RTP NSBE JR - Team Immunity - Medical Mistrust and Awareness of COVID-19 and Vaccines (Paper)

Medical Mistrust and Awareness of COVID-19 and Vaccines 1

Medical Mistrust and Awareness of COVID-19 and Vaccines Team Immunity: Lauren Lascano and Brelyn McDonald Research Triangle Protégés Chapter of NSBE Jr. Region 2 Feb 14, 2021

Medical Mistrust and Awareness of COVID-19 and Vaccines 2 Table of Contents Abstract……………………………………………..………….………………………………………... 3 Introduction……………………………………………..……….………………………………..……... 4 Material and Methods……………………………………………………...……………………………. 5 Results…………………………………………………………………………………………..………... 6 Discussion……………………………………………………………………………….….…………….. 8 Conclusion………………………………………………………………………………………………... 9

Medical Mistrust and Awareness of COVID-19 and Vaccines 3 Abstract COVID-19 is a novel addition to science and critical knowledge is still evolving. Public health education will bring awareness to how critical it is to be vaccinated. This research examines the attitudes, opinions, and perceptions of COVID-19 vaccination in traditionally medically underserved communities.

Some have been hesitant to take the vaccine for various reasons. This includes the fact that clinical trials typically use predominantly white male participants, providing less conclusive understanding for underserved demographics. Literature also indicates consistent medical mistrust in clinical trial participation from the focus demographic is due to a prior history of discriminatory and ethically compromised practices. All of these factors will affect the continued wellness and lifestyle of the target demographic. The intent of the experiment is to understand how much effect Team Immunity can have on these factors, after providing education and awareness to address key concerns. This research is based on a convenient sample accessible to the research team from the traditionally medically underserved. It is ongoing and will serve as a resource, as new findings are realized. Increasing public awareness will enable traditionally medically underserved populations to make informed decisions regarding their desire to receive an appropriate COVID-19 vaccine. The purpose of this study is to research the impact of the COVID-19 vaccine on traditionally medically underserved communities, to understand hesitations, and to provide information to enable informed decisions, including for those with underlying medical conditions and pre-dispositions. A focus group from traditionally medically underserved participants has been identified. A qualitative research method will be applied. They completed a pre-test survey of questions, based on research and public sentiment to gauge their knowledge level of COVID-19 and the vaccine.

This group was provided with an information session on January 19th, 2021. They completed a post-test survey on the same questions. The effect on opinions will be evaluated. We surveyed and analyzed their opinions regarding the vaccine before and after the information was explained. This data was analyzed for trends and insights to enable solutions Team Immunity can provide to close gaps in awareness and to address trust barriers. Team Immunity has researched the problem and enabled our target demographic to

Medical Mistrust and Awareness of COVID-19 and Vaccines 4 access information through the information session. We hypothesize that more people will be interested in taking a COVID-19 vaccine if education is provided to determine best personal options considering one’s health, if barriers to trust are addressed, healthcare disparities are minimized, and an equal opportunity to access the appropriate vaccine is provided.

Introduction The beginnings of COVID-19 started in the Fall of 2019 in Wuhan, China, and soon spread quickly thereafter. The first case of COVID-19 in the United States was confirmed in late January of 2020 and since then, COVID-19 has disproportionately impacted minority groups such as African Americans and Latinos. According to the CDC, Black and African American people have 1.1 times the amount of cases, 2.9 times the amount of hospitalizations, and 1.9 times the amount of death due to coronavirus in comparison to white people. Hispanic and Latino people have 1.3 times the amount of cases, 3.2 times the amount of hospitalizations, and 2.3 times the amount of death due to coronavirus in comparison to White people (CDC, 2021). Disparities in COVID-19 outcomes likely stem from systemic racism in education, housing, and medical care. Inequity in minority groups is not new (Selden and Berdahl, 2020).

“Redlining” was a tactic that was used to refuse to insure mortgages in and near African American neighborhoods (Gross, 2017). This has kept people in neighborhoods with low opportunity, which discourages them from gaining more socioeconomic opportunities. This structural racism has kept socioeconomic opportunity away from those who live in low-income neighborhoods (Gross, 2017).

Along with housing discrimination, some studies have shown discrimination in healthcare for people of color (Egede, 2006). However, other studies also indicate that the discrimination that people of color face is also due to a lack of socioeconomic status (Egede, 2006). Within the African American and Latino communities, there are more essential workers than in the White community (Selden and Berdahl, 2020).

In the African American and Latino Communities, only 13.3 and 12.5 percent are able to work from home compared to 22.8 percent of White people (Selden and Berdahl, 2020). This evidence suggests disparities

Medical Mistrust and Awareness of COVID-19 and Vaccines 5 in employment-related infection. COVID-19 has further demonstrated the structural disparities in minority groups in the United States.

The Pfizer and Moderna vaccines are two COVID-19 vaccines in the United States that the CDC provides a plethora of information for. Many Americans are hesitant to take the vaccine and 30% of the US does not intend to get vaccinated against COVID-19 (Callaghan et al., 2021). Groups of people with the least amount of intention to be vaccinated include Black people and women (Callaghan et al., 2021).

Something that emphasizes the reluctance of minority groups in medicine is the history of medical mistrust (Callaghan et al., 2021). The history of medical mistrust in racial and ethnic minorities stems from unethical research practices and inequities in healthcare, due to systemic racism and implicit biases. When people try to link unethical research such as the Tuskegee experiment to current COVID-19 vaccinations this can steer people away from wanting to get vaccinated (Callaghan et al., 2021). From this, we can infer that attempts to link other unethical instances have similar effects on other minority groups such as the Puerto Rico Sterilization incident and the Hispanic community. More documented unethical medical research events also include Henrietta Lacks and the gynecological practices by John Sims on enslaved women.

Material and Methods To begin our process, we consulted public health professionals, clinical researchers, and subject matter experts. A convenience sample from traditionally medically underserved participants was identified. A qualitative research method was applied. They completed a pre-test survey of questions, based on research and public sentiment to gauge their knowledge level of COVID-19 and the vaccine.

This group was provided with a presentation from a public health agency. Some of the key points included statistics on the spread in North Carolina, the availability of vaccinations, a question and answer portion, and the history of medical mistrust in the Black community. They completed a post-test survey on the same questions. The effect on opinions was evaluated. We have surveyed and analyzed their opinions in a standard analytical tool regarding the vaccine before and after the information is explained.

Medical Mistrust and Awareness of COVID-19 and Vaccines 6 This data was analyzed for trends and insights to enable solutions Team Immunity can provide to close gaps in awareness and to address trust barriers. This was shared with professional societies that represent traditionally medically underserved demographics and community non-profits consisting primarily of Black and Latino people. This was promoted via social media, word of mouth, families, and industry colleagues. We hypothesized that more people will be willing to take the vaccine after becoming more educated on the subject matter and followed the scientific method. We referenced prior research in our questions. Three participants did not complete the post-assessment.

Results Here is a link to all of the data collected: Team Immunity Survey Analysis

Medical Mistrust and Awareness of COVID-19 and Vaccines 7 There were a total of 49 responses from both the pre and post-assessments; 26 took the preassessment and 23 took the post. There were 6 people of Hispanic, Latino, or Spanish origin that took both the assessments, 1 Asian American person that took both tests, and 18 Black people did the pre-test and 15 Black people took the post-test. 17 women took the pre-test and 15 women took the post-test. 8 men took the pre-test and 7 men took the post-test. 1 non-binary person took the pre and post-test. The major age brackets were 25-29 with 6 people on the pre and post-tests, 30-39 with 6 people on the pre and 5 people on the post-test, and 40-49 with 5 people on the pre and 4 on the post-tests. The age range was from 16-62. There were 41 questions on the survey in total. Questions 1-8 had to do with current, general awareness of COVID-19. Questions 9-15 and 25 had to do with medical mistrust. Questions 16-20 had to do with current awareness of the vaccine(s). Questions 21-22 had to do with the perceived effectiveness of government response. Questions 23-24 had to do with trust regarding the vaccine. Questions 26-27 have to do with the vaccine and where people have gotten information. Questions 28-40 are profile and lifestyle questions. Question 41 was for additional comments and question 42 was to check for an improvement in understanding. In Question 1, all participants agreed in both tests that wearing a mask when going out lowers the risk of spreading COVID-19. In question 2, all but one participant in the preassessment disagreed that people testing positive for COVID-19 cannot spread the virus as long as they wear a mask. In the post-test, everyone disagreed. In question 3, all participants disagreed with both tests that someone that has recovered from COVID-19 can go out regularly without a mask. In question 4, all but one participant in the pre-assessment disagreed that if someone contracts COVID-19 they cannot contract it again. In question 5, all but one participant in the pre-assessment agreed that going to a restaurant had a larger chance of spreading COVID than going to the grocery store. In question 6, all but 6 out of 26 participants agreed that covid is not only spread from person to person. In questions 7-8, all but one person agreed that COVID-19 is airborne and that eating at a restaurant has a higher chance at contracting COVID than going to a quick grocery store run. In questions 9-15 people became warier of medical professionals in the post-assessment. In question 16 all participants were aware that there is at

Medical Mistrust and Awareness of COVID-19 and Vaccines 8 least one approved COVID vaccine. On question 17 on the pre-assessment, 30.77% of participants were not aware of the side effects of the COVID vaccine and on the post-assessment, 8.7% of participants were not aware of the side effects. On question 18, 38.46% of participants in the pre-assessment were not sure of where to obtain information about side effects of the COVID vaccine and in the post-assessment that became 4.35%. In question 19, all participants were aware that there was at least one variant of COVID. In question 20, 7.69% of participants of the pre-test were not aware of how the COVID-19 vaccine was administered. In the post-test, 4.35% were not aware of how the COVID-19 vaccine was administered. In questions 21 and 22 people were less sure that their federal and state governments were ineffectively responding to COVID-19. In question 23, 10.37% more people were willing to take the COVID vaccine after the information. In the pre-assessment on question 24, the majority (42.31%) of people wouldn’t take the COVID vaccine because they do not trust the healthcare system and in the post-assessment the majority of people would take the vaccine. In question 25, 10.04% more people trust medical professionals in the post-test than in the pre-test. In question 26, 46.15% and 69.57% of people in the pre and post-assessments prefer to be vaccinated in their healthcare provider’s office. In question 27, most people receive their trusted information about COVID from the CDC and their social media as well as the news. On the post-test question 42, 91.30% of participants said that they now are more informed on COVID-19 and its vaccinations.

Discussion This assessment includes questions on several topics such as reviewing their general knowledge of how COVID-19 spreads (1-8), their sentiments on medical mistrust (9-15, 25), government response and effectiveness, their demographic profile. and lifestyle (28-40). Questions 1-8 did not show a significant change in the pre and post-assessments. These questions reviewed the current awareness of the sample. There was already a good understanding of basic knowledge and desired behaviors. At a high level, questions 2, 4, 5, 6, and 7 had an improved understanding of COVID-19 and how it spreads. 10 percent more people also were willing to take the vaccine after being introduced to more information. At

Medical Mistrust and Awareness of COVID-19 and Vaccines 9 a high level, people seemed to have more distrust in the post-assessment. This is likely because the information shared about medical mistrust in the black community was new to some and therefore became more educated on how medicine has not always been as ethical as it is today. All-in-all there is still more work to be done to address mistrust. One interesting finding from the assessment was that on question 11, “I completely trust medical researchers’/healthcare providers’ decisions about how biospecimens are best used.” people seemed to be less sure which was indicated by no participants strongly agreeing anymore and more unsure/strongly disagreeing participants than the pre-assessment.

However, on question 25, “Do you trust medical/healthcare providers?” 10% more people answered yes than the pre-test. This could possibly be as a result of the wording of the question and that people generally trust medical workers, however do not feel that they completely trust them. This could also be as a result of people not trusting healthcare workers with biospecimens specifically. The increase of mistrust in question 11 may be as a result of introducing new information regarding historical experiments that created medical mistrust.

Conclusion Our hypothesis is that more people will be interested in taking a COVID-19 vaccine, if education is provided, to determine best personal options considering one’s health, if barriers to trust are addressed, healthcare disparities are minimized and an equal opportunity to access the appropriate vaccine is provided. Our hypothesis was correct and we were able to improve the understanding of participants and we detected a positive change in their sentiments regarding the vaccine. All in all, we found that introducing more information about the vaccine helped people to become more knowledgeable on the subject. Our results as to if people are more trusting of healthcare professionals seem to point in both directions of less trust after information about past mistrust was introduced. Some limitations of our sample are that we had a convenience sample, so the results were not as randomized. We also had a bit of non-response bias as well, because not all people that took the pre-assessment took the post-assessment.

We were also limited in our access to statistically significant tools. If we were to do this again, we would

Medical Mistrust and Awareness of COVID-19 and Vaccines 10 try to advertise the event so that more people of the public could attend, all could take a pre-assessment and randomly chosen participants would be selected to take a post-assessment. From that, we would analyze only those who took both assessments.

References Selden, T. M., & Berdahl, T. A. (2020) COVID-19 and Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition. Health Affairs, 39(9), 1-6. https://doi.org/10.1377/hlthaff.2020.00897

Gross, Terry. (2017, May 3) A ‘Forgotten History’ of How the U.S. Government Segregated America.

NPR. https://www.npr.org/2017/05/03/526655831/a-forgotten-history-of-how-the-u-sgovernment-segregated-america Egede, L. E. (2006) Race, Ethnicity, Culture, and Disparities in Health care. Journal of General Internal Medicine, 21(6), 667-669. https://doi.org/10.1111/j.1525-1497.2006.0512.x (2021, February 12) Hospitalization and Death by Race/Ethnicity. CDC. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalizationdeath-by-race-ethnicity.html (2020, December 20) U.S. COVID-19 Vaccine Product Information. CDC. https://www.cdc.gov/vaccines/covid-19/info-by-product/index.html Callaghan, T. (2021) Correlates and Disparities of Intention to Vaccinate Against COVID-19.

Social Science & Medicine. https://doi.org/10.1016/j.socscimed.2020.113638