FLINT, Michigan -- Dr. Peter Stoyanoff is an emergency medicine physician who has worked at Hurley Medical Center for 24 years. He considers himself a “community physician.” When the COVID-19 pandemic initially struck in Genesee County, his urgent care was the only location providing antibody testing for first responders.
He has been trying to overcome infrastructure boundaries to control the spread of the virus.
“People are dying, we're going to have 500,000 people dead by the end of February. And when you think about that many people, you're going to lose half a million people in this country because of this,” Stoyanoff said.
Misinformation has allowed masks, testing, and the vaccine to become heavily politicized issues. The polarization has led to many unnecessary deaths.
“This [the vaccine] will keep you from getting the virus,” Stoyanoff said. “This will stop the spread of this pandemic, you have to just say simply this vaccine will save our country.”
A common misconception about the vaccine is that it was rushed through clinical trials and that the RNA in the vaccine can affect or alter the DNA in humans.
“mRNA and the technology used for the vaccine is using [applied] science that has been around for 20 years,” he said. “Within eight days of the virus being here, we already had the gene sequence. It was a very simple thing to do because we already knew other coronavirus’ gene sequences. And they've [the creators of the Moderna vaccine] tried to do a vaccine for other coronaviruses, including SARS. They realized that the mRNA technology was probably going to be the best or the easiest to mass produce quickly. It turned out to be true. They were able to get the gene sequence and make the technology to mass produce the RNA strand.”
The steps for clinical trials were not skipped due to the already established research on other coronaviruses in the past. The vaccine technology is well understood and the vaccine is made with zero preservatives, which leads to the temperature sensitivity of the vaccine. The need to keep the vaccine at uniquely freezing cold temperatures creates further issues considering distribution and infrastructure holding of the vaccine.
Stoyanoff is currently looking for more ways to involve other community partners and urgent cares in Flint to aid in solving these infrastructure issues and increase the means to distribute the vaccine more quickly and effectively. “Obviously it would be nice to have five years or three years of data on the vaccine,” he said. “So give the vaccine and see how people are doing after you've given 20 million doses.Yeah, that'd be great. But we don't have time for that.”
Another significant issue for medical professionals in majority African American communities like Flint is historically-based and valid distrust of doctors and healthcare providers in the Black community. A poll in the fall of 2020 conducted by The Undefeated and the Kaiser Family Foundation found that only 6 in 10 Black adults trust doctors “to do what is right most of the time.” An often-cited example of where that mistrust comes from is the Tuskegee Syphilis Study, where Black men participating in the study were told they were receiving free healthcare from the U.S. Government but were never told of their diagnosis or treated despite the study lasting more than 40 years.
Stoyanoff and Dr. Debra Furr-Holden, a Flint native and Associate Dean for Public Health Integration at Michigan State University, Division of Public Health in the College of Human Medicine, both agree that issues with vaccine acceptance are far deeper and greater than the historical impact of the Tuskegee incidents. The major setbacks with the vaccine are distribution/infrastructure issues, systemic racism, and misinformation being given to the public.
“It's more than Tuskegee because Tuskegee was not that long ago,” Furr-Holden said. “And Tuskegee wasn't something that happened, you know, over the course of a few months or a few years, it happened over the course of several decades. That study went on for like 30 or 40 years. It's the modern day experience, you know, people know during COVID African-Americans were disproportionately turned away from hospitals. They were disproportionately not the people chosen to go on ventilators. They were disproportionately sent home to die, you know, and so people know that. People share those stories.”
Misinformation is the greatest hindrance in ending the pandemic and opening the country again. “We live in a fact-resistant society,” Furr-Holden said. “We had a former president who said climate change isn't real. He told people to drink or inject bleach. He said Hydroxychloroquine looks like it would stop people from producing the virus. He just said it at the presidential platform and just spewed all kinds of bad information. And then later pretended like it was never said as if we could unhear it or unsee it. And so if anything, I feel like what you're getting in the Black and Brown community is a high level of valid skepticism.”
The problem now is people have just enough information and the gap in between their posts of information has created a nearly uncrossable chasm. Furr-Holden, local philanthropic organizations, and other community leaders have partnered together to end misinformation and decrease racial disparities in Flint.
“What we [epidemiologists] saw in African Americans was attributable to occupational exposure,” she said. “African Americans were represented in high-demand, low-wage jobs, and forced to work and not be able to stay at home and shelter in place because they had to keep the lights on. We kept building solutions on top of things, but not dealing with the underlying real inequities that gave rise to them.”
Patients with COVID-19 that had higher mortality rates who had previously been diagnosed with diabetes does not explain why more African-Americans contract the virus. “It might explain some of the excess death, but it doesn't explain cases. It's an easy, usual suspect to point to, but when we found out it was due to occupational exposure, primarily, which is attributable to education and wealth inequality,” Furr-Holden said.
In March of 2020, African Americans in Flint accounted for 85 percent of positive COVID cases and 91-percent of deaths. At the end of September, 2020, data showed that African Americans made up 38-percent of cases and 50-percent of deaths. Furr-Holden attributes this major success to building relationships with the community and its leaders. This relationship is founded on trust that was not developed overnight.
“A lot of people who are involved in the task force participated in our truth, racial healing, and transformation work that had been happening for a year before the pandemic,” she said.
The work and efforts being made by experts like Stoyanoff and Furr-Holden give hope for the same efforts in areas such as cardiovascular disease or diabetes. The relationships and positive impacts both are creating alludes to a future that decreases racial disparities and deconstructs systemic racism in healthcare.
Furr-Holden sees a new kind of hope on the horizon in Flint.
“We now know we can actually rapidly impact and turn the tide on health disparities,” she said. “We can. And the access is there for us to come together. We can use these kinds of multi-sector, multi-stakeholders approaches that also include community at the table. I want to make sure that's really clear. We had community at the table. And if we can do that with COVID, we can do that in cardiovascular disease, we can do that in breast cancer, we can do that in addiction. We can do it anywhere.”