Update (10/12/23): Allegheny County announced on Thursday, Oct. 12 that it received its supply of COVID-19, influenza and respiratory syncytial virus [RSV] vaccines. Community members can receive all vaccines at the county’s Immunization Clinic by appointment or on a walk-in basis. Call 412-578-8062 to schedule an appointment.

Reported 9/27/23:

The path to vaccine equity? Address 3 fears, study suggests.

Kristina Terrell took months to make up her mind before she received a COVID-19 vaccine.  

Terrell, who is immunocompromised, said she needed the time to consult her doctor: Would her health condition keep her from mounting a robust immune response to the vaccine? What side effects might she experience? And how were drugmakers able to bring the vaccines to market so quickly? 

Terrell is Black. Her doctor, who is white, welcomed her questions and patiently answered them. 

“She’ll let me talk through something 100 times until she’s blue in the face answering them,” said the 38-year-old from Garfield, who supports a large family that includes her mother and children. “There’s no barrier in her relationship with me and I’ve always felt that she’s had my best interests [at heart], although she doesn’t look like me.” 

Her doctor’s advice helped her make a decision: She took 10 family members to a mobile vaccine clinic at a community block party last year. They all received a first dose of the Pfizer vaccine and completed their primary vaccine series about a month later. 

A vaccine clinic was held at a community center in Northview Heights, in Pittsburgh, in April 2023. (Photo courtesy of Ruth Howze/Black Equity Coalition)

Terrell said she has friends and family members who refused to be vaccinated. Their hesitancy is part of a problem that advocates have been trying to solve for more than two years: lower uptake of COVID vaccines in Black communities across Allegheny County.  

Vaccine hesitancy was reported by more than half of participants — all of whom were Black — in a recent study by researchers at the University of Pittsburgh and the Black Equity Coalition [BEC]. They surveyed nearly 400 Black adults in the county from September 2021 to January 2022 to understand drivers of that hesitancy, which the World Health Organization defines as a delay or refusal to get vaccinated despite the availability of vaccines. 

The researchers believe unvaccinated participants (about 23%) knew they were at risk because most wore masks to avoid a COVID infection. But they remained unvaccinated due to fear of illness (40%), side effects (26%) and not knowing the long-term effects of the vaccine (33%). Addressing their concerns might boost COVID vaccine uptake in Black and other communities of color, the researchers said in the study.

“We see [those reasons] as actionable,” said Ashley Hill, an assistant professor of epidemiology at Pitt, a BEC member and the lead author of the study. 

Addressing concerns amid ‘horrible rollout’

Less than 20% of Americans got the previous bivalent booster, with lower uptake among Black and Latino people.

The Pitt and BEC study was published last month in the journal Health Equity — just as providers, advocates and public health officials were gearing up for the rollout of the new monovalent COVID booster, which targets the Omicron variant XBB.1.5 and provides protection against EG.5, the dominant variant in the United States.   

The rollout of the new booster is off to a rocky start. Some people were turned away by pharmacies and other providers, who didn’t have the supply to honor their scheduled appointments. Others had trouble getting their health insurance to cover the cost of the shot. Because the federal Public Health Emergency ended in May, the U.S. government isn’t buying vaccine doses and distributing them to providers like it did during previous rollouts, leaving it to the commercial market. The Centers for Disease Control and Prevention said uninsured Americans can still access free COVID vaccines through its Bridge Access Program

“This horrible rollout seeks to upend all the good work we’ve done these past three years,” said Miracle Jones, the director of advocacy and policy at 1Hood, which worked to combat health misinformation and disinformation through social media campaigns and other programming. 

“I can’t direct a community member to go to the Health Department to get a vaccine right now,” she added. 

The county ordered booster doses “within the first hour” after they were made available, said Neil Ruhland, a spokesperson for the Allegheny County Health Department. The doses had not arrived as of Tuesday and were not yet available at the county’s Immunization Clinic. The county will announce the availability of doses when it receives them, said county spokesperson Amie Downs.   

Despite the bumpy rollout, Hill said healthcare providers in the region can use the study’s findings to work toward better uptake of this latest booster in Black communities. Doctors, nurses, physician assistants and other providers should encourage patients of color to ask questions, listen to their concerns, validate their feelings and provide factual information.   

“I think there’s certainly lessons learned,” she said. “[We should] really do the things that we saw worked effectively and not do the things that we saw were harmful or did not work.” 

Meeting valid fears with communication 

Vaccine hesitancy among Black people is a complicated issue with many causes, including misinformation, medical racism and previous vaccine rollouts that didn’t center communities disproportionately affected by COVID. The kind of patient education Terrell’s doctor provided is just one way to boost vaccine uptake. Another way is to bring the vaccines to people who don’t have the means to leave their homes and navigate bureaucratic healthcare systems. 

Ruth Howze has been doing that work as BEC’s community engagement specialist since COVID vaccines became available in 2021. She organized mobile vaccine clinics — including the one Terrell went to — during previous rollouts and will do so again this fall with BEC’s partners. The clinics will target the most vulnerable community members, including elderly, unhoused and homebound people. 

“Inequity is not new with this new rollout,” said Howze, a veteran public health educator who got her start during the early years of the HIV/AIDS crisis. Doctor’s offices and even federally qualified health centers were “holding tight on their vaccinations” during previous rollouts and requiring people to come to them. It’s why BEC had to “get creative” to secure vaccine doses by partnering with small pharmacies who were willing to go into communities.        

When Hill and the other researchers had trouble recruiting participants for the study, they turned to Howze for help. She took the survey to hair salons, barber shops, laundromats and community events, where she faced questions about how the researchers would use the data.   

The Black Equity Coalition and its partners are holding the following vaccine clinics.

Email info@blackequitypgh.org for information about more clinics.

  • COVID and flu vaccines at Pennshaw Estates, 115 Shaw Ave., Turtle Creek, Oct. 2, 2023, 11am to 12:30pm
  • COVID and flu vaccines at Electric Avenue Apartments, 325 Electric Ave., East Pitttsburgh, Oct. 2, 2023, 1pm to 2pm
  • COVID and flu vaccines at Lemington Apartments, 7151 Mary Peck Bond Place, Pittsburgh, Oct. 3, 2023, 10am-12pm
  • COVID and flu vaccines at Versailles Apts, 4626 Walnut St., McKeesport, Oct. 5, 2023, 11am to 12:30pm
  • COVID and flu vaccines at Mt. Ararat Baptist Church, 271 Paulson Ave., Pittsburgh, Oct. 8, 2023, 12pm-4pm
  • COVID and flu vaccines at Second Avenue Commons shelter, 700 Second Ave., Pittsburgh, Oct. 12, 2023, 9:30am to 12pm 
  • COVID and flu vaccines at Harriet Tubman Residence,  515 Negley Run Blvd., Pittsburgh, Oct. 17, 2023, 10:30am to 1pm 
  • COVID and flu vaccines at Light of Life Health Fair, 234 Voeghtly St., Pittsburgh, Oct. 24, 2023, 10am to 4pm

Howze said people asked “What do you need this information for?” and “What are you going to do with it?” She thought recruitment would be easy because of the relationships she had built in the community, but she underestimated people’s lack of trust in the medical establishment, which she said includes large institutions such as Pitt.

“And it was all pretty valid,” she added.   

Hill agreed that the participants’ concerns about how their data would be used were rooted in real issues. 

During focus groups separate from the study, Hill said some participants brought up the infamous Tuskegee Syphilis Study as a reason for their distrust of the government and medical professionals. (Thomas Parran Jr., the founding dean of Pitt’s Graduate School of Public Health, was a driving force in the Tuskegee study.) Others “talked quite openly” about their knowledge of doctors who experimented on slaves in the antebellum period for medical technology and innovation. 

Researchers at UCLA found that vaccine hesitancy among Black Americans may hinge more on their present-day, unsatisfactory experiences in the healthcare system.  

Talking to Black doctors may help build trust and inspire some folks to get vaccinated, said Hill, citing the success of 1Hood and the Gateway Medical Society’s “Ask a Black Doctor” series. It created virtual forums that linked community members with BIPOC doctors who answered their questions about vaccines and other health issues. The series ran for more than a year during the early part of the pandemic. 

Jones, who moderated some of the “Ask a Black Doctor” discussions, said she knows community members — including some on 1Hood’s own team — who got vaccinated because of the advice those doctors provided. But there were some holdouts, she said, which meant there was more work to be done. 

Non-Black providers and public health officials bear the most responsibility to do that work, she added. 

“They have all the responsibility, because they created all the problems, right?” she said. Those providers should examine their approach to healthcare and ask, “Is it rooted in white supremacy and is it harming folks?”

Terrell plans to get the new booster, but doesn’t know when one will be available to her due to the issues with the rollout — a process which resurfaces some of the very questions at the root of vaccine hesitancy in the Black community. 

“Who actually is getting the first order of supplies?” she said. “Who is that meant for, and what communities are they attempting to provide them for? That’s my concern more than anything else.”          

Venuri Siriwardane is PublicSource’s health and mental health reporter. She can be reached at venuri@publicsource.org

This story was fact-checked by Jamie Wiggan. 

This reporting has been made possible through the Staunton Farm Mental Health Reporting Fellowship and the Jewish Healthcare Foundation.

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Venuri Siriwardane is a health reporter for PublicSource, with a focus on mental health. She comes to PublicSource through the Staunton Farm Mental Health Reporting Fellowship. Venuri has a dual background...