The speed at which we are racing to develop and deliver a vaccine for the novel coronavirus is on a collision course with a lack of trust by many racial and ethnic minorities in the medical research system.
We need a vaccine for COVID-19 to stem this pandemic. We need it to work for those most at risk. And we need those most at risk to trust the process through which it was developed and to have trust in the vaccine itself once it becomes available.
The communities that trust the system and the process the least are the ones we need the most to help us all out of this pandemic.
Speed and trust are both priorities right now. The problem is, they are at odds with each other. At the moment, we are choosing speed. And our lack of progress in building trust with racial and ethnic minority communities is why these two priorities are in conflict.
This reality has been paved by a stained history of exploitation and mistreatment of racial and minority communities in medical research. The result of our failure to fully address this history is a medical research system that many do not trust.
We see the implications of this as evidenced by the low diversity rates in clinical research. Black people make up approximately 14 percent of clinical trial participants in the United States. Yet they are disproportionately impacted by many diseases and disorders. And this lack of diversity in clinical trials has resulted in therapies that don’t work or don’t work as well for the very people who are at higher risk.
This is not news — companies and the Food and Drug Administration have been working on diversifying trials for a long time, but with limited success. We see this playing out with the COVID-19 vaccine trials.
Recently, nine of the major biopharmaceutical companies involved in COVID-19 vaccine trials, trying to reassure an anxious public, signed a pledge promising they would wait to seek government approval until they had sufficient data showing any potential vaccine is safe and effective. The letter sent an important statement, but in an environment where the audience does not trust the messenger, the words fall flat.
At the same time, social media is buzzing with negative conversations about the focus on recruitment of minorities into COVID vaccine trials, with community members and trusted messengers using words like “guinea pig” and “lab rat” to explain why they won’t participate in the trials and why their communities shouldn’t either. This foreshadows even greater problems convincing people to accept a vaccine created and administered by a system they clearly do not trust.
The way to break out of this problem and pave a new course is to recognize that recruitment must be preceded by education and transparency, messages must be delivered by trusted messengers and enrollment must be accessible and available at trusted community sites.
It may seem counterintuitive to suggest slowing down to do the critical work of building trust in the middle of a pandemic when people are dying every day. But if we don’t build trust and engage with the communities that are disproportionately impacted by COVID, we will remain stuck in a medical research system where health outcomes are not the same for all. Just as there is the need for speed to a vaccine, there is a need to engage communities in the development of these solutions. And as COVID has demonstrated with devastating clarity, we’re all in this together.
This pandemic has already left a path of devastation at the individual, community, national and international levels. But it does offer us the opportunity to pave a new path, a new future where trust is built, where diverse communities choose to participate in research, where new therapies work for those most at risk and where health outcomes improve.
The implications of doing this right (or wrong) will be felt far beyond the immediate need related to development of a COVID vaccine; the same communities disproportionately impacted by this virus are also disproportionately impacted by many chronic conditions and diseases for which sponsors struggle to meet their diversity goals in recruitment for clinical trials. Trust can help produce a diverse clinical trial pool that will result in good science, good social policy and better health outcomes for all.
Ronnie Tepp, MPP, is a principal at Pyxis Partners and Krista Forbes, M.Div., MPH, is a senior associate at Pyxis Partners.
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