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Health Team

A vaccine helped end racial disparities in pneumococcal disease. There's hope a vaccine will do the same for Covid-19

Posted October 24, 2020 1:17 p.m. EDT

— The world is focused on a Covid-19 vaccine to get everyone back to some version of normal, but the vaccine could also have another beneficial effect: It could reduce the disparities that have made the disease so deadly for some racial groups.

A recent study showed that a vaccine against pneumococcal disease erased racial differences in the rates of those infections. Pneumococcal bacteria cause potentially deadly types of pneumonia and meningitis, as well as heart and bloodstream infections.

"These results are amazing because they demonstrate that with the use of an effective vaccine, we in the US can reach out and literally eliminate disparities," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center and co-author of the study, which was published in the Journal of Infectious Diseases.

There's hope a vaccine against the coronavirus could do the same for Covid-19 disparities, he said, but two concerns would need to be addressed.

First, the vaccine would need to be widely distributed to minority communities. Second, there would need to be education about the vaccine aimed specifically at minorities, who are especially hesitant to take it.

"We're going to have to look these hard truths in the face," Schaffner said.

Vaccine made racial disparities disappear

Before the introduction of a pneumococcal vaccine in 2010, Black people were approximately 1.5 times more likely than White people to get sick from pneumococcal infections, according to the Vanderbilt study.

There are many reasons for those differences, including genetic factors, comorbidities, overcrowding, hygiene conditions, nutrition and poverty, according to a 2014 editorial in Clinical Infectious Diseases.

The recent study looked at 20 Tennessee counties that represent 55% of the state's population. After the introduction of the vaccine, the incidence of pneumococcal disease declined overall, and differences between Blacks and Whites disappeared. White people actually had slightly higher rates of illness.

Schaffner said other parts of the country have likely seen similar results.

He attributed the success to vaccination of children, who receive pneumococcal vaccines at ages 2 months, 4 months, 6 months, and 12 to 15 months.

For more than 25 years, the Vaccines for Children program at the US Centers for Disease Control and Prevention has helped provide vaccines to children of all backgrounds, even if their parents can't afford them.

"We have the capacity to eliminate disparities in our current system when it's applied comprehensively and intelligently," said Schaffner, a member of the CDC's Advisory Committee on Immunization Practices.

Unclear plans for getting Covid-19 vaccine to minority communities

With no coronavirus vaccine available yet, there remain stark racial differences in who is impacted by Covid-19. Black people are 2.6 times more likely to get coronavirus than White people, and Latinos are 2.8 times more likely to catch the virus than White people, according to the US Centers for Disease Control and Prevention.

"Our goal is to ensure every American has easy access to a vaccine once available, and ensuring access to minority communities and medically underserved populations is a top priority," according to a statement sent to CNN by a spokesperson for the Department of Health and Human Services.

It's unclear how the government intends to meet that goal.

Unlike the pneumococcal vaccine, the Covid-19 vaccine campaign will focus on adults at first, not children, and there's no program to ensure adults of all backgrounds have access to vaccines.

Last month, the CDC announced $200 million in funding to states for Covid-19 vaccine preparedness, but the agency's playbook for states to develop vaccine programs hardly mentions minority communities.

This week, an official with the Association of State and Territorial Health Officials said they still didn't have the federal money necessary to implement vaccine implementation plans.

Minorities have less access to health care, which could compromise their ability to get the vaccine once it's available.

"There are big time cost and distribution issues that need to be addressed," said Gary Puckrein, president of the National Minority Quality Forum.

It's also not completely clear that the vaccine will be free.

"We feel comfortable that our aspiration and the President's aspiration to provide vaccines to every American at zero out of pocket cost, that we're going to achieve that," Paul Mango, deputy chief of staff for policy at the US Department of Health and Human Services said at a telebriefing with reporters October 9.

'A real need to build up confidence'

Even if there's easy access to a free vaccine, there are questions about whether people of color will choose to take it.

Decades of discrimination and abuse by the health care system has left minorities, particularly Black people, mistrustful of doctors and scientific authorities.

Trust in the US Food and Drug Administration, which will authorize a vaccine, has been further eroded by a sense that the government is rushing the vaccine and forsaking safety, Puckrein said.

A recent poll shows Black people distrust a Covid-19 vaccine more than White people do.

A third of White people said they would shun a Covid-19 vaccine even if it were free and deemed safe and effective, but nearly half of Black people -- 49% -- said they would say no, according to the poll of 1,769 people conducted from August 20 through September 14 by the Kaiser Family Foundation and The Undefeated.

"The FDA's voice has been weakened quite frankly in terms of trust, so there will be a real need to build up confidence in minority populations," Puckrein said.

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