In March 2021, the Centers for Disease Control and Prevention reported that Blacks, Latinos and American Indians were roughly two to four times more likely than white, non-Hispanic individuals to be hospitalized due to COVID-19 and two to three times more likely than white, non-Hispanic individuals to die from the virus.
The country’s troubling history of discrimination, medical mistreatment and other socioeconomic issues have made people in these populations hesitant to participate in coronavirus vaccine trials—a critical factor that can help drive vaccine acceptance.
In the summer of 2020, Drs. Gary Gibbons and Eliseo Pérez-Stable of the National Institutes of Health established two outreach programs that funded new partnerships between NIH and local organizations to inform wary populations about COVID-19 testing and new vaccine trials. The doctors also worked with several pharmaceutical companies to support these efforts.
“The year 2020 will be remembered for two big events: COVID-19 and bringing to light structural racism, which includes health care,” said Dr. Francis Collins, the director of the NIH. “Dr. Gibbons and Dr. Pérez-Stable are addressing both of those crises with laudable, highly challenging community outreach.”
The first program, RADx-UP, was designed to increase COVID-19 testing in underserved communities and examine the socioeconomic factors that affect testing rates for these populations. The program provided funding for 53 projects in 33 states to help implement testing in underserved and vulnerable populations.
The second program, the Community Engagement Alliance Against COVID-19 Disparities, conducts targeted local outreach to churches, doctors, community advocates, educational institutions, and other leaders and institutions in 11 states. It was designed to ensure Black, Latino and American Indian populations receive accurate information about the vaccines and disease treatments by addressing misinformation and promoting faith in science through trusted messengers at the local level.
“Science needs to partner with communities and not have the researchers come in with the science to tell everybody what to do,” Pérez-Stable said.
Lawrence Tabak, the principal deputy director at NIH, recalled that the institute’s leaders initially wanted to address low vaccine acceptance in underserved communities by asking social media influencers, celebrities and athletes to speak up. Gibbons and Pérez-Stable, however, insisted on engaging the trusted voices within those communities. “The genius of this is the on-the-ground personal touch,” Tabak said.
As part of their mission, Pérez-Stable and Gibbons also worked with pharmaceutical companies, NIH leadership and others across the Department of Health and Human Services to recruit a greater diversity of vaccine trial participants.
Gibbons said that drug companies tend to recruit clinical trial participants “who are most willing to put up their hand.”
“Often that tends to be people who have certain privilege and socioeconomic flexibilities, but not necessarily those who are most adversely affected by the disease,” he said.
Throughout 2020, Gibbons and Pérez-Stable met with the drugmakers Moderna, Johnson & Johnson, AstraZeneca and Novavax to discuss strategies for diversifying clinical vaccine trials. The doctors worked particularly closely with Moderna. On their recommendation, the company eventually paused its normal recruiting procedures and began to target only participants from underrepresented communities.
“The two of them made it unambiguously clear that if we followed the typical path of enrolling clinical trials, we would be failing the very communities that were hardest hit by the pandemic,” Tabak said.
These efforts were successful. According to Pérez-Stable, Black and Latino participants composed roughly 20% of Moderna’s trials in mid-August. Two months later, underrepresented groups made up 37% of these trials—with Latinos, Blacks and Asian Americans constituting 20%, 10% and 4% of the participants, respectively. The Johnson & Johnson trials, launched in the winter, initially included 12% to 15% Blacks and Latinos before the community engagement program team used the same recruitment strategy to achieve similar growth among these populations.
Gibbons explained that more diverse clinical trials enable medical professionals to produce research that shows vaccines are safe and effective for different populations.
“I couldn’t look anybody in the eye from the African American or Latino community and say, ‘We need you to have this vaccine to protect yourself, but very few people who look like you or have your lived experience ever took it in those clinical trials,’” he said.
Gibbons and Pérez-Stable hope the outreach programs will help change the way scientific leaders tackle health disparities for other diseases besides COVID-19.
“My mission,” said Pérez-Stable, “is to make the science of minority health and health disparities an important part of all the questions that we ask about any clinical topic, whether it be infectious diseases like COVID-19, diabetes or cancer.”
Collins noted that the programs have made a difference, but acknowledged that the data on both COVID-19 and other vaccine trials shows there is more to do. The NIH director is optimistic that the doctors’ initiatives will make a difference by building “the right connections and trust in minority communities.”
Photo credit: Sam Kittner