A vial of the Moderna COVID-19 vaccine. Photo by Darrow Montgomery.

The gap between those most and least at risk from COVID-19 might just get wider after showing signs of narrowing. A recent anti-vaccine misinformation (or potential disinformation) campaign in Prince George’s County and an anti-misinformation vaccination campaign targeting Black folks in the DMV highlight some of the vaccine hesitancy and access issues that continue to plague certain communities. Misinformation and systemic issues are very much alive, even as the data shows a recent encouraging rise in vaccinations among Black and Latinx folks.   

First, the Current National and Local Gap

While delta surges in both highly vaccinated and unvaccinated areas across the country, it’s much more likely for COVID-19 infections in unvaccinated people to lead to hospitalization and death. And the latest Centers for Disease Control and Prevention data on vaccinations by race and ethnicity still show Black and Latinx people lagging behind in national vaccination rates. The CDC has race and ethnicity data for 58 percent of people who have received at least one dose of the vaccine. Among that group, 10 percent are Black and 16 percent are Latinx, as of Aug. 2. In D.C., Black people have received 43% of vaccinations but account for 56% of the total cases and 71% of deaths in the District, the CDC reports.

…With Signs of a Narrowing Gap

But CDC data also shows that recent vaccinations are reaching larger shares of Latinx and Black populations relative to overall vaccinations. In D.C., between March 1 and Aug. 2, the share of vaccinations going to Black people, who make up 46 percent of the District’s population, rose from 26 percent to 43 percent. For Latinx people, who make up 11 percent of the District’s population, the share of vaccinations was 14 percent as of Aug. 2.

…With Upcoming Changes for the Already-Vaxxed

President Biden is expected to announce, possibly this week, a plan to get most Americans COVID booster shots eight months after they’ve been fully vaccinated. The plans, which are still in development, would mean that, starting next month, folks could get third shots (only two-shot vaccines are pending approval for boosters by the FDA, as the J&J vaccine is still in the data-gathering phase for boosters), according to a source privy to conversations with White House health officials about booster shots. Some of the first to receive the booster would be health care workers, nursing home residents, and folks 65 and older, just like with the first emergency use-authorized doses in December. This plan would come after last week’s announcement that the FDA and CDC had authorized and recommended a third shot to many immunocompromised folks

Boosters, which have induced a much higher antibody response against the initial coronavirus strain and the delta and beta variants than people who received two vaccine doses, would help maintain a high level of protection against COVID in folks who first got vaxxed six to 12 months earlier, according to a statement by Pfizer and BioNTech on Monday. It’s not just the vaccine companies who say so: Dr. Peter Hotez of Baylor College of Medicine in Houston said on CNN Monday night that research has shown getting a third shot eight months after the last dose can yield high levels of virus-neutralizing antibodies and a “really robust” immune response

So folks who are vaccinated but with waning levels of antibodies would be even more protected from COVID after receiving booster shots—while unvaccinated folks would continue to be at risk for more severe COVID infections as the highly contagious delta keeps spreading, further widening the gap in protection between the vaccinated and unvaccinated.  

…With Many of the Same Barriers for the Unvaxxed

There have been solid grassroots and government efforts to encourage more residents to get vaccinated—including AirPod and VISA gift card give-aways and iPad and scholarship raffles as part of a recent youth vaccination incentive initiative in the District, as well as the work of resource-connector groups like the COVID-19 Community Corps and the direct vaccination access and education from organizations like the Mary’s Center COVID-19 response team. Yet many of the same vaccine access and hesitancy issues plague majority-Black and Latinx communities. 

What Are Some of These Folks’ Biggest Barriers to Getting Vaccinated?

A lack of health insurance and structural factors like poverty and housing instability all impact an individual’s ability to get the COVID vaccine, just as they impact other health inequities, Jennifer Haley, a research associate in the D.C.-based Health Policy Center at the Urban Institute, told City Paper. For folks who can’t take time off work to get vaccinated, require transportation or child care to get jabbed, or can’t otherwise just pull up to a vaccination site, they might not know about services for the vaccine clinic to come to them. 

Lack of Health Insurance

The vast majority of residents that community health organization Mary’s Center serves are Latinx, and about 15 percent are Black (though that may change as Mary’s COVID-19 response team seeks to expand outreach throughout Wards 7 and 8). Among these majority-Latinx communities served, a common barrier to getting jabbed is a lack of insurance, says Dara Koppelman, the Chief Nursing Officer at Mary’s Center who leads COVID response team efforts. Uninsured residents are far more likely to not seek healthcare because they can’t afford it, and if they don’t know the COVID vaccine is free, they may refrain from seeking out the vaccine. Folks who don’t have health insurance likely also don’t have a primary care doctor, so they are less likely to receive messages from a trusted medical person about the vaccine. Many DMV Latinx residents tend to be relatively trusting of doctors and other medical staff, Koppelman told City Paper. But “if someone has not been able to receive care previously, they may not be as trusting of the healthcare system,” Koppelman adds.

In a Kaiser report this June that distinguished between the vaccination attitudes in a “wait and see” and “definitely not” group of unvaccinated people nationwide, among people under 65, folks without medical insurance make up 24% of the unvaccinated population, while only 12% of insured people with insurance haven’t been vaccinated. 

The “wait and see” group refers to people who have said they want to see how vaccinated folks fare in the long term before deciding whether to get the shot themselves. Kaiser found that having to pay for the (free) vaccine is one of the major concerns in the “wait and see” group, half of which are people of color.

Fears Around Adverse Health Effects

Among both the “wait and see” group and “definitely not” (in the latter, 70 percent are White adults), concerns, to varying degrees, center on fears around the vaccine’s impact on fertility and getting the vaccine from a place they trust.

One thing that folks have brought up is just fear of what the vaccine will do to their body,” Haley told City Paper. “That’s something I’ve heard, like, ‘I’ll wait and see what it does to y’all, you know, if it’ll turn you into zombies,’ or whatever the misinformation is, ‘and then I’ll take it and then I’ll consider it.’”    

Sterilization and fertility concerns are one such worry. While the historical and ongoing mistreatment of Black residents by the medical system and ensuing trauma is well known in such events as the Tuskegee Syphilis experiment, eugenics boards in the U.S. have disproportionately targeted Black women after World War II. Latinas have also faced forced or unknowing sterilization—and not just with “la operación” of Puerto Rican women in the 1950s and 1960s as a form of population control. A 2020 investigation uncovered that ICE was facilitating non-consensual hysterectomies of Latin American immigrant women at the border

Fears Around the Gov Getting Your Info

Koppelman also points out that many Latinx residents’ concerns stem from their immigration status. Some fear deportation if, when they get jabbed, they must provide information that the government may use against them. While folks administering the jab don’t collect information that the government can access and use for these purposes, these fears derive from long-existing and recent anti-immigration policies and the psychological distress of enduring constant vigilance as an undocumented person. While concerns around government surveillance aren’t limited to undocumented people, it’s perhaps most prevalent in these folks.

Hesitancy about Vaccine Protection

Lately, as more information emerges about breakthrough cases of COVID-19 among vaccinated people, some look to these cases and ask why they should get jabbed when the vaccine isn’t 100 percent effective. But no vaccine is 100 percent effective at preventing illness. The COVID-19 vaccine is highly effective at preventing severe illness, hospitalization, and death.

A similar belief contributing to vaccine hesitancy comes from folks who have already gotten COVID and think their antibodies will sufficiently protect them from the virus. As antibodies wane over time (hello, booster!), the robust immune response COVID survivors generally get post-infection can start to dwindle starting three months later, Dr. John Wherry, director of the Institute for Immunology at the Perelman School of Medicine at the University of Pennsylvania, told WHYY on PBS. 

These increasingly common arguments devaluing the vaccine’s protective abilities are unfounded when comparing COVID-19 infections in vaxxed to unvaxxed folks, research shows. 

“Infections in unvaccinated people are the bigger problem by far,” Kathleen Neuzil, director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, told Newsweek. “They get infected more; they get sicker; and they likely transmit virus more readily.”

The numbers don’t lie: unvaccinated people who contract COVID-19 are 25 times more likely to be hospitalized and to die. 

Misinformation in Prince George’s County

Nationwide, anti-vaccine misinformation continues to circulate, not least through social media. Last month, President Biden said vaccine misinformation campaigns engaging folks on platforms like Facebook were killing people. He wasn’t the only one. 

“I think social media is playing a big role in amplifying misinformation, which is leading to people not taking the vaccine, which is killing them,” Dr. Nahid Bhadelia, founding director of the Center for Emerging Infectious Diseases at Boston University, told CNBC.

COVID misinformation has surged even more with the rise in delta cases, according to misinformation experts in a New York Times report. Mentions of misinformation-prone phrases shot up by five times the rate in June, based on Zignal Labs tracking of social media platforms as well as TV, print, and online media. Among the most prevalent lies were that vaccines don’t work (up 437 percent), that they contain government-implanted microchips (up 156 percent), that the vaccines cause miscarriages (up 75 percent), and that folks should rely on their “natural immunity” (up 111 percent). 

Many of these falsehoods were at the crux of a vaccine misinformation campaign in Prince George’s County just a few weeks ago. Among many false claims, the flyer called vaccine shots “experimental injections” unauthorized by the FDA, claimed that they resulted in animals’ death after tested animals caused “Antibody-Dependent Enhancement,” and that they have caused sterilization, harm to future generations, and many deaths, particularly among African-Americans. 

The flyer, which local health officials say targets the African-American community in majority-Black Prince George’s County, alarmed local health officials and vaccinated residents who have been struggling to convince their loved ones to get vaccinated. 

“This kind of misinformation will further cause people to hesitate getting vaccinated at a time when the pandemic has turned into a pandemic of the unvaccinated,” Dr. George Askew, the chief administrative officer of the Prince George’s County Health Department, told WTOP in response to the news about the flyer. “The people who are dying from COVID now are overwhelmingly—overwhelmingly—people who have not been vaccinated.”

Dr. Askew first learned about the flyers when they were distributed in Baltimore, then became even more unnerved when residents brought them to his attention in Prince George’s County, NBC Washington reports. The county has seen a high COVID positivity rate and still low rate of vaccination in recent weeks. COVID canvassing has recently stopped in the area after some success—with 8,452 residents visited at home in the last week of May, 70 percent, or 5,916 Prince George’s residents, received their vaccinations between the first and second canvasses. Yet alternate outreach efforts continue, as they do in other DMV communities at high risk for COVID spread and severe symptoms. 

Just a Few Local Resources Combating Access Issues and Misinformation 

Leandra Lacy, a training and technical assistance specialist in the Research to Action Lab at the Urban Institute, believes in the power of relationship building to help combat vaccine misinformation. The community ambassador model, which involves people who already know folks in the community, including faith leaders and other community leaders, allows folks to get a better grasp of what people’s needs are and get them on board, she told City Paper. Trusted messengers are a big part of the solution, Lacy says.

Haley agrees with this approach around vaccine information and persuasion: “Trying to give people repeated messages from various parts of their lives. So, you know, hearing the vaccine message from your doctor, as well as from community leaders, as well as an official government message, and all repeated conversations.”

Lacy also touts the work of community-based organizations (CBOs), nonprofit hubs that provide specific services to the community or to target populations within those communities, such as Mary’s Center and Family Success Centers, a part of Community of Hope, in combating COVID vaccine misinformation and barriers to access. The CDC and the U.S. Department of Health and Human Services have lauded CBOs for playing an especially vital role during the pandemic in helping folks from disproportionately impacted populations obtain critical services and support. 

Here are some more details about a few of these CBOs and other resources for COVID vaccine information and services:

Mary’s Center: Walk-in locations that require no appointments can be found in Adams Morgan, Fort Totten, and Petworth centers and senior wellness centers at 3531 Georgia Avenue NW and 324 Kennedy Street NW in D.C., and Adelphi and Silver Springs in Maryland. 

Mary’s Center also coordinates, through its telemedicine program, at-home vaccination services, sending medical assistants to apartments for folks unable to leave their homes for any reason, including lack of transportation, child care, time off work, disability, etc. Mary’s Center vaccine information and health education outreach includes going to churches and other places of worship, schools, street fairs, farmers’ markets, and other community events and gathering spaces. 

Community of Hope: Services, which span healthcare and housing, include COVID testing and vaccination services at walk-in clinics across the city.

•The COVID Community Corps: Well known for providing vaccine information, this group of folks who knock door to door and attend events throughout the city to connect folks to the resources they need.

•The Anacostia Coordinating Council: While this group participates in initiatives as varied as advocacy for green spaces and census outreach, the ACC is also working with Mayor Muriel Bowser’s office to encourage residents in Wards 7 and 8 to get the COVID-19 vaccine.

There’s a reason these and other resources address far more than COVID vaccine access issues: COVID is just one representation of larger health inequities, as Haley and Lacy remind us. 

“A lot of the cracks in our public health system like these issues aren’t new,” Lacy told City Paper. “It’s just that COVID exposed the cracks and then exacerbated the cracks. Now, they’re like … fault lines, they’re huge.”

—Ambar Castillo (tips? acastillo@washingtoncitypaper.com)

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