Dr. Simone Wildes grew accustomed to late-night medical emergencies long before her days as an infectious disease specialist at South Shore Health, which operates urgent care centers and South Shore Hospital in Weymouth.
As a child growing up in Jamaica in the 1970s, Wildes would often hear a frantic knock at the door around 2 or 3 a.m. Bleary-eyed, her mother — a midwife and the only medical resource in their rural parish — would grab a flashlight and walk down unlit roads to help a patient in need. Wildes grew up without the luxuries many take for granted — no telephones, no streetlights.
She was also exposed to infectious disease before she could understand the meaning of the term. She saw people suffering from Hansen’s disease — also known as leprosy — and infected wounds from unmanaged diabetes. She herself had hookworms at age 10. Watching her mother scramble to quell suffering and death in the area inspired Wildes to study medicine.
She is now part of a national movement of Black and brown doctors who — between treating patients during a global health crisis — are bringing trusted medical information about the COVID-19 vaccines to churches and community groups, as well as privately chatting with acquaintances and loved ones. By instilling confidence in the vaccine, Wildes and others like her hope to ensure progress in communities too often let down — or actively harmed — by the medical field.
One person who needed convincing was Wildes’s mother, Marcia, who is now 82 and lives in Miami. She had concerns about potential long-term effects of the vaccine. “Mother,” Wildes reminded her, “when we were in Jamaica, everyone lined up and we got vaccines, and we were happy to.” Wildes’s mom recently got her first dose of Pfizer’s COVID-19 vaccine.
“I had to go back to our roots,” Wildes says now, “and remind her what it was like when we had less.”
Vaccine hesitancy can be found in every corner of the country, but the concern is particularly acute in communities of color. In a December poll of nearly 1,200 Massachusetts residents, 38 percent of white respondents said they would like to receive the vaccine as soon as it became available, compared with 28 percent of Black respondents and 22 percent of Latino respondents. (The poll analysis did not specify attitudes of Asian residents.)
Although these poll results indicate racial disparities in vaccine acceptance, the actual vaccination rates paint an even starker picture: As of March 11, 22 percent of white Bay Staters had received at least one vaccine dose, compared with only 15 percent of Black residents, 8 percent of Latinos, and 13 percent of people of Asian descent.
One major problem has been the disparities in access, especially early in the vaccination process. In January, according to a Globe analysis, “fewer than 14 percent of Black residents and roughly 26 percent of Latinos live in census tracts that are within 1 mile of a vaccination site, compared with nearly 46 percent of white residents.”
However, among those people reluctant to get the vaccine, rather than unable to access it, the concern is understandable. By now, most know about the ethical abuse people of color have faced in medicine: Henrietta Lacks, a Black woman whose cervical cancer cells were harvested without her consent or knowledge; the Tuskegee experiment, a 40-year government study in which hundreds of Black men were used as lab rats and intentionally left untreated for syphilis without their knowledge.
But structural racism in medicine is not a thing of the past, and news about people of color who died at the hands of police last year once again put a spotlight on the pervasiveness of prejudice. Meanwhile, the coronavirus is tearing through communities of color and claiming lives at a staggering rate. In the first half of 2020, COVID-19 reduced overall American life expectancy by a year — but Black Americans lost nearly three years, and Hispanics lost nearly two years. Now, Wildes says, Black and brown people face “twin crises” of rampant racism and a deadly pandemic.
The result is mistrust among those who need the vaccine the most, says Wildes, who is a member of both the state’s Department of Health COVID-19 Health Equity Advisory Group and its COVID-19 Vaccine Advisory Group. “It might seem like the race issue is unrelated to the hesitancy, but there is a connection,” says Wildes. “People of color feel they are not valued.”
Wildes began her outreach in November, when questions about long-awaited vaccines cropped up in the community. Since then, she has participated in about 50 sessions, she says — a rough estimate from a whirlwind of in- and out-of-state presentations she has given over Zoom. Attendees range from community leaders to everyday folks tuning in from their beds. Generally, she talks for about 15 minutes, then opens it up to questions.
Wildes uses a combination of anecdotes, statistics on COVID-19 rates and deaths, and available science from vaccine trials to communicate one key piece of advice: Get the shot.
Among the parishioners of a Methodist church in Milton who attended one of Wildes’s virtual information sessions in February was Paula Aymer, 75, an early skeptic of the COVID-19 vaccine development process. “It seemed to be happening helter-skelter, kind of in a hurry,” says Aymer, who is Black. “I was hoping Black folks wouldn’t be a test for it.”
But the virus kept claiming lives, and the deaths seemed to be creeping closer to Aymer’s social circle. Her son’s barber. The grocery store clerk she chatted with every now and then. “These were not sick people. I thought, I better do something. I better be more concerned about my own vulnerability,” Aymer recalls. She received her second dose on March 3. “One of the things that helped convince me to get the vaccine was the number of deaths in the Black community. They were dropping like flies.”
Wildes’s remarks at Aymer’s church session made that reality even more salient — as she does during most of her presentations, Wildes talked about the toll COVID-19 is taking on communities of color, and warned about the lifelong effects it can have in the form of post-acute COVID-19 syndrome.
Some audience members from past sessions have had concerns about how much data scientists have gathered from non-white participants. Wildes has gotten the question: “Were there enough Black people in the trials?” Wildes tells them that, given the meager representation people of color usually have in scientific trials, the numbers were good by comparison: Among Pfizer’s participants, 10 percent were Black people from the United States, and Hispanic or Latino people accounted for 26 percent. In Moderna’s trial, 10 percent of participants were Black and 20 percent were Hispanic or Latino. In fact, Moderna slowed its trial in September to recruit more people of color, she says.
Of course, some people have concerns entirely unrelated to race. Roxbury resident Judy Cummins just wants to see more data gathered over time. Though proven safe in the short term, the absence of long-term data leaves the 28-year-old with unanswered questions.
“There’s this narrative that Black people don’t want the vaccine because of history,” says Cummins, who is also Black. “People just say, ‘She’s a woman of color, she must not trust the medical system.’ That’s not true for me. I’m just assessing the risk. I don’t want to die.”
But Wildes has found that much of the mistrust she’s hearing has emerged from years of racial injustice. One group she has spoken to has been people who work in prisons. On February 25, she participated in an information session convened by Wayne State University in Detroit, focused on COVID-19 mitigation strategies among the incarcerated. Wildes answered questions about the vaccine testing and approval process — explaining it was fast-tracked not because researchers were careless, but because all resources were poured into the effort to fight COVID-19.
Another panelist, Dr. Alysse Wurcel, an infectious disease specialist at Tufts Medical Center who works to educate inmates on COVID-19, said the incarcerated populations are a microcosm of racial disparities in vaccine confidence nationwide. Though counterintuitive, vaccine hesitancy may be even stronger among those confined to crowded, poorly ventilated jails and prisons — where people of color have long been overrepresented. More than half of the state inmate population is Black or Hispanic, according to the Massachusetts Department of Correction.
“We have definitely seen there is a more frequent uptick of vaccinations in white inmate communities compared with Black and brown communities who are incarcerated,” Wurcel said.
A survey conducted by the Middlesex Sheriff’s Office in January found that only 40 percent of inmates would agree to get the shot, even though they were included in Phase 1 of the Massachusetts vaccine rollout. Inmates generally cannot be compelled to be vaccinated.
Although the information sessions didn’t include inmates, several of the 83 registrants passed along questions they had collected. They included: Can I get the vaccine if I have psoriasis? What about asthma, or HIV? Is it safe for pregnant women? The short answer to all of those questions: Yes. People with underlying conditions — pregnancy included — are more vulnerable to severe illness, Wildes explained.
“The most common question I get is: Will this affect pregnancy or fertility?” Wildes told the audience. “The answer is, this particular group [pregnant women] was not involved in trials that were done, but based on the information right now, the American College of Obstetricians and Gynecologists is recommending they do [get vaccinated].” (Pregnant women are now being included in ongoing vaccine trials.)
She added, “When pregnant women get COVID, they could get very ill, meaning they need to be on a ventilator. Sometimes they go into early labor and, unfortunately, sometimes they die.”
Answering these questions helps address some of the existing inequity by engaging with a vulnerable population, Wildes said. “People who are incarcerated are historically marginalized populations,” she explained. “We have to make sure we take care of them, too.”
Wildes is joined in her efforts to educate and improve access to the vaccine by countless other doctors of color, and state officials are joining in. The Massachusetts Department of Public Health announced last month the launch of an outreach initiative to help the 20 cities and towns most vulnerable to COVID-19, determined in part by the population of Black and brown residents, including Brockton, Chelsea, Fall River, and New Bedford.
The approach will include identifying gaps in vaccination locations, along with answering questions about the COVID-19 vaccines with information tools like the public-information campaign “Trust the Facts. Get the Vax.”
“Massachusetts is making inroads,” Wildes says. “The effort is there.” But, she adds, “Making it happen is another thing,” and it’s not yet clear how effective these efforts will be.
In the meantime, Wildes will continue to spread the vaccine gospel.
Though she rarely shares her childhood stories with patients and audiences, that time in her life — which in some ways feels light-years away — stays with her and drives her commitment to improving access and equity. “I know what many people in these communities have been through, and I lived that experience,” Wildes says. “Even though I don’t live it now, it’s still a part of me.”
Before and after most information sessions, audience members are asked to share the likelihood that they will get the shot. And often, the answers shift ever so slightly by the end of the discussion.
“I think it helps motivate people to get the vaccine, because they see you’re trying to help, and that you, as a Black person, understand,” Wildes says. “It’s interesting to see the needle move.”
Lindsay Kalter, formerly of The Boston Herald and Politico, is a freelance health journalist based in Ann Arbor, Michigan. Send comments to email@example.com. Preregistration for an appointment at the state’s COVID-19 mass vaccination locations is available at vaccinesignup.mass.gov.