How can vaccine developers earn the trust of Black Americans?
Black people make up 13% of the U.S. population and they account for 21% of deaths from COVID-19. But only 3% of enrollees in vaccine trials are Black, according to a recent “Perspective” column in The New England Journal of Medicine.
“This problem threatens both the validity and the generalizability of the trial results and is of particular concern in vaccine trials,” write 4 authors associated with the National Center for Bioethics in Research and Health Care at Tuskegee University and the Center for Bioethics at Harvard Medical School.
A critical barrier to greater participation of Black people in COVID-19 trials is the “deep and justified lack of trust that many Black Americans have for the health care system in general and clinical research in particular,” write the authors. This distrust can be traced to the infamous syphilis study at Tuskegee, in which investigators withheld treatment from hundreds of Black men in order to study the natural progression of the disease. But that lack of trust is also rooted in “centuries of well-documented examples of racist exploitation by American physicians and researchers,” they suggest.
The authors propose 5 steps that vaccine developers can take to earn the trust of Black Americans so they will participate in vaccine trials:
- Ensure that the informed-consent process, design, and conduct of clinical trials are transparent.
- Guarantee that people who have suffered from the social determinants of poor health that are prevalent in many Black communities will have fair access to vaccines.
- Provide credible evidence that pharmaceutical companies will not submit a vaccine for approval until it has been thoroughly vetted for safety and efficacy.
- Ensure that trial participants will receive appropriate medical care if they are injured as a result of receiving an experimental vaccine.
- Launch “Operation Build Trustworthiness” and involve individuals and organizations with solid reputations for trustworthiness in Black and other minority communities.
“It would be wrong, as well as ineffective, to ask Black communities to simply be more trusting,” conclude the authors. “Clinicians, investigators, and pharmaceutical companies must provide convincing evidence—sufficient to overcome the extensive historical evidence to the contrary—that they are, in fact, trustworthy.”