwide have either been vaccinated or are planning to get vaccinated. That is up 14 points from a similar story conducted in February,

It is good news, but community leaders say there is still a lot more work to do.

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Daniel Perreault


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