“If [the vaccine] came out today, I wouldn’t take it, “said Lonzo Bullie, a retired school principal who has called Tuskegee, Alabama, home for 26 years.” I’m still reluctant … because I don’t have enough information on it. “
The two FDA-approved COVID-19 vaccines are more than 95% effective in preventing symptomatic disease, and the side effects reported are minor. The studies – each involving more than 30,000 volunteers – showed that the vaccines work equally well in people of all races and ethnicities.
But Bullie, who is also chair of the NAACP’s Tuskegee-Macon County chapter, said skepticism about the vaccine within the African American community stems from “the history of the US government experimenting with black people” and years of ” assault “.
Tuskegee, where Bullie lives, is ground zero for the infamous 1930s syphilis study. The American Public Health study at the Tuskegee Institute, which recruited 600 black men, was designed to record the natural progression of syphilis infection, but the researchers did not inform the participants or ask for their consent. The investigation lasted 40 years and left an indelible mark on the black community.
Residents of rural colored communities grapple with not only a pervasive mistrust of vaccines and the health care system, but also multiple obstacles when vaccine distribution begins, including a lack of access to medical facilities.
According to the 2018 American Community Survey, nearly one in four Alabama residents (24.1%) is black or Latino.
According to Dr. Mona Fouad, director of the University of Alabama at Birmingham’s Minority Health and Health Disparities Research Center in Birmingham, Alabama focus groups are meeting to address vaccine hesitancy among communities of color, particularly among African-Americans and Latinos .
“Tuskegee came back again, and again, and again, in every group we talked about,” Fouad told ABC News. “People started to remember Tuskegee.”
She said that before the pandemic, outreach groups gained traction by “overcoming” distrust in the health care system in communities of color, but now COVID-19 has “made Tuskegee nervous again.”
“We have learned that the mistrust stems from a lack of information and transparency,” said Fouad.
In a statement to ABC News, the Alabama Department of Public Health said, “ADPH has addressed access to testing in rural and colored communities by working with partners including historically black colleges and universities, faith communities, and housing authorities” in an effort to combat discomfort about a COVID-19 vaccine.
However, advocates and local leaders said more inclusion and transparency will be needed to increase the participation of colored communities.
“As we see more people taking it, especially people of color, who are using the vaccine, people will be more likely to [taking it], ”Said Benard Simelton, president of the Alabama State Conference of the NAACP.
He also added that explaining the “technicalities” and giving clearer public messages about the vaccine will help people in rural communities understand it better. In addition, various messages are needed to ensure that all communities understand the information.
According to Ana Espino, executive director at the Alabama Coalition for Immigrant Justice, language is also a huge barrier to COVID test access because people “have not disseminated the information in any language other than English.”
It’s important to involve local community leaders in rural Alabama to have them assure and explain vaccine safety in a way for people to identify, Simelton said.
“The key is to develop that trust factor in the community,” he added.
Mistrust is not the only challenge in delivering vaccines to rural communities
In parts of rural America, vaccine delivery will face unique health care barriers, including underutilized clinics, lack of refrigerated vaccine storage units and hard-to-reach residents living miles from major hospitals, experts say. The state’s public health systems, already overburdened as a result of the pandemic, will be responsible for ensuring day-to-day supplies and accessibility for rural residents.
Geographic isolation and a labor shortage in hospitals in rural areas across America add to the burden of providing vaccinations.
According to a 2018 Pew Research Center study, Americans in rural areas live an average of 10 miles from the nearest hospital, and among the quarter of rural Americans who travel the longest to reach an acute care facility is the average travel time 34 minutes by car.
“Access to hospitals is difficult because you have people who don’t have transportation or have reliable transportation, distance is definitely a barrier,” Espino said. “In rural Alabama, black and brown people would really struggle with accessibility.”
According to the Health Resources and Services Administration, 64.6% of Alabama’s rural counties are considered “areas with a shortage of health professionals” because of insufficient primary care, dental, and mental health services to serve residents. In addition, 55.7% of Alabama’s rural population does not have adequate health care, HRSA said.
When the vaccine becomes available to the general public, people in rural communities will have to travel far distances to access larger hospitals in cities where doses can be properly stored in refrigerated units, Simelton said.
“There is a significant portion of the community that will not be able to get the vaccine that may need it,” said Simelton. “We need to make it available in sufficient quantities for everyone in the community to use.”
And in places like rural Alabama, the burden of providing vaccines during a pandemic takes its toll.
In a December 16 briefing, Army General Gustave Perna, COO of Operation Warp Speed - the Trump administration’s program to accelerate vaccine rollout – described minor shipping accidents in Alabama, including when shipments of the vaccine arrived, but stored at the wrong temperature.
Because the impact of storing the vaccine at the wrong temperature is unclear, the vials were not used and were returned to Pfizer.
“When COVID came along, I felt like we were being pushed back another two decades,” said Fouad. “[COVID] impacted our rural, disadvantaged communities in our cities far more than anyone else. “
In addressing inequalities in vaccine access for rural communities, the Alabama Department of Public Health “is partnering with state health clinics, federally qualified health centers, county health departments and other providers to provide access to COVID-19 vaccines statewide. . ” according to a statement by Chief Medical Officer, Mary G. McIntyre.
Fouad said the lessons learned from state surveillance during COVID with limited testing access and little quarantine opportunities for disadvantaged rural communities served as a “continuum” in informing public health leaders’ decision-making about vaccine rollouts.
“Now that the vaccine is out, we don’t want to make the same mistakes,” she added.
Mark Nichols of ABC News contributed to this report.