“What if [the vaccine] left today, I wouldn’t take it, “said Lonzo Bullie, a retired school principal who called Tuskegee, Alabama, for 26 years.” I’m still reluctant … because I don’t have enough information about it. “
The two FDA-authorized COVID-19 vaccines are more than 95% effective in preventing symptomatic diseases and the reported side effects are minor. The tests – which included more than 30,000 volunteers each – showed that vaccines work equally well among people of all races and ethnicities.
But Bullie, who is also president of the NAACP’s Tuskegee-Macon county branch, said that vaccine skepticism in the African American community comes from “the history of the United States government experimenting with blacks” and years of “bad guys” -tracts “.
Tuskegee, where Bullie resides, is ground zero for the study of the infamous 1930s syphilis. The US Public Health study at the Tuskegee Institute, which recruited 600 black men, aimed to record the natural progression of syphilis infection, but the researchers did not inform the participants or ask for their consent. The study lasted 40 years and left an indelible mark on the black community.
Residents in rural communities of color are struggling not only with widespread distrust of vaccines and the health care system, but also with a number of obstacles when vaccine distribution begins, including the lack of access to medical facilities.
Almost one in four rural Alabama residents (24.1%) is black or Latino, according to the 2018 American Community Survey.
Focus groups across Alabama are gathering to address vaccine hesitation among communities of color, particularly among African Americans and Latinos, according to Dr. Mona Fouad, director of the University of Alabama at the Disparities Research Center and Birmingham Minority Health.
“Tuskegee came back again, and again, and again, in all the groups we talked about,” Fouad told ABC News. “People started to remember Tuskegee.”
She said that before the pandemic, outreach groups were gaining traction with “overcoming” mistrust in the healthcare system in communities of color, but now COVID-19 “has brought courage back over Tuskegee”.
“We learned that distrust comes from a lack of information and transparency,” said Fouad.
In a statement provided to ABC News, the Alabama Department of Public Health said: “ADPH addressed access to testing in rural and black communities, working with partners, including historically black colleges and universities, religious communities and housing officials” in one effort to combat unease with the COVID-19 vaccine.
However, advocates and local leaders said more inclusion and transparency will be needed to increase participation by black communities.
“As we see more people taking, people of color, in particular, getting the vaccine, people will be more able to [taking it]”said Benard Simelton, president of the NAACP Alabama State Conference.
He also added that explaining the “technicalities” and providing clearer public messages about the vaccine will help people living in rural communities to have a better understanding of it. In addition, diverse messages are needed to ensure that all communities understand the information.
According to Ana Espino, executive director of the Alabama Coalition for Immigrant Justice, the language also represents a major barrier to accessing COVID tests, because people “do not have the information distributed in any language other than English” .
It is important to involve local community leaders in rural Alabama so that they ensure the safety of the vaccine and explain it in ways that people can relate to, Simelton said.
“The key is to develop this trust factor in the community,” he added.
Distrust is not the only challenge in providing vaccines to rural communities
In parts of rural America, vaccine delivery is expected to face unique health barriers, including understaffed clinics, lack of cold storage units for vaccines and hard-to-reach residents who live miles from large hospitals, experts say. State public health systems, already overburdened by the pandemic, will be responsible for ensuring day-to-day delivery and accessibility for rural residents.
Geographic isolation and labor shortages in rural hospitals across America add to the burden of providing vaccination.
According to a 2018 Pew Research Center survey, rural Americans live an average of 16.5 miles from the nearest hospital and, among the quarter of rural Americans who travel the longest to reach an intensive care center, the average time journey is 34 minutes by car.
“Access to hospitals is difficult, because you have people who do not have transport or do not have reliable transport, distance is definitely a barrier,” said Espino. “In rural Alabama, black and brown people would really struggle with accessibility.”
According to the Health Resources and Services Administration, 64.6% of rural Alabama counties are considered “areas with a shortage of health professionals” due to the lack of sufficient primary, dental and mental health care providers for service residents. In addition, 55.7% of the rural population in Alabama does not have adequate health services, said the HRSA.
When the vaccine is available to the general public, people living in rural communities will have to travel long distances to access larger hospitals in cities where doses can be stored properly in refrigerated units, Simelton said.
“There is a significant portion of the community that will not be able to get the vaccine they want,” said Simelton. “We have to make it available in quantities large enough for everyone in the community to accept.”
And in places like rural Alabama, the burden of providing vaccines in the midst of a pandemic is already taking its toll.
At a briefing on December 16, Army General Gustave Perna, COO of Operation Warp Speed - the Trump administration’s program to accelerate the vaccine’s launch – described minor setbacks with delivery in Alabama, including when the shipments from vaccine arrived, but had been stored at the wrong temperature.
As the impact of storing the vaccine at the wrong temperature is unclear, the vials were not used and were sent back to Pfizer.
“When COVID arrived, I felt like we were pushed back for another two decades,” said Fouad.[COVID] it impacted our needy rural communities in our cities far more than anyone else. “
In addressing disparities in access to vaccines for rural communities, the Alabama Department of Public Health is “working with rural health clinics, federally qualified health centers, county health departments and other providers to provide access to COVID vaccines. -19 across the state. ” according to a statement provided by the Chief Medical Officer, Mary G. McIntyre.
Fouad said the lessons learned from state oversight during COVID with limited access to tests and few quarantine options for underserved rural communities served as a “continuum” to inform state public health leaders of the vaccine’s launch.
“Now that the vaccine has been launched, we don’t want to make the same mistakes,” he added.
Mark Nichols of ABC News contributed to this report.