Distrust, skepticism, but also relief as Floridians weigh rollout of initial COVID-19 vaccines

By: - December 9, 2020 7:00 am

Credit: Fiona Goodall/Getty Images

For all the anticipation surrounding the rollout of COVID-19 vaccines, large portions of Florida’s population plan to give the injections a pass, at least until the products have a chance to prove themselves.

They particularly include African Americans. To understand why, you need know only one word: Tuskegee.

As in the Tuskegee experiment, beginning in 1932, when researchers studied the progression of syphilis in Black men without informed consent or access to penicillin when it became available. They allowed the disease to take its course, and African Americans haven’t forgotten.

“Always. It’s just embedded in our DNA,” Tallahassee community activist Miaisha Mitchell said of that episode, which extended into the 1970s.

“They’re not trusting the medical system,” she said of Black Americans. “Health care providers have not always been our best friends.”

Mitchell runs or belongs to a host of organizations trying to improve health disparities for Black Tallahasseeans, including the Greater Frenchtown Revitalization Council in Tallahassee — which works on community development in a predominantly Black neighborhood — and the Tallahassee Food Network.

Some evidence does suggest demand for the shots is increasing as the release dates near. According to a Pew Research Center poll released on Dec. 3, more than 60 percent of respondents definitely or probably will take the vaccine if one were available, an increase from 51 percent in September.

Some 39 percent definitely or probably would pass, although about half that number might change their mind once they know more. Twenty-one percent don’t plan to get vaccinated and don’t think more information would change their minds.

Elsewhere, public health experts have attempted to measure vaccine aversion among Blacks and other demographic groups by looking to rates of vaccination against influenza. Florida ranks second to the bottom in its flu vaccination rate, at 45 percent; only Nevada was worse. The South overall scores a 52 percent vaccination rate, which corresponds to the national rate, according to Kaiser Family Foundation data.

The U.S. Department of Health and Human Services goal for flu vaccinations is 70 percent — meaning that Florida falls seriously short.

The data reflect racial disparities. Blacks in Florida scored a 38 percent flu vaccination rate; Hispanics 37 percent; and whites 50 percent.

Vaccine-shy

“Achieving a high COVID-19 vaccination rate among people of color will be particularly important because they are bearing a heavy, disproportionate burden of the disease, and population immunity is not likely to be reached without high vaccination rates across all communities,” Kaiser said.

Age disparities also exist, with Florida children vaccinated at a rate of 56 percent; adults aged 18 through 64 at 33 percent (the lowest among the states); and older people at 66 percent.

The study attributed these disparities to a range of factors including access to health insurance (Florida has not accepted Medicaid expansion under the Affordable Care Act), differences in funding and infrastructure for vaccine administration, and “and variation in levels of concern or misconceptions about vaccine safety, side effects, and efficacy.”

A doctor draws blood from one of the Tuskegee (Alabama) test subjects. Credit: Wikimedia.

Specifically, a Kaiser survey found that only 17 percent of Black Americans said “they would definitely get a COVID-19 vaccine if it was determined safe and available for free, compared to 37 percent of white Americans, largely due to safety concerns or distrust of the health care system.”

“While there are important distinctions between COVID-19 and seasonal flu, including that COVID-19 is much more serious, and the public’s receptivity to a COVID-19 vaccine may differ from that of the flu vaccine, these findings suggest there may be significant challenges to achieving equity in distribution and sufficient levels of immunity in the U.S. with a COVID-19 vaccine,” the report concludes.

Mitchell, the activist, hopes more Black people will seek vaccinations as the program expands and more people they know take the shots without ill effects, perhaps within a year or so. “It’s that evidence-based thing again — ‘I’ll just have to wait and see.’ That’s what people are saying.”

That’s just one aspect of the logistics challenge. Parsing the situation is difficult, given that the DeSantis administration has been less than forthcoming about its plans to administer these products.

Gov. Ron DeSantis participated in a COVID-19 vaccine planning summit hosted by the White House on Dec. 8, 2020. L to R: Tennessee Gov. Bill Lee, Texas Gov. Greg Abbott, HHS Secretary Alex Azar, and Louisiana Gov. John Bel Edwards. Source: Screenshot

Gov. Ron DeSantis — who was at the White House on Tuesday for a COVID vaccine summit — has been appearing in video messages discussing vaccine administration, saying in one that the state hopes to secure as many doses as possible while acknowledging that officials won’t have enough to vaccinate everyone “right off the bat.”

Asked for more details about the plans, the Florida Department of Health referred the Phoenix to the Division of Emergency Management, which offered no response to multiple requests for specifics regarding any updates to an October draft vaccination plan and how officials hope to overcome any public resistance to the vaccines.

Here’s what we do know:

The federal government is preparing to ship to the states 40 million doses of a vaccine manufactured by Pfizer and German partner Pfizer-BioNTech. Indications are distribution will be prorated according to population. Since nearly 330 million people live in this country, those initial supplies won’t go far, relatively.

DeSantis has announced that his top priority for the shots will be residents of long-term care facilities who are most vulnerable to the coronavirus, followed by “high-risk frontline health care workers” and then people above age 65 or with significant underlying health conditions “to the extent we have enough.”

During the vaccine summit, DeSantis said he hopes to vaccinate every nursing hope patient by the nd of December.

He stressed: “No one will be mandated to take the vaccine. This will be available, but not mandated.”

Meanwhile, on Tuesday a U.S. Food and Drug Administration study found that the Pfizer vaccine is safe and effective, based on preliminary data, as the Associated Press among others has reported. Its efficacy rate reportedly is around 95 percent.

That’s true even after a single dose, according to reports circulating on Tuesday. Orginally, the plan was to administer two doses 21 days apart; a Modena vaccine requires two doses 28 days apart; AstraZenica’s version requires two doses at still-to-be-determined timing, according to the governor’s office.

A Johnson & Johnson vaccine likely to secure federal approval seems to hold the most promise, according to the governor, because it’s already in mass production and doesn’t require ultra-cold transport and storage, as does the Pfizer version.

“Perhaps that could start hitting by the time we get into February. There would be enough produced of that to have widespread vaccination,” DeSantis said.

“Distributing a vaccine across a wide and diverse state is a big challenge, but this is a major priority for the state of Florida,” he said.

The plan

Planning for vaccine distribution began in July. Since then, the state has purchased 5 million syringes, 5 million needles, and 5 million alcohol swabs, according to DeSantis.

The administration has signed up five hospitals with the ultra-cold storage: Jackson Memorial Hospital in Miami, Memorial Regional Hospital in Hollywood, AdventHealth Orlando, Tampa General Hospital, and UF Health Jacksonville.

“Details of how and when the vaccine will be distributed and who will receive any initial doses are still being worked out at the state and federal levels, although it’s our understanding that front-line health care workers will be among the first eligible to receive them,” U.F. spokesman Dan Leveton told the Phoenix via email.

“We do not yet have details of what this will mean for U.F. Health and our hospitals in Gainesville, Jacksonville, The Villages, and Leesburg and hope to learn more within the next few weeks. We look forward to sharing more information with the communities we serve as it becomes available,” he said.

Through what it called Operation Warp Speed, the Trump administration provided some $10 billion to ramp up a vaccine development and distribution system and the advance purchase of millions of doses. For example, the feds have paid Pfizer $1.95 billion for 100 million doses of its vaccine according to a Kaiser Family Foundation report dated Oct. 20.

At the state level, a working group includes representatives of the state’s immunization program, public health experts, epidemiologists, emergency medical services, emergency management, hospitals, nursing homes, and — naturally — lawyers.

Members include Florida Surgeon General Scott Rivkees; Shamarial Roberson, deputy secretary for Health; and Carina Blackmore, the state epidemiologist.

A draft “COVID-19 Vaccination Plan” for Florida, dated Oct. 16, envisions three phases for distribution. Initially, doses will go to the hospitals with the deep-cold equipment. These will be targeted to high-priority groups including those long-term care residents.

“So far, nearly 2,000 long-term care facilities have registered so that they can start getting their residents vaccinated as soon as the vaccine arrives,” DeSantis said in video remarks on Nov. 19.

Older people are particularly vulnerable to COVID-19, and Florida has a lot of them: more than 4.3 million aged 65 or older, according to the October draft report. As of September, long term care residences were home to 145,563 patients with 222,541 staff.

Efforts also are underway to identify vulnerable ethnic populations, college students living in close proximity, inmates, and disabled persons (of whom the state has counted more than 20 million).

Large pharmacy chains CVS and Walgreens will play important roles, DeSantis said, including the initial drive to vaccinate residents of long-term care facilities.

“Additionally, pharmacies will play a key role in the vaccination delivery to the general population in similar fashion to the way they provide annual flu vaccinations,” the draft report says.

Later phases

In Phase 2, as supplies increase, “pediatricians, primary care providers, and pharmacies will receive doses,” the draft says.

“It is likely that in this phase, the [county health clinics] will open public mass vaccination clinics,” it says, and the departments of Health and Emergency Management “might open such clinics to ensure there is equitable distribution of the vaccine, in the same way COVID-19 testing was made available.”

In Phase 3, “Once the vaccine is widely available and demand for the vaccine stabilizes, the state will transition to providing the vaccine through routine health care delivery systems, including commercial pharmacies. CHDs will continue to offer vaccine clinics that are open to all members of the public as needed to meet vaccination goals.”

The document lays out strategies to monitor storage and handling, safety, recruit providers, remind people to take second doses when necessary, and more.

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Michael Moline
Michael Moline

Michael Moline has covered politics and the legal system for more than 30 years. He is a former managing editor of the San Francisco Daily Journal and former assistant managing editor of The National Law Journal. He began his career covering the Florida Capitol for United Press International. More recently, he wrote for Florida Politics.

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