“Yes [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 don’t have enough information on this. “
The two FDA-cleared COVID-19 vaccines are over 95% effective in preventing symptomatic illness, and reported side effects are minor. The trials – which each included more than 30,000 volunteers – have shown that the vaccines work equally well in people of all races and ethnicities.
Tuskegee, where Bullie resides, is the starting point for the infamous 1930s syphilis study. The US public health study at the Tuskegee Institute, which recruited 600 black men, was supposed to record the natural progression of syphilis infection, but the researchers did not notify participants or seek their consent. The study spanned 40 years and left an indelible mark on the black community.
Nearly one in four rural Alabama residents (24.1%) are black or Latino, according to the 2018 American Community Survey.
Focus groups across Alabama are meeting to address vaccine reluctance among communities of color, especially among African Americans and Latinos, according to Dr. Mona Fouad, director of the University of the ‘Alabama at the Minority Health and Health Disparities Research Center in Birmingham.
“Tuskegee has come back again and again, and again, in every group we’ve talked about,” Fouad told ABC News. “People started to remember Tuskegee.”
She said that before the pandemic, advocacy groups were gaining traction by “overcoming” mistrust of the health care system in communities of color, but now COVID-19 “has again boosted Tuskegee.”
“We have learned that mistrust comes from a lack of information and transparency,” Fouad said.
In a statement provided to ABC News, the Alabama Department of Public Health said, “ADPH has addressed access to testing in rural communities and communities of color by working with partners including colleges and historically black universities, faith communities and housing authorities “in an effort to combat the discomfort over a COVID-19 vaccine.
However, advocates and local leaders said greater inclusion and transparency will be needed to increase participation of communities of color.
“As we see more people taking it, people of color in particular taking the vaccine, people will be more prone 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 would help people living in rural communities understand it better. 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, language also presents a huge barrier to accessing COVID tests, as people “don’t have the information distributed in a language other than English.” .
It is important to involve local community leaders in rural Alabama so that they reassure vaccine safety and explain it in a way that people can relate to, Simelton said.
“The key is to develop this factor of trust in the community,” he added.
Distrust is not the only challenge in delivering vaccines to rural communities
In parts of rural America, vaccine delivery is expected to face unique healthcare barriers, including understaffed clinics, a lack of refrigerated vaccine storage units, and difficult residents. to reach living miles from major hospitals, experts say. The state’s public health systems, already overburdened by the pandemic, will be responsible for ensuring daily delivery and accessibility to rural residents.
Geographic isolation and labor shortages in rural hospitals across America add to the burden of immunization.
According to a 2018 Pew Research Center survey, rural Americans live an average of 10.5 miles from the nearest hospital and among one-quarter of rural Americans traveling the longest to reach an acute care facility, the Average journey time is 34 minutes by car.
“Getting to hospitals is difficult because you have people who don’t have transportation or don’t have reliable transportation, distance is definitely a barrier,” Espino said. “In rural Alabama, blacks and browns would really struggle with accessibility.”
According to the Health Resources and Services Administration, 64.6% of rural Alabama counties are considered “health worker shortage areas,” lacking enough primary, dental, and mental health providers to serve the residents. In addition, 55.7% of rural Alabama does not have adequate health services, HRSA said.
When the vaccine becomes available to the general public, people living in rural communities will have to travel long distances to access large city hospitals where doses can be properly stored in refrigerated units, Simelton said.
“There is a significant portion of the community that won’t be able to get the vaccine that might want it,” Simelton said. “We need to make it available in large enough quantities that everyone in the community takes it.”
And in places like rural Alabama, the burden of providing vaccines amid a pandemic is already taking its toll.
In a December 16 briefing, Army General Gustave Perna, the COO of Operation Warp Speed - the Trump administration’s program to accelerate vaccine deployment – described minor incidents with delivery to Alabama including when vaccine shipments arrived but had been stored at the wrong temperature.
Since the impact of storing the vaccine at the wrong temperature is unclear, the vials were not used and were returned to Pfizer.
“When COVID arrived, I felt like we were pushed back for another two decades,” Fouad said.[COVID] has impacted our rural and underserved communities in our cities far more than anyone. “
In addressing disparities in vaccine access for rural communities, the Alabama Department of Public Health is “working with rural health clinics, federally licensed health centers, health departments of county and other providers to provide access to COVID-19 vaccines statewide ”. according to a statement provided by Chief Medical Officer Mary G. McIntyre.
Fouad said lessons learned from state surveillance during COVID with limited access to testing and few quarantine options for underserved rural communities have served as a “continuum” to inform decision-making officials of state public health on vaccine deployment.
“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.