Last December, the FDA reported on both the Pfizer-BioNTech and Moderna Covid-19 vaccine and the respective race and ethnicity of their research participants in the Phases 2 and 3 research trials. The Pfizer trial included ages 16 or older and the Moderna trial included those 18 and older. Of 285 million in the United States population, over 40 thousand participated in the Pfizer trials and over 27 thousand in the Moderna trial. When looking at the combined totals of subjects compared to the general population, whites were found to be over represented. Whereas 73.6% of the U.S. population are white, 79.4% to 81.9% of the subjects reported their race as white. American Indian/Alaska Native and Native Hawaiian or Other Pacific Islanders had the exact percentage of research participants to those of the U.S. population; 0.8% and 0.2%, respectively. The second largest contrast in proportion of participants to the U.S. population was seen in comparing those of Asian race. Only 9.7-9.8% of research subjects reported themselves as Asian, whereas the total U.S. population percentage is 5.9%. The biggest discrepancy can be seen in research participants who reported their race as Black. Only 9.7-9.8% of research subjects were Black, whereas Blacks make up 12.3% the current total U.S. population. Regarding ethnicity, 17.6% of the U.S. population reports themselves as being Hispanic and 20-26% of participants identified themselves of Hispanic ethnicity. However, 82.4% of Americans report themselves as non-Hispanic and 73.2% to 79.1% of research subjects identified themselves as that ethnicity.
Despite these Covid-19 vaccine trials demonstrating greater diversity than previous trials of other pharmaceuticals, these statistics still represent a disparity in the representation of people of color as research participants in a vaccine designed to boost the immunity of a virus that is disproportionately affecting people of color in the United States.
The good news is that despite this disparity in the diversity of representation in the clinical trials, the findings did show that the safety and efficiency of the Pfizer-BioNTech and Moderna vaccines were similar across groups despite race. The question many pose in reaction to such statistics is why minorities are underrepresented in clinical trials. The main four reasons include: barriers to access, lack of information, and historical and continuous racism and discrimination. Barriers to access come in the form of few clinical trials being offered through under-resourced hospital systems that minorities use for health care. Also, minorities are less likely to have eligibility to participate in such trials due to having co-morbid conditions or not having health insurance. These attributes can exclude them from participation in such research studies.
Other challenges to access may be their limited or lack of transportation resources, being unable to request off of work, caregiving schedules, or not having access to technologies for monitoring during a research study. Some research studies have reported that physicians are less likely to offer clinical trial participation to minority patients. Enrollment efforts of research studies often may not reach the minority population if they are not culturally sensitive to address language or health literacy barriers. The history of medicine in the United States also has seen the abuse and mistreatment of minorities such as the Tuskegee syphilis experiment. As a result of such abuse and ongoing racism and discrimination, minorities are less willing to participate in clinical trials.
The racial and ethnic diversity of clinical trials in the further development of Covid-19 vaccines is imperative. This pandemic has impacted those of Black adults and minorities the most, so more trials should effectively recruit and maintain the participation of minorities. Minorities already historically have had lower vaccination rates and express more concerns about receiving the Covid-19 vaccine and perhaps their concerns are valid based on the data presented in this essay. Therefore, it is important that Covid-19 vaccine researchers ensure the safety and efficiency of the vaccine across all of the United States to increase the trust and confidence of minorities that they should get the vaccine.
Patricia Cummings, BSN, RN, had an experience that most other nurses don’t get. She gave the COVID-19 vaccine to Vice President Kamala Harris and her husband, Second Gentleman Doug Emhoff. Cummings, a student in Walden University’s Master of Science in Nursing program and clinical nurse manager at United Medical Center says that it was a phenomenal experience, but also acknowledges how the Black community is facing challenges with people receiving the shot.
“My experience of being able to inoculate Vice President Kamala Harris and her husband was truly humbling and exciting. I feel honored that I was given an opportunity to be a part of history, as Vice President Harris is the first woman and the first African American and Asian American person to be appointed to that role. It is certainly one of the greatest highlights of my nursing career thus far,” says Cummings.
But she says that, initially, even she, a nurse, was hesitant about getting vaccinated. “I wanted to conduct my own research on the scientific background of the vaccine as well as speak with colleagues who are experts in the fields of infectious diseases and epidemiology. After reviewing the results of the clinical trials and the vaccine production process, I was convinced about the efficacy and safety of the vaccine, and hence decided to take it,” Cummings explains. “As the mother of two children, we have had to make several adjustments in our socialization, schooling, and other activities. I desire to return to a level of normalcy in my personal life, and I understand that getting vaccinated is presently the only viable solution to avoid contracting and spreading the virus. I am also saddened at the hundreds of thousands of lives lost as a result of the virus and am anxious to seeing the pandemic come to an end.”
Cummings says that one of the biggest challenges facing the Black community is having access to the virus. “Until recently, the vaccine was only accessible at a few hospitals and clinics that are typically far and inaccessible. Additionally, the registration process has been arduous and often requires one to be computer literate, as many sites require registration via the internet,” she says.
However, this isn’t the only reason why BIPOC are hesitant to get vaccinated. History has scared many people. “Hesitancy in the BIPOC population is primarily attributed to their distrust in the U.S. health care system. Historical events such as the Tuskegee Experiment, in which Black men were deceived regarding treatment for syphilis, have had lasting effects on the BIPOC community,” says Cummings. “Additionally, many have expressed skepticism about the short timeframe in which the vaccine was created and the fact that, at first, the only available vaccines required two doses.”
Cummings suggests that nurses can help alleviate patients’ fears because they’ve tended to be seen as people whom the BIPOC can trust as providing information. “Nurses should therefore provide factual information about the efficacy and safety of the vaccine based on their understanding of the clinical trials, as well as the vaccination process thus far,” she says. “Additionally, they should promote vaccination as a part of primary prevention, health, and wellness.”
Building trust in the community she serves is something that Cummings works on regularly. “As a student at Walden pursuing my MSN in the Nurse Executive program, I have learned the importance that the role of a leader as a change agent plays in influencing others to make beneficial choices. I have therefore chosen to put significant effort into sharing information about the vaccine’s efficacy and safety in hopes of building trust in my community,” says Cummings. “I also share my own vaccination experience and am transparent about my initial hesitancy. Additionally, I participate in community events that afford me a voice to safely share information and answer questions in real time.”
Another problem, though, faces certain minority communities—not speaking the same language. “One challenge that I believe exists among Hispanics and other non-English speaking populations is a language barrier. I have not seen adequate advertising and information provided in languages other than English. I believe that it is imperative that vaccine information is presented in a manner that is comprehensible to all people,” says Cummings. “It is important to add that I am passionate about health promotion and wellness. I believe that all people should be able to make informed decisions. My goal is not to strong-arm anyone into accepting the vaccine, but merely to provide them with truthful information and my own experiences in hopes that they make wise choices.”
Anyone working in a healthcare setting pays extra attention to infection prevention. With so many different people carrying infectious diseases in closed areas, infection control is a priority.
There’s more to stopping the spread of germs than simply washing your hands. Although hand washing is extremely important, nurses can also adopt other practices to help stop infections from spreading from person to person (and to avoid becoming a patient themselves). They are also a good resource for patients who can learn good infection control methods and also learn about other prevention methods including vaccinations.
Wash Your Hands
Nurses’ hands require near constant cleaning with soap and water or antibacterial gel. Because nurses touch everything from patients’ bodily fluids to medical devices to food, having clean hands is the top way of keeping infections in check. Nurses know this, but it’s also important for them to share this information with their patients and families. Whether it’s visitors to the nursery or family members who are taking care of wounds or stomach infections at home, this is one activity that cannot be stressed enough.
Protect Clean Surfaces
Everything a nurse touches has the potential to spread germs or infectious illness. Being mindful of the surfaces you touch, whether you are wearing gloves or not, helps you stay healthy and protects your patients.
Promote Vaccinations
Staying up-to-date on your own vaccinations helps protect you from preventable diseases and is a key to infection prevention. A flu shot every year, required by some healthcare organizations, is protective as are routine vaccinations to prevent tetanus or pneumonia (if you’re eligible). With the recent explosion of measles cases across the country, you can also help educate your patients on the safety and effectiveness of vaccines to keep serious and potentially deadly diseases out of their own homes and communities.
Know Proper Procedures and Protocol
Some nurses are exposed to extremely contagious and dangerous infectious diseases. Outbreaks of Ebola have caused infectious in the healthcare workers helping patients, for example. Knowing your organizations protocol for handling such cases or for handling outbreaks is essential. If you aren’t sure about the current protocol and process, keep asking until you find out or until a protocol is established. Flu outbreaks are common in the wintertime, but in our increasingly global world, outbreaks of other diseases that have primarily been in other countries can easily jump to any area. Nurses have to be ready to handle whatever might evolve.
As a nurse, infection control is a big part of your responsibility to your patients, but it’s also a responsibility to yourself. Remaining as healthy as possible lets you care for and protect your patients.
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