Reality Check: Montgomery Influencers Offer Perspective on COVID-19 Vaccines

Looming outside the State Capitol building in Montgomery, Ala., is a monumental reminder of the exploitation suffered by Black residents of this region: a statue of J. Marion Sims, the gynecologist who practiced his surgical techniques on enslaved Black women without using anesthesia. Just about half an hour away, as residents are quick to point out, is Tuskegee, site of the U.S. government’s decades-long medical experiment conducted on impoverished Black men with syphilis who were intentionally left untreated as they grew sicker and died.

Given this history, it’s not surprising that many in Montgomery don’t fully trust the federal government’s promise of a groundbreaking COVID-19 vaccine to protect them and stop the pandemic.

“People don’t want to be experimented on, especially if they’re Black,” says Roschelle Tyus, a Montgomery community organizer. “They don’t want to feel like they’re being tested like a guinea pig.” 

This lack of trust ran particularly high during the Trump administration, Tyus says, when the vaccines were first authorized. Under President Joseph R. Biden, she adds, things might be better, but when it comes to getting a COVID-19 vaccine for herself, Tyus remains in the “wait-and-see” camp.

Trust Issues

Indeed, this wait-and-see approach to vaccination remains pervasive, particularly among Black and Latino adults, according to a recent Kaiser Family Foundation survey. In Alabama, mistrust runs deep: only 17 % of Black and Latino individuals from across the state told researchers they’d be willing to get a COVID-19 vaccine. “I didn’t expect that [mistrust] would be that deep and across the board,” says Dr. Mona Fouad, director of the University of Alabama’s Minority Health & Health Disparities Research Center.

Fear and mistrust surrounding the COVID-19 vaccine continues, even as the virus disproportionately afflicts Black, Latinx, and Indigenous people. Public health and government officials nationwide, worried that without broad buy-in, the country won’t attain “herd immunity,” are trying to persuade communities of color to drop their so-called “vaccine skepticism.”

But persuasion is the wrong approach, says Grace Lesser, a senior project lead at Partners In Health, the social justice nonprofit currently working with the city of Montgomery to help support and strengthen its pandemic response. “We need to provide people with clear facts about the vaccine -- what we know and don’t know,” Lesser says. “That way, we are trusting people to make informed health decisions about what is best for them.” She points out that given this country’s patterns of health injustice, mistrust around the vaccine is well-placed. Lesser cites a recent PIH-funded survey of 1,000 Montgomery residents in which 45% of respondents said the U.S. health care system treats people unfairly based on their race or ethnic background either all or some of the time. Rather than unilaterally pressing people to trust the government or vaccine producers, Lesser says, officials must establish trustworthiness by being transparent and also making immediate, material investments in high-quality, equitable health care.

Supporting Hard-Hit U.S. Communities

To assist in these efforts,  PIH launched its U.S. Public Health Accompaniment Unit (USPHAU) in May 2020, following a successful partnership with Massachusetts establishing a new contact tracing workforce. Since then, U.S. states, cities, and communities hard-hit by COVID-19 have requested assistance from PIH, and the unit’s reach has expanded. Now, the USPHAU is partnering with state and local health authorities and community organizations in more than 15 regions, from Newark, N.J. to Pima County, Ariz. and the Navajo Nation, providing support for a range of pandemic response efforts, including equitable vaccine distribution.

In Montgomery, which is 60% Black, and where 20% of residents live below the federal poverty line, the pandemic’s pain has reached far into the community. COVID-19 killed four Montgomery public school teachers in a single week in January, and the case positivity rate has hovered around 20% for much of the winter. In response, the USPHAU is working with Mayor Steven Reed’s office to support several pandemic-related efforts. These include: launching a new community health worker program to help residents access basic resources and providing technical assistance to open a new Montgomery Crisis Center for unhoused individuals and families with COVID-19. The USPHAU is also deploying a communications campaign guided by insights directly from Montgomery residents to more effectively reach vulnerable individuals. Recently, the unit has supported free rides to get vaccinated and a food pantry during vaccination clinics. 

Shifting Attitudes

Like every PIH effort across the globe, the work in Montgomery began by listening to local leaders and influencers to better understand their needs and perspectives.

Larnetta Moncrief, owner of the Diva Lounge Hair Salon, often gets an earful from clients during styling sessions. She says many of them don’t really trust the government and are “terrified to take the vaccine.” Moncrief was among them. “I was one that was very skeptical about it,” she says, summing up her initial stance. “There’s no way I’m going to do this.” But then, suddenly, her resistance weakened. It happened at a virtual vaccine information session in late December, says Moncrief, who also works with a local nonprofit that helps mothers released from prison transition back to the community. A young, African-American physician she’s known since high school, Dr. Brian Gary, spoke at the event about the vaccine’s safety and said he’d get inoculated right away. “For some reason he put me at ease,” Moncrief says. “Now I’ve talked to even more people and I’m feeling confident about it, so when it’s my time, I’m ready.”

Indeed, attitudes about the vaccine appear to be shifting, says Pastor Richard Williams, a 30-year-old self-described “Holy Agitator,” who has made it his mission to transform Montgomery’s Metropolitan United Methodist Church into a full-service social needs hub. For example, the church-sponsored mobile food pantry feeds about 2,000 adults and students each month; hosts regular, free COVID-19 and HIV testing (with free condom giveaways); connects people facing eviction to legal services; offers mental health support and teen counseling programs; and recently began a burial program to donate grave plots to families who can’t afford to pay.

While “distrust” still persists, Williams says, more and more individuals are reconsidering the value of the shot as they see doctors and nurses and family members rolling up their sleeves. Now, he says, the focus is increasingly on gaining access to the vaccine -- and questioning why those most in need aren’t always at the front of the line. “The issue now is accessibility,” he says. “It’s disheartening to see how the vaccine is being disseminated and the talk of ‘future plans’ that it will be available in the communities I serve…I can’t find those plans.” Williams, who recently got the COVID-19 vaccine himself, wants to remove any obstacles blocking community members from getting it too. At one of Montgomery’s early vaccination clinics, for instance, he manned the food pantry, doling out bags of groceries filled with beans, grits, and canned goods to residents.

Williams, however, is well aware that vaccines alone won’t end the crisis. Educating individuals about the importance of masks and social distancing remains critical, he says. “I have colleagues in the ministry who don’t believe mask wearing is necessary because God will protect them; there are people who have gone back to in-person worship services, singing in the choir without masks on,” he says.

“I try to have conversations on this when I can [but] some have questioned my faith. I say: ‘God gave me science and sense...I wear a seatbelt.’”

He says there remains so much misinformation, it’s difficult to cut through the noise. “It’s not like people don’t want to know,” he says. “They just want clear facts.” Williams is currently working on a series of COVID-related sermons, and he says the first might address vaccines: “God gave us instructions on how to live in our daily life, and in much the same way, mRNA vaccines give us instructions to fight the virus.”

No Word for “Vaccine”

Rhonda Thompson, director of Montgomery’s Nehemiah Center, which helps families living in poverty access essentials like food and other social supports, says communicating clearly about disease and health care is already fraught -- full of stigma and misinformation. Adding COVID-19 to the mix introduces even more obstacles. For instance, Thompson said, within the city’s Mixtec population, an Indigenous community of about 4,000 people from Mexico with their own subculture and language, there is not even a word for “vaccine.” “There’s so much fear and mistrust,” she says. “It’s concerning.”

Residents agree there’s a dire need for straight facts and myth-busting on why, say, the COVID-19 vaccine does not lead to sterilization in women, nor does it enter a person’s DNA. And it’s critical that these facts are delivered by “trusted messengers” – members of the community – and not just from government websites.

That’s why Montgomery city council member Oronde Mitchell says he’ll sign up for a COVID-19 vaccine appointment, even though he doesn’t even get a regular flu shot. What’s more, he says he’ll document the process on his Facebook page for everyone to see.  “I’m doing it for my dad,” he says, and for others in his multiple orbits: Mitchell also works as a truant officer in the schools and at a local funeral parlor. 

Subverting the Narrative

To address people’s fears about the vaccine, and also show its benefits, Mayor Reed has held a series of virtual gatherings with public health experts and community leaders, “There are understandably many questions about the vaccines and a lot of information—and misinformation—circulating,” said Reed, the city’s first Black mayor in its 200-year history. “In Alabama, we know all-too-well about the historical disparities and continued inequities in the health care system, especially among African-American communities. I am committed to providing truthful, transparent information to empower our residents with the knowledge to make informed decisions about their health.”

Informed decision-making was not an option for the enslaved women J. Marion Sims ruthlessly experimented on. But Michelle Browder, a social justice entrepreneur and local tour guide who also works with kids in underserved communities, is trying to subvert the narrative that elevated Sims to be “the father of gynecology.” Alongside artists and activists, Browder recently unveiled plans to honor three women subjected to Sims exploitation: Anarcha, Betsey, and Lucy will be memorialized as "the mothers of gynecology," with a 15-foot public monument in downtown Montgomery. The goal, Browder says, is to tell these women’s stories and “shine a light on ongoing racial disparities in the health care industry today.”