CDC has to get the messaging right with the COVID-19 vaccine

As the Centers for Disease Control and Prevention (CDC) is exploring race as a factor for consideration in the prioritization of COVID-19 vaccination receipt, the agency must use lessons from its own past to help guide communication efforts.

In 2001 when letters containing anthrax were mailed to Sens. Tom Daschle (D-S.D.) and Patrick Leahy (D-Vt.), two vastly different populations were affected in Washington, DC — Brentwood Post office employees, who were predominately Black, and Hart Senate Office staff, who were mostly white. 

Focus groups with these two groups revealed stark differences in their perception of the CDC’s public health response. Many of the Brentwood postal workers felt significant racial and economic disparities in treatment, often due to simple issues of miscommunication.

When a vaccine for anthrax was offered, it was viewed with significant mistrust often due to inconsistent public health messaging, especially among the postal worker population.

Undoubtedly, anthrax is very different from COVID-19. For anthrax, there was an effective antibiotic treatment with a previously developed vaccine offered only as an alternative after exposure.

The COVID-19 vaccine, if successfully developed, will be a new approach to prevention. However, both diseases involve changing recommendations in the face of uncertainty and hence require nuanced public health responses.

A number of factors affect the decision to receive a vaccine, including risk perception, safety concerns and availability. However, mistrust plays a major role in vaccine uptake, especially when that vaccine is considered novel without a history of prior use.

Much of the mistrust in the medical system existing within communities of color has roots in another CDC led project — the Tuskegee Syphilis Study. In Tuskegee, 399 Black men were left untreated with latent syphilis for 40 years, even after the discovery of penicillin, safe and effective treatment of the disease. This study and others have left a long legacy affecting the willingness of people of color to obtain life-saving medical treatment for a wide variety of conditions ranging from cancer to HIV.

Today, 40 percent of Blacks cite that they would not get the COVID-19 vaccine if offered, despite the virus exhibiting a significant toll on this population.

Blacks have been previously shown to be less likely to participate in drug trials.

However, blacks are overrepresented in studies that do not require informed consent, based on a 1996 Food and Drug Administration exception allowing enrollment in cases of incapacitation. 

This is not necessarily a bad thing. Such exceptions are needed to make advances for potentially life-saving therapies when a patient is critically ill. However, the discrepancy in these statistics highlights a significant finding. When it comes to communities of color, efforts for recruitment may be blunted unless in the most convenient of cases and the benefits of cutting edge research may be one-sided. 

In the case of COVID-19, we must ensure that the knowledge gained from the early use of the vaccine is universal. This includes recruiting diverse participants to clinical trials of the vaccine to understand whether it is equally effective across race, ethnicity, gender, and among groups with various co-morbid medical conditions. 

This involves taking the time to have a thoughtful discussion with individuals about the study process, including the use of culturally appropriate approaches to recruitment and the employment of diverse research staff. It is also critical that communities of color be engaged in giving input about such recruitment early in the planning process. 

Once the vaccine has been proven to be effective and is available, we must provide equitable access to the vaccine to these same communities. This should not be simply based on who has the strongest lobbying power but instead take into consideration those individuals who may benefit from the vaccine, yet whose voices may not be represented among special interest groups. 

I have faith that the CDC’s intentions are good, however, more than ever it is important for the agency to invest in a significant public health communication strategy directed at individuals of all racial and ethnic backgrounds. The CDC has an opportunity to make a difference. Let’s make sure we get the messaging right this time. 

Janice Blanchard, M.D., Ph.D., is a professor of emergency medicine at George Washington University. The opinions expressed are her own.