Trump’s Surgeon General Battles Rising Covid Vaccine Skepticism
(Bloomberg) -- A coronavirus vaccine may be available as soon as the end of the year, but that will “mean nothing if people don’t trust it,” says Jerome Adams, U.S. Surgeon General, a job known as the nation’s doctor.
Many people don’t, and time is running short to convince them otherwise.
Adams, a key member of the White House Coronavirus Task Force, said he spends his days, nights and weekends racing to boost vaccine confidence. It is a daunting challenge, given that overcoming the pandemic hinges on vaccine use and the administration he works for has at times undermined confidence that a shot will be safe and effective. The question now is whether Adams and others can reverse the public’s reluctance — especially among Black Americans — to accept government assurances.
“I just want to say to people out there of this, that I'm at the table fighting for you, and specifically bringing up issues of equity, both as a Black man, and as someone who has championed these issues throughout my career,” he said in an interview.
Though low confidence in immunizations has been a pressing issue in the U.S. for years, Adams said, politics now has roiled the medical landscape and fueled new doubts. An inoculation will only be effective if a large majority of Americans get it, including Black people, who have higher infection and mortality rates.
“There's no chapter in the pandemic playbook for a presidential election,” Adams said. “That's made it very difficult for anyone to have a true conversation about health without some of these other agendas and areas of mistrust seeping in.”
President Donald Trump has urged U.S. regulators to expedite approval of Covid-19 vaccines and treatments, while accusing the Food and Drug Administration of slowing development to harm his re-election chances. The president has repeatedly said a vaccine would be approved by Election Day on Nov. 3, though that timeline has proven untenable.
Many Black Americans and others hard hit by the virus are unmoved by Trump administration entreaties to get the vaccine as soon as it’s available. The leading Black doctors group, the National Medical Association, said it would review vaccine data and make recommendations to physicians and patients.
Angela Riley, a Black pharmacist and a city councilwoman in Binghamton, New York, said there's a disconnect in the Trump administration's messaging to Black Americans.
“You have not prioritized me and my well-being overall, in terms of housing, in terms of arrest, in terms of social justice,” Riley said. “You've consistently tweeted racist remarks, you've talked about how the virus isn't real, yet you want me to go first?”
Adams has tried to shift the discussion about the vaccine to the science and the rigors of the approval process, not the politics. He said he has elevated concerns of doctors, faith leaders and others to Vice President Mike Pence, head of the virus task force, and Adams’s political patron: While serving as Indiana governor, Pence appointed Adams as the state’s health commissioner.
“This isn't about Donald Trump or Joe Biden,” Adams said. “This is about knowing there is a process in place and holding people accountable for the process.”
There is little sign that Adams’s approach is working. Only half of U.S. adults say they would “definitely” or “probably” get a vaccine to prevent Covid-19 if it were available, according to a September poll from Pew Research Center. That’s down from 72% in May. Mistrust is more pervasive among Black adults, with only 32% saying they’d likely get a Covid-19 vaccine, down from 54% in May.
Vaccine skepticism among racial and ethnic minorities is rooted in historical medical malpractice and exploitation, such as the infamous experiment in Tuskegee, Alabama, where Black men with syphilis were denied treatment without their knowledge over four decades. A previous Surgeon General is considered an architect of the notorious experiment. Adams said he carries the weight of that history in the role he now occupies.
These past wrongs are compounded by the shortcomings of today’s health-care system. One concern has been a lack of diversity in early-stage Covid-19 vaccine clinical trials. Later trials better reflect the racial and ethnic makeup of the U.S. after drug companies made extensive efforts to recruit volunteers in communities of color.
Still, overcoming deeply rooted reluctance is difficult when there’s lack of trust in the messenger.
Adams’s critics say he’s been an ineffective communicator for an administration that has been faulted for tone-deaf handling of racial issues. Some of his attempts to appeal directly to Black Americans on virus issues have drawn rebukes from lawmakers. And Adams’s senior role in the administration closely ties him to the hurried effort to Covid-19 vaccine.
But Evelyn Lewis, a family physician in Newnan, Georgia who has worked in the drug industry, lauds Adams for walking the tightrope.
"In that administration, if you disagree, you'll get thrown under the bus, and then run over by it,” said Lewis, who knows Adams professionally. “His ability to navigate that environment is critical to his ability to represent the community."
Just because Adams has a seat at the table doesn’t mean Lewis trusts the Trump administration or the health agencies it oversees. She remains concerned that the FDA and the Centers for Disease Control and Prevention have been compromised by the White House’s political agenda.
That leaves Lewis wrestling with one of the most difficult questions of her medical career: Should she advocate for people of color to line up and get inoculated should a shot become available?
“That’s a gut-wrenching question for a person like myself, who is a physician, who is an African-American,” Lewis said. “I'm still to-be-determined on my position. I want to see the data.”
Lisa Fitzpatrick, a CDC-trained epidemiologist, is among those trying to allay those doubts by volunteering for a clinical trial of a Covid vaccine.
“Being a Black physician, I needed to put my money where my mouth is,” said Fitzpatrick, now a professor at the George Washington University School of Medicine and Health Sciences. “This has to be a community-driven effort by people who are trusted.”
And while Adams said he doesn’t believe U.S. government officials, including himself, have yet earned the confidence of Black Americans, he’ll continue to work through those who are trusted. The stakes are high as the pandemic rages on.
“We need to help America understand,’’ he said, “that you cannot have social justice if you don't have health equity."
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