.Brayden Heflin, 7, of Warren, reacts to receiving his Covid-19 vaccine from Trumbull County Combined Health District RN Lindsay Adams of Lordstown during the Covid-19 Vaccine Clinic at the Eastwood Mall Tuesday evening...by R. Michael Semple

A study at The Ohio State University’s Wexford Medical Center shows that black Americans initially were more hesitant to get a COVID-19 vaccine at the beginning of the pandemic, but became more likely than white Americans to decide for a vaccine as the pandemic wore on.

Still, a gap remains in the number of black and white Americans vaccinated.

Tasleem Padamsee, an assistant professor of health services management and policy at OSU, who led the study, said that at the end of 2020, when vaccines were first becoming available, around 38 percent of black Americans were hesitant to get a COVID-19 vaccine compared with 28 percent of white Americans.

“There was a ton of talk about this at the time,” Padamsee said. “The explanation for the higher rates often relies on a little bit of general hesitance or mistrust of health care institutions.”

Historically, black patients have been used as “guinea pigs” for health research to benefit other groups, and the black community is very well aware of that, Padamsee said.

Surveys also have shown that in general, black Americans don’t receive the same quality of care at health institutions as white Americans, she said.

“Concern stemming from the history of black Americans with clinical trials and mistrust of the health care system has built great hesitancy,” said Youngstown Health Commissioner Erin Bishop.

The Minority Community Vaccination Action Group was established in March 2021 in response to high vaccination hesitancy among minority community members in Youngstown and Mahoning County, according to Bishop. The group is a “special and intensive effort” to increase “the percentage of vaccines that go into the arms of minorities.”

In Warren, city health district epidemiologist Jacob Marvin said the vaccine uptake has been “much stalled” across all races.

“However, from a comparative perspective, minorities do seem to be more hesitant, and that is reflected in our numbers and our engagement with the community,” Marvin said.

WARMING UP

Padamsee, however, hypothesized the discrepancy would be a temporary problem, and that with time and information the black community would become less hesitant toward getting a COVID-19 vaccine –and, after seven months of surveying a group constructed to be representative of the general population, Padamsee found that to be true.

“What we found was that black Americans experienced a much larger increase in vaccination intention over this time,” she said.

By June 2021, surveys showed that 26 percent of black Americans and 27 percent of white Americans were still hesitant about getting vaccinated — a 12 percent drop among the black community, as opposed to a 1 percent drop among white Americans.

Padamsee said the research found that people are more likely to take the vaccine if they think it is safe, effective and necessary to keep themselves and their communities safe.

“The racial difference is kind of the belief in some of those factors,” Padamsee said. “Over the same period we found that black Americans were more likely to come to the belief that vaccines were necessary to protect oneself and one’s community.”

Padamsee said it’s important not view the shift to less vaccine hesitancy strictly as people changing their minds.

“This is a community of people that is very invested in protecting themselves, and that community of people took a minute to kind of say, ‘I’ve got what I need to know, this is the right choice.'”

VACCINE RATES

Despite the shift in intention, vaccination rates among black Americans remain lower than among white Americans. As of Jan. 31, 55 percent of black Americans have received at least one dose of a COVID-19 vaccine, as opposed to 61 percent of white Americans, according to the Kaiser Family Foundation, a nonprofit that compiles and analyzes facts regarding national health issues. Its data on vaccination by race comes from the Centers for Disease Control, which has reported the race / ethnicity for 74 percent of people who have received a vaccine dose.

Padamsee said a 6 percent difference is “pretty big.”

Statistics from the Warren City Health District show 45.7 percent of all vaccines have been given to white community members, as opposed to 23.6 percent to black community members, according to Marvin.

In Youngstown, 10,520 of the city’s roughly 23,632 black residents 12 and older, or about 45 percent, have had at least one dose of a COVID-19 vaccine, as opposed to 21,137 of about 33,708 white residents 12 and over, or 63 percent, as of the most recent data available from the Youngstown City Health District. That’s a gap of about 18 percent, much larger than the national gap. The race of 2,297 vaccinated Youngstown city residents was not reported.

The reason for the disparity? Likely, it’s a matter of access, Padamsee said.

“We are living in a time when it’s still really important that we look at these kind of questions,” Padamsee said. “We have copious data that in almost every health arena … black Americans are systematically disparaged compared to white Americans.”

SOCIAL DETERMINANTS

At play are social determinants of health, the conditions in which people are born and live that affect a wide variety of health outcomes and quality of life.

Social determinants of health include factors such as having sidewalks in a neighborhood to promote walking, having access to a grocery store with healthy food options, or, in this case, having awareness of and access to a vaccine site.

In the Mahoning Valley, early attempts to register for COVID-19 vaccines online and fruitless efforts to make appointments by phone left many black residents assuming it “just must not be meant for them to get the vaccine,” Bishop said.

Padamsee said another issue specific to the COVID-19 vaccine has been letting everyone know the vaccines are free, regardless of whether you have health care. When people are used to getting big bills from medical doctors, they may not realize the vaccine isn’t going to cost them anything, she said.

Another access barrier relates to work, Padamsee said. If someone can’t get out of work to get vaccinated or can’t afford to miss a day of work if they feel ill after being vaccinated, and they depend on that paycheck, they may decide it’s not worth getting the vaccine, she explained.

“We really need to dive into these communities and see what’s going on,” Padamsee said.

OUTREACH

Since 2020, Aaron Clark, an osteopathic doctor with OSU’s Wexford Medical Center, has been leading an initiative to reduce disparities between white and minority populations when it comes to another common immunization: the flu shot.

“We know that immunization is our best defense against things like influenza, so we want to make sure we’re including all the communities that we serve equally,” Clark said.

Clark said using data from the Wexford Medical Center, his team found a 13 percent disparity gap between the vaccination rates of nonwhite and white. After two years of outreach, that disparity gap has lowered to 11 percent.

Clark said the initiative has involved doing internal and external communications to highlight the importance of influenza immunizations and to address concerns. That has involved nurses and physicians of color highlighting the importance of immunizations through livestreams and on social media and having information about flu shots in the form of posters and window clings at places where the shot is available.

“It’s a hard gap to close, and it’s going to take a long time to get it to zero,” Clark said.

Back on the COVID-19 front, the Warren health district has tried reaching out to the local minority community by going to the Trumbull Community Action Program and by partnering with Downtown Grooming Lounge to host several COVID-19 vaccine clinics, according to Warren Deputy Health Commissioner John May.

The city has been a part of the “Shots at the Shop” national initiative, which trains qualified barber shops and beauty salons to serve as trusted COVID-19 vaccine educators.

Mahoning County and Youngstown’s Minority Community Vaccination Action Group partnered with organizations led and operated by people of color, including churches, fraternities, sororities, social clubs and agencies, according to Bishop.

Youngstown City Health District employed outreach workers who assist people with registration and scheduling, and Just In Time Transportation offered free transportation to dedicated minority vaccination clinics, she said.

“The group built trust by creating opportunities through radio, print, TV spots and social media for grass-roots minorities to see and hear from trusted minority leaders about their experiences with the vaccination and why and how they made decisions to take the vaccine,” Bishop said.

The Minority Vaccination Action Group continues to meet regularly and has an upcoming webinar at 5 p.m. Feb. 28.

avugrincic@tribtoday.com