By Cody Mello-Klein | firstname.lastname@example.org
As Alexandria attempts to hit its 80% vaccination target by the end of the summer, the health department and various city partners are encountering some challenges to overcoming barriers among the local Black community.
In Alexandria, 67.5% of adults age 18 or older have received at least one vaccine dose as of Tuesday, according to the Alexandria Health Department. But the city’s Black residents have received the vaccine at a lower rate than other race and ethnic groups relative to their proportion of the total population: Just 17% of those who have been vaccinated in the city with a race or ethnic designation identified as Black, though Black residents make up 21% of the city’s population.
Conversely, vaccination rates for white and Latino residents almost exactly mirror their percentage of the population: White residents make up 52% of the city’s population according to the 2018 Census five-year estimates, and they comprise an identical 52% of those with an ethnic identification who have been vaccinated. Hispanic residents account for 17% of the total population, and they make up 16% of the city’s vaccinated population with a race or ethnic designation.
Asian or Pacific Islander residents have been vaccinated at a rate higher than their representation in the total population. They account for 6% of the total population and 8% of the vaccinated population. The remaining 7% of those vaccinated with a race or ethnic designation identified as “other race” or two or more races. City-wide this group accounts for 4% of the population.
Natalie Talis, population health manager for AHD, and other city leaders said that the lower vaccine numbers among Black residents are due to multiple factors.
Barriers to vaccine access due to childcare needs, work demands or transportation remain an issue for some residents, according to Talis.
“We hear a lot of stories about how people are just really hesitant, they don’t want to do this stuff, but there is still that interest in the community and people have just encountered barriers, like transportation, or it just didn’t work for their work schedule,” Talis said.
Misinformation has remained a prevailing challenge for the health department’s vaccination efforts. Hearts of Empowerment, a nonprofit that partnered with AHD for a vaccine clinic on June 25, has been working to educate Black and Latinx families about the vaccine in the DMV and has dealt with similar issues.
“If there’s one notion of a false narrative, it kind of spreads quickly like wildfire, especially in a smaller community like that,” Nkosi Davis, director of corporate outreach for Hearts of Empowerment, said of the apartment complexes that his organization has worked with.
At the same time, hesitancy founded on the historic use and abuse of the Black community by the medical profession have created barriers and misperceptions that, while justifiably founded, have proven difficult for AHD to overcome.
“I think you’re always going to have people of color who don’t have the greatest history, in general, with the United States government, whether it be federal or local,” Councilor John Chapman said. “I think some of that basis is historical and definitely plays a part in a lot of the hesitancy we’re seeing from communities of color.”
The history of the American medical system’s relationship with Black Americans is long, troubled and full of stories that have left many wary of any widespread medical efforts.
There is the story of Henrietta Lacks, a Black woman who, in 1951 at the age of 31, was diagnosed with a specific kind of cervical cancer by doctors at Johns Hopkins. Lacks received treatment, but during her treatment, doctors took two samples from Lacks’ cervix without her consent or knowledge.
Those cells were used to create a cell line called HeLa, an “immortalized cell line” which is still used in biomedical research today. Neither Lacks nor her family were ever compensated.
Then, there are the Tuskegee experiments, which the U.S. Public Health Service conducted on Black sharecroppers in Alabama. Performed between 1932 and 1972 with the purpose of chronicling the workings of untreated syphilis, the study involved 399 men who were not told they had latent syphilis and another group of 201 men who did not have the infection.
The men involved in the study, which was originally supposed to last only six months, were never told about their diagnosis and were given placebos as treatment, even after 1947, when penicillin was widely available as a form of treatment. By the time the study was leaked to the press and terminated in 1972, 28 men had died from syphilis and 100 died from complications related to it. Forty of the men’s wives were also infected with syphilis, and 19 children were born with a congenital form of the infection.
“People who have experienced racism in healthcare or bias in those senses, especially when you look at the historical context, it makes a lot of sense,” Talis said. “The fact that there is still significant racism in those systems and internal bias, there is all that piece as well.”
Talis also said that her staff has noted a general mistrust of government and institutions among Black residents in their 20s and 30s, particularly based on “interactions with the criminal justice system and those kinds of experiences.”
Those barriers could prove more and more dangerous, particularly as the Delta variant of COVID-19 spreads across the United States, posing a new threat to those that are still unvaccinated.
“The last thing we want to see, especially for these families that experience so much hardship in the pandemic, is for them to go through that again via a positive test result or not getting vaccinated because they’re misinformed or miseducated,” Davis said.
Despite these challenges, AHD has undertaken “a pretty aggressive outreach campaign” specifically aimed at the Black community and other vulnerable communities in which the threat of COVID-19 is most present, according to Talis.
The health department has a team of five outreach workers, funded by the Federal Emergency Management Agency, who speak either Spanish or Amharic, and are constantly canvassing neighborhoods and apartment complexes. Much of their work is focused on low-income apartment buildings and communities of color, areas where information about the COVID-19 vaccine has not always been readily available.
These workers provide information and assist residents in setting up vaccine appointments. According to Talis, these workers have knocked on more than 7,000 doors across the city.
“I think people have a lot of questions and they’re seeing things on social media that are just completely false, so a lot of the work we do is asking people why they haven’t been vaccinated yet, and then really listening to what’s driving why they haven’t been vaccinated,” Talis said.
By putting a face and a name to the health department’s efforts, Talis said she hopes AHD can start to chip away at some of the historic mistrust when it comes to healthcare.
“Again, our approach is we interact as individuals, and so even though we’re representing the health department … I’m Natalie, I’m talking to you and I want to talk to you as my neighbor, as someone in this community,” Talis said.
AHD has also focused its efforts on strategic community partnerships in an attempt to reach Black residents.
Although the health department has been working with churches and other faith groups throughout the pandemic, more recent partnerships with grocery stores, barber shops and beauty salons have proven fruitful. Between partnered sites and door knocking outreach, Talis said AHD has been able to set up appointments for about 40% of the unvaccinated people they encounter.
Grocery store managers at Food Star and Global Food have allowed AHD to set up shop outside their stores, and store managers have at times sent out their entire staff to talk with AHD workers and set up appointments, according to Talis.
“As we connect with more and more of those partners of trust, I think we are able to get further into some of these communities,” Chapman said.
The relationship between barbershops, a nexus of culture and conversation for Black and brown communities across the country, and AHD is the most recent example of a longstanding yet unexpected partnership. Public health workers have long organized diabetes education and intervention efforts by training barbers and beauticians on the talking points, Talis said Rick Wanzer, the owner of Another Level Hair Studio in west Old Town, has allowed AHD staff to set up in his shop, where they have helped set up vaccine appointments for residents.
Wanzer, who grew up in Alexandria and founded Another Level in 2002, had worked with the health department to get more than 120 people vaccinated, including his staff.
“We’re in the community, so you have to do your part,” Wanzer said. “You can’t just be there and have a business and just shut the doors and walk away. You’ve got to get involved in the community.”
Although Wanzer said the majority of his clients were eager to get the vaccine, there were some, especially younger people, who were “apprehensive about getting vaccinated” due to concerns around potential long-term effects. Some said they refused to get the vaccine because they claimed “they have the antibodies now,” according to Wanzer.
Hearts of Empowerment has taken a similar approach, according to Davis.
“Our task was kind of to go in there and educate them and realize that once they see people like them of a similar background getting vaccinated and are able to show that level of trust, that was most important for us,” Davis said.
As a result of this community approach, vaccine events like the one held by Hearts of Empowerment on June 25 at the Charles Houston Recreation Center have started to resemble community cookouts and parties more than clinics.
About 200 people showed up to the event, including Mayor Justin Wilson and Chapman, which included a vaccine clinic alongside music, free food, a moon bounce, a dunk tank and a grill manned by members of the Alexandria Sheriff’s Office. By the end of the event, more than 75 people had received vaccines.
“We normalize the fact that everybody has to get vaccinations to fight this virus,” Chapman said. “That being normalized is a big key to what I saw them doing.”
According to Talis, normalization within the community, not the monetary incentives that have been used in other jurisdictions, is the best way for the city to achieve not only its vaccination goal but a better relationship between the community and public health as a whole.
“How can we build on this relationship even well beyond the pandemic to address the other health issues in our community?” Talis said. “Can we build on those foundations and then come back and talk about, how do you deal with chronic health issues? Are you getting tested for STIs? Or do you need support with other immunizations?”