When Dana McIntosh knocked on 178 doors last summer and fall in an effort to convince her neighbours to attend community COVID-19 testing pop-ups, they always answered when they saw her familiar face through the peephole.
The 43-year-old has spent her whole life here in Toronto’s Jane and Finch area, one of the hardest hit by COVID-19. She went to three schools in the area, attended hundreds of local events and has earned her status as a trusted neighbourhood influencer.
“It’s not harmful, it won’t hurt you,” she’d say about the test.
She didn’t bring up scientific studies or daily case counts, but instead talked about the risks in a way that would get her neighbours’ attention: They could have COVID-19 and not know it, and then pass it on to their children or parents, she warned.
After she made her pitch, almost every person had the same question for her: “So, Miss Dana, have you had it done?”
She’d assure them she had, multiple times in fact, and sometimes she’d even administer a nasal swab on herself to prove it didn’t hurt, that her nose didn’t bleed, that her brain didn’t shift (a concern she heard from many). And that, more than anything else, was what convinced people.
That’s precisely why she was recruited by Black Creek Community Health Centre as one of 25 community outreach workers to get people out to the testing pop-ups in Toronto’s northwest, which is home to a large Black and low-income population.
In the months ahead, Ms. McIntosh will be called on again, this time to convince her neighbours to get the COVID-19 vaccine.
The problem is, she doesn’t have a reassuring answer to “the question” this time: For now, she’s scared to get vaccinated and doesn’t plan to for at least 18 months.
“All I can say is, ‘This is to protect you and your family.’ Right? When it comes to me … I’ll be straight up. ‘I haven’t done it yet,’ ” she said.
In Toronto, 79 per cent of people who contracted COVID-19 in the city between mid-May and the end of November, 2020, identified as racialized – the majority Black or South Asian. Among those who spent time in hospital for COVID-19, 71 per cent were racialized. Advocates have identified them as priority groups when it comes to rolling out the vaccine to the wider population, and experts, including those at Toronto Public Health, say one of the best strategies is using trusted community influencers such as Ms. McIntosh to spread the word. But what happens when those advocates and influencers are also vaccine hesitant?
“I’m not naive enough to think this will be an easy sell,” said Cheryl Prescod, the executive director of Black Creek Community Health Centre, the organization that recruited Ms. McIntosh. A month after the first Canadians had received the vaccine, she said “more than 50 per cent” of her community ambassadors team expressed a willingness to get vaccinated themselves. But the rest, including Ms. McIntosh, still felt they needed more information. Ms. Prescod is organizing weekly sessions so health care providers can build trust in the vaccine among the ambassadors and then those ambassadors can build trust among neighbours.
“This is an age-old problem of racism, of lack of trust in our system,” Ms. Prescod said. “Historically, certain groups of people have been made to be guinea pigs in trials and scientific studies. So they’re saying, ‘We don’t trust that this is something that will help us. It is something that will harm us.’ ”
But the need for buy-in is crucial, she said, given the impact COVID-19 has had on racialized Canadians. The high rates of infection are due to a range of structural factors: Many racialized people are essential workers who don’t have access to paid sick days, they rely on crowded public transit to get around and live in substandard housing where social distancing can be difficult.
Ms. Prescod says the way COVID-19 has spread in her neighbourhood should justify priority access to the vaccine for Black community members, many of whom have been working essential jobs the past year and putting themselves at risk.
“Maybe they’re not at the bedside, but they certainly are at the front line offering some of these services, and there’s no mention of them being vaccinated [ahead of others],” she said.
Race-based health data is extremely limited in Canada, but those who study health inequities have long identified the many ways anti-Black racism manifests itself in health care.
In a statement released last June, the Toronto-based Alliance for Healthier Communities noted that Black women are screened for cervical cancer at the lowest rate of any group, Black children struggle to get the same pain-management options as white children and Black people with sickle cell anemia – a condition they suffer from at disproportionate rates – are treated as “drug seekers” in the Canadian health care system.
Perhaps the most cited source of mistrust is the Tuskegee Experiment, where 600 Black men were recruited by researchers at the U.S. Public Health Institute to participate in a study on “bad blood” and told they would receive free health care in exchange for their participation. In fact, they were the subjects of an unethical study on what happens to the Black male body when syphilis is left untreated for decades. Even as this disease ravaged subjects’ bodies, causing death in some, researchers withheld treatment.
“There is a rightful mistrust of a system that has failed, attacked and killed people in racialized communities for far too long,” said Andrew Boozary, a physician and the executive director of population health and social medicine at University Health Network.
“We can’t vilify people for the choices that they make,” he said, “but we need to ensure that there is persistent engagement on a variety of mediums to present the science.”
In marginalized neighbourhoods, where the social effects of the pandemic – job loss, poverty, food insecurity and evictions – were felt most acutely, that mistrust of government has deepened.
Sarah Ali, a long-time Black community organizer in Toronto’s northwest end, says much of her own resistance to taking the vaccine is rooted in anger over the way the government has long neglected issues that have brought death to poorer communities but managed to clear enormous hurdles when it came to responding to the COVID-19 outbreak.
“Let’s say some of the most vulnerable die from gun violence? It’s business as usual. Poverty? Business as usual. Homelessness? Business as usual. Suddenly, COVID-19 comes in and it’s the end of the world,” she said.
Ms. Ali said she hadn’t yet made up her mind on the vaccine until the summer, when at a community event, she spoke to community members who raised concerns about how quickly the vaccine was developed and whether it was safe.
It’s difficult to know where trust in the vaccine stands among racialized residents in this country, as no polling has yet offered a breakdown of responses by race or ethnicity.
A late December poll conducted by Nanos Research and commissioned by The Globe and Mail found that 68 per cent of Canadians said they would “definitely” take the COVID-19 vaccine and 19 per cent would “probably” take it. The poll sampled 1,048 Canadians, but did not ask them for their race or ethnicity.
In October, Toronto Public Health commissioned Ipsos Reid to conduct an online survey with Torontonians about their willingness to be vaccinated, in which 73 per cent of respondents said they would definitely or probably get it – but it was a snapshot of the general population, where 50 per cent of respondents were white and 7 per cent were Black.
Vinita Dubey, Toronto’s associate medical officer of health, said Toronto Public Health plans to do more polling in the city to get a more granular look at how different racial groups and neighbourhoods feel about the vaccine, which will in turn shape the targeted messages developed for these groups.
Polling in the United States suggests higher-than-average vaccine hesitancy among Black Americans, but that trust is steadily growing as people see others receive their vaccine (many Black public-health advocates pointed to the power of seeing the first vaccine in the U.S. being given to a Black ICU nurse by a Black physician). While 50 per cent of Black Americans surveyed by the Kaiser Family Foundation on Sept. 20 said they would get the vaccine, by Dec. 20, that figure had risen to 62 per cent.
There is no “golden method” to make the hesitant more willing to be vaccinated, says Maya Goldenberg, an associate professor of philosophy at the University of Guelph and author of the forthcoming book Vaccine Hesitancy: Public Trust, Expertise, and the War on Science, but rather a few approaches that have proven successful. Dr. Goldenberg’s research focused on hesitancy around childhood vaccinations and said that conversations with primary care providers are a helpful place to start.
“Even people that harbour all kinds of hesitancy around vaccines and around Big Pharma and have all kinds of concerns about new technologies, they usually will say they trust their health care provider for health information,” she said.
Dr. Dubey said what her agency has found most impactful is working with the groups the community turns to because “giving them the information may actually allow it to be received.” On Thursday, the City of Toronto announced the creation of a task force of Black community members with expertise in both vaccines and knowledge translation to convey information to residents in the months ahead. That work can’t start early enough.
In downtown Toronto’s Regent Park neighbourhood, where 70 per cent of the population is racialized, Sureya Ibrahim is the sort of person the local police division, school board and health researchers often turn to when trying to connect with the local community. She has a massive network, both through her job at a neighbourhood community-development organization and through all the local groups she volunteers with. And until this past week, Ms. Ibrahim had been an obstacle to any public campaigns to build trust in the vaccine in her neighbourhood.
Like Ms. Ali, she’s incensed that gun violence and homelessness in her community have not been given the sort of attention and resources the vaccine has.
“We are not getting the basic stuff people need, so why are you just forcing a vaccine on them?” she asked in December, just after the vaccine had been approved by Health Canada.
The vacuum that government mistrust has created has been filled with a steady stream of misinformation about the virus from her WhatsApp feed: videos of people claiming 100 people in the United Kingdom were paid $100,000 each by the government to take the vaccine and died (no, they didn’t get paid to be in a trial, or die), blaming vaccines for causing autism in children (there is no link) and spinning out conspiracy theories about the virus being engineered in a Chinese lab by a profit-hungry pharmaceutical company (it was not). And Ms. Ibrahim has forwarded along much of this misinformation to her substantial networks.
But last week, Ms. Ibrahim, an Ethiopian immigrant, was in a Zoom workshop with other Harari women led by a scientist in their community who spent hours talking about the very same misinformation Ms. Ibrahim was receiving and circulating. These “facts” were bogus, unsubstantiated, backed by people interested in selling books, he told the women in the virtual meeting. This got through to her and she not only stopped forwarding that information, but has asked a friend who manages many social-media accounts in the community to not share any vaccine myths either.
S. Shyam Sundar, the co-director of the Media Effects Research Laboratory at Penn State University, has extensively studied the way in which WhatsApp has been used to transmit misinformation to the masses, and one finding of his research is that when people receive messages on the platform, the original sourcing of the information is less important than who it came from.
If it’s a friend or family member, he said, you’re willing to trust them because you think they’re looking out for your welfare and don’t stop to ask whether the facts have been verified. People let their guards down when information comes to them in a feed they have curated, as opposed to the results of a Google search. And if it’s in video form, people tend to trust the message even more.
This is why Dr. Sundar says public-health agencies should try to “seed” every social platform with their own messages on the vaccine to counter the misinformation – and to match the style of what is most shared as closely as possible.
“If they are sexy enough in the messaging and sensationalist enough, they should be able to get that same kind of traction,” he said.
Recently, Ms. Ibrahim’s aunt, a front-line worker at a long-term care home, called her to let her know she’d received the vaccine. Ms. Ibrahim knew the purpose of the call: not just to convince her it was safe, but to have her spread the message to her network.
“Tell people I had my first dose,” she instructed Ms. Ibrahim. She called her again a few weeks later to tell her she’d just received her second dose. “I didn’t die,” she teased. “I’m alive.”
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