Washington Foreign Press Center briefing on overcoming racial disparities in vaccine hesitancy and access.
Transcript
Good morning and welcome to the Washington foreign Press center briefing on overcoming racial disparities in vaccine hesitancy and access. My name is john Mcandrew and I’m today’s moderator are briefer. Today is Dr Eliseo J. Perez. Established director of the National Institute on Minority Health and Health Disparities at the National Institutes of Health. He will discuss how minority communities are grappling with vaccine misinformation, the value of fact-based health communication and how federal and local officials are working together to counter disinformation, build public trust and improve vaccine confidence and access for underserved populations. And now for the ground rules. This briefing is on the record. We will post a transcript later today on our website. Dr Perez Established will give an opening statement and then we will open it up for questions. We have only a limited amount of time, but we’ll try to get to as many of your questions as possible and with that over to you, Dr Perez established. Yes, thank you, jen and good morning everyone. That’s really my honor and privilege to be here to talk to you today about the work we do every day at the National Institutes of Health. Um I direct the National Institute on Minority Health and Health Disparities and as you know, are familiar with the National Institutes of Health focuses on Research and Science. Uh I never in my role as director of the, of the entity that is dealing with health disparities and minority health. I have been involved in a variety of, of projects related to the COVID-19 pandemic and health disparities about a year ago was when it was noted that the there was a disproportionate burden being observed in african american communities. Subsequently american indian As well as Latino Hispanic communities in the us and over the course of this past 13 months, this pattern has not changed. About 50 of all cases. About 45 of mortality has occurred in Latinos, American Indians, Alaska Natives, and African American communities in pacific Islanders, even though we represent about a third of the US population. Um this has been due to the underlying structural inequities that have existed in these communities for decades, that have not been attended to significantly over this time. Uh and this pandemic was just this opportunity to cause havoc in our communities. Uh, communities living closer together to families in one setting, lack of ability to shelter in place employment that did not allow for the privilege of teleworking, like I have been doing primarily for the past year. Um, and this is the main reason that we’ve seen disproportionate infection and morbidity. Uh, there are more cases more diagnosis of diabetes and heart disease in these communities that have led to an increase in mortality. Hospitalization and mortality among those who do get sick and then delay coming to the hospital because of under insurance or lack of insurance. In many cases, the mortality trends have continued their about double. It has been estimated that up to two years of life expectancy may have been lost uh for Latinos and african americans in this past year. So, um as a response, NIH has focused a lot on research uh in my area, on the social behavioral and economic consequences of the pandemic have been a primary emphasis. We, using additional appropriations from Congress were able to stand up 69 projects to promote testing interventions in these underserved and vulnerable communities. A program we call rad X. U. P. And then in last summer, uh as a consequence of the vaccine trials being launched. Working with my colleague, Dr Gary Gibbons at the National Heart lung Blood Institute, we set up a program called Covid Community engaged Alliance Against Covid 19 disparities. We call it Seal for short, C E A L. And it started as an effort to increase and enhance participation in the trials being sponsored by the U. S. Government and Moderna, uh and subsequently other pharmaceutical companies. Um We though set up a structure leveraging our community engaged researchers that we had funded for many years to develop networks within their states um to promote uh adequate information, address misinformation uh and promote trust in science amongst our communities of color. Um, this has been ongoing now for about eight months. Uh We focused primarily on african american and latino communities that have also included other minority communities. And american indians were the 11 states right now and planning to expand this of course in december. Uh we started to deploy the vaccine’s beginning. First book fighter and then the Moderna products. And remarkably over these four months, the United States has immunized well over 100 million people. Um, This is an unprecedented effort on the part of the public health. However, we are seeing inequity in the distribution that I expect will be decreased substantially as we can get more and more people. Vaccinated reports from states that feed into the Centers for Disease Control and Prevention provided some picture of where we are doing with proportional distribution of vaccines by race, ethnicity. Um, and even though some states have gotten really good handle on the pandemics such as California, for example, latino or hispanic populations, there have been under immunized compared to the burden of disease that they carry in in a state or the proportion of the population in other states, such as Maryland or Alabama. Where african americans are more important of a minority there, much closer to the proportion of their burden of disease or the proportion on the population. Um, so our efforts at NIH uh, primarily had focused on this promoting testing through community engaged research. Um, and also this seal effort to promote trust in science because this misinformation campaign has been incredible and we, we really rely on trusted messengers which tend to be local experts. Everybody always thinks well we get a celebrity to promote this now that the best person to promote this are you’re a nurse, a physician, a pastor, a trusted community leader and do locally or regionally. And I think that there has been research on this, that we know that this is how it works. So I will pause there and entertain questions. I’m sure you’ll have many. Thank you. Great, thank you. We’ll now turn to the Q. And a portion of the briefing if you have not already done. So please take the time now to rename your zoom profile with your full name and the name of your media outlet. You can virtually raise your hand to ask a question or submit your question in the chat field. We do have a advanced submitted question from Katarina. So coup in Greece her question is, do you have an estimate of the cost of vaccine? Hesitancy to the health and economic opportunities of underserved populations. So thank you for that question. It is an important and complicated one. But let me address two points first, vaccine. Hesitancy traditionally has not been disproportionately present in minority communities with covid. What we saw from the early surveys in let’s say may june and september was an increasing proportion of african americans were less likely to accept the vaccine. Fortunately we uh we were able to mobilize uh physicians African American leaders as well as uh science leaders in government to address this directly. In the latest poll from the Kaiser Family Foundation showed that over 60 of African Americans will accept the vaccine. So the hesitancy has decreased significantly. Um uh the cost can be measured in excess cases of disease and therefore lost productivity at work, excess hospitalizations, which then would increase the burden on society and of course, uh mortality uh and and the and the and the loss of that represents both emotionally as well as economically. These kind of studies have not been uh completely done. We are embarking on such a study now globally for health disparities within n I M H. D. Uh and we will try and and parcel out what the cost of covid has been in our communities. So thank you. Thank you. We have another question that was submitted in the Chatfield from burned to bozeman. I believe he is with Arabian business in the U A. E. I’ll read his question. How much of an issue is language in terms of access for the latino slash hispanic community? What is being done to address the issue of vaccine misinformation that is out there in spanish. Thank you again for that question. So, I’ve got 70 of all Latinos Hispanics that live in the United States were born in the United States. About 20, actually are predominantly Spanish speaking and up to half of the all Latinos actually speak spanish at home. So language is an important issue and having quality accurate translation of all our educational materials that NIH is endorsing or producing is really a high priority for us. There are many uh, latino investigators across the country, particularly in areas with high proportions of latino populations, texas, florida, California, the Southwest in general where there are expert, uh, expert scientists who know how to do this and do it very well. Uh, it isn’t important as important as having it actually in simple language. So we don’t get bogged down with sophisticated medical terminology in communicating our message is misinformation. President social media is a problem and a challenge across all of society. Um, I believe that we, as a scientific community may have been a bit passive in responding to this initially because we need to also promote facts, promote science. Uh, not necessarily counter every single, um, unusual claim made about either covid 19 or the vaccine, such as, oh, they’re injecting a microchip. Oh, I’m gonna be infertile from it. Oh, I’m going to get sick from it. Uh We do address those directly in in our in our materials and unequivocally answer when we have a clear information that counters this this type of of information. Remember that Scientists tend to always think, well we’ve got to consider all the aspects and in this case we need to just be very clear and simple language. Um, and as a former primary care doctor, I know that that’s how we need to often uh to respond to patients questions about particular issues. Okay, thank you. We have a couple hands raised so we’ll go to some live questions first. I’d like to call on Jorgen bets from D. B. A. In Germany. Please admit yourself and ask your question hi and thank you so much for doing this briefing. So I wrote for media in Germany where vaccines are really scarce and you know, people don’t know whether they will be able to get it even six months down the road. So for for for for us it’s interesting how how to explain the vaccine hesitancy that we already see in the U. S. And that it must be feared will become an even bigger issue in the weeks and months to come. You mentioned misinformation. Um and of course tuskegee gets mentioned distrust in government. But then also why is the hesitancy bigger in racial and ethnic minority groups? I know it’s a big question but just the mindset is how do you explain to my german readers? Why is this happening? Thank you. Well, thank you for your question. Um uh the african american community has had a conflicting history with science and with government. You mentioned tuskegee. Uh there are similar examples, multiple other examples and the health care system has not been the most user friendly for that community in particular. So that distrust is definitely present. It’s a distrusting institutions is distrust in systems. However, both based on data that has been collected through surveys and my own experience, I do believe that individual clinicians, regardless of their race ethnicity can overcome this with open, direct and frank conversation. I think the reason a lot of people get turned off is there dismissed? Their concerns are not paid attention to, their questions are not answered. They’re not listened to and we really do need to pause, listen and respond in a respectful and direct way and not assume. Oh that’s crazy. Why are you bringing this up? Fortunately, the african american professional community has mobilized on this topic in a way that is remarkable. Black doctors dot org. I have been part of double A. C. P. Town halls where we have had tens of thousands of listeners uh in different contexts. Um we’ve had scientists, we’ve had pastures, we’ve had advocates and community organizers as well as regular people come and talk about issues around covid and issues around the vaccine. And I do believe that the latest data do show that we are moving the needle To uh to a higher proportion. So the the the acceptance of vaccine theoretically of course by the African American community has gone from about 40 to over 60 in a matter of a few months. And so we just need to keep moving in that direction. I would I would also point out that In other vaccine issues, for example, childhood immunizations um minority communities have actually been more accepting even of vaccines and the white community. Um and for measles, mumps, rubella, you know, the baby immunizations that we all administer are over 90 in all racial ethnic groups. As of most recent data available. And the vaccine hesitancy or the anti-vaxxer movement. Pre Covid uh was primarily uh an issue that had most traction within a white middle class community. For reasons I don’t understand, I don’t pretend, but I’m just observing what the data would show. Um but you’re right that this distrust historical mistrust in systems has surfaced in the context of what has happened with Covid, but I think we have tried to address that directly and I do believe we are we meaning not just an age, but all of the african american professional community and leaderships are making a difference and the same has happened with the latino community and the american indian community. Um, and although the hesitancy in in those communities has been considerably less than what has been reported for the african american community. Hope that helps. Okay, just as a reminder, you can submit questions in the chat field or virtually raise your hand. We do have another question from Michael Pearson de Volkskrant in the Netherlands. Please mute yourself and ask your question. Thank you. Um Unit we can’t hear you, Michael mm we can see you but we can’t hear you. Maybe try to submitting it in the chat. Okay? We’ll give him a minute to to type up his question in the meantime. Do we have any other questions? I just see Michael’s hands raised. Okay. Mhm. I would add a comment just in general uh that the equity of distribution of vaccines has been much discussed as well um And I can just share my personal experience and getting vaccinated. Um I don’t see patients anymore. So I wasn’t in the first group of being vaccinated But I’m over 65. So once the D. C. Vaccinate made itself available. I said well let me go on the website and try to get an appointment. Well it took me about three times and I’m pretty good with doing this technology thing. Uh I say well I can I can get one nearby. Well ended up being two miles away which is fine and luckily it was a saturday. But you can see the issue that these structural barriers were there. If you’re 80 years old and living alone uh maybe don’t have a computer. You had no way to get a vaccine. If you if you call the phone number which I did once. Um because I wasn’t sure my appointment was confirmed. The first thing I was I heard was there are 300 callers ahead of you. Um And you have to have the time and the patience to wait On the phone. So we’re getting over that as supply has improved. And um, we are committed to the notion that by June or beginning of summer there will be vaccine available for every adult in the United States who wants one, every person over the age of 16. Well, thank you for sharing. We do have another question. I see. Michael is probably still typing. We do have another question submitted. This is from jenny Lanzano, from Catalonia Radio in Barcelona. Her question is how things like what is happening right now with astrazeneca vaccine in europe or johnson and johnson here, how could these things impact in the hesitancy that already exists in the US? And could you please elaborate a bit more on what is the best way to overcome this hesitancy? Right. Um, so I would um, uh, first of all, the astrazeneca vaccine has not yet been authorized by the FDA here. So we have no experience with it. I’m closely followed all the reports and the association with this uh immune mediated uh clotting and uh and robotic and hemorrhage similar to what we see with other drugs, which is a rare event. But real apparently appears to be real. And I think it’s one of the things to remember and sobering, you know that that nothing is without side effects, no matter how infrequent sometimes they can be severe. We saw that early on with the Messenger RNA vaccines, Pfizer and Moderna vaccine causing severe allergic reactions. NFL access like reactions that if unattended would would lead to death. Uh so clearly you never want a preventive intervention like this to lead to a severe adverse effect or death. But it is one of the one of the realities of of medicine that nothing is without some potential side effect. The johnson and johnson vaccine is uh slightly less efficacious in preventing disease, but similarly effective in preventing death. And so as a one dose vaccine cheaper to produce uh easier to store, I think it has a huge role to play in the United States and in on on the world stage. Um and have no reason to say one vaccine over the other. This is better to go for this one or that it’s the best vaccine possible is the one you can get the soonest possible time. And uh none of us really think this is gonna be a one time vaccination campaign. Um Covid is probably gonna be with us for for my lifetime anyway. Um and so we’re likely to see boosters or annual vaccination so similar to what we see with influenza respiratory infections. Um, and then I would challenge this group to tell me what is the vaccine hesitancy in your country because I’m not sure that this is a us only phenomena. Um if we have 30 of the adult population of the us hesitate to be vaccinated against COVID, they don’t say categorically not. There’s a group that says categorically not. But if you add that to those who say, well, I’m not so sure. Um, I think that we can persuade them and you say, what can we do? Well, the best way is to provide accurate scientific information through trusted messengers and those trusted messengers may begin with US leaders in government, science leaders and government, but it really has to go all the way down uh, to your local level. Local leaders, community organization leaders, uh faith based organization leaders, local clinicians, the and not just doctors, but nurses, um and and role model. That’s number one, and number two is to remove all structural barriers, make it as easy and as possible. Now the vaccine is free. So there’s no cost to anyone. There’s no need to show anything to other than, you know, the normal things we do in health care, make sure there’s the person that you’re that says they’re getting the vaccine. So some identifier, but no one is checking anything else. Uh and there’s no consequences for getting into some database that someone’s going to come after you or anything like that. So I do think that the structural issues does take a commitment to doing that. I think that our government is committed to doing this. But, you know, these things are not always uh simple to implement just because you want to do them and we learn as we do it as we roll it out. So I do think that smaller countries, uh sort of more homogeneous populations are able to do a great job with this. The challenge in the United States, of course, as you know, we’re 50 states with all their own jurisdictions and all own authorities, but um and also very heterogeneous country in terms of population. But I think we’ve done a remarkable job to get to where we are now, but it’s far from over and we still got to keep pushing the vaccination of as many people as possible. Michael person has submitted his question in the chat from evokes Grant and I will read it. His question is, do you have a goal for vaccine acceptance among minority communities? If the 40 hesitancy is similar to the 40 hesitancy among white conservatives, what percentage would be needed to get to national herd immunity? Well, there I will I will answer that by referring to my colleague and uh expert Dr Tony Fauci. Um, but this is well known in public health science. And if you when you get to 80 either immunized or immune from natural infection, you begin to see the benefits of what public health scientists have for a long time called herd immunity. Some people don’t like that term is sort of the herd referring to animal herds, but it is a term that has been used traditionally. And we have seen people talk about this with respect to other kinds of pandemics. Um, of course you don’t want to necessarily get to Herd immunity by natural infection only because the cost is huge. As we’ve seen how many people have have died uh in the planet as a consequence of COVID, almost 600,000 in the United States alone. Um, and if you go back to other era, you know, the measles vaccine, you know, the measles epidemic. I was, I’m old enough to have had measles um, as a child. Uh, and the cost of measles, uh, most people did find most kids were not, did not get that sick, but a certain proportion would get very sick and die or develop encephalitis and have lifelong consequences. So we didn’t necessarily want to achieve herd immunity to measles just by letting every child get infected. We really reached it by a very effective vaccine distributed at that time in the sixties, uh, in the late sixties and early seventies, where we achieved now 95% immunity. And I would say that the majority of the residents I I taught during my the last 25 years at UCSF had never seen a case of measles because it just unless they went in certain countries because it had been essentially eradicated from the United States for domestic transmission. So I think if we get to 70 75% we begin to discuss that we really are achieving our goal. Um and remembering that the immunity from covid is not may not be lifelong, like it is from other infections. So we may have to boost uh in a year or two years. We’ll see. The data will will will indicate to us when we need to have another vaccine, another dose of the vaccine. Thank you very much for all these helpful insights on behalf of the U. S. Department of State. I would like to thank dr Perez Established for giving his time today to brief the foreign press today and good morning to everyone. Okay? Thank you. Thank you.