Donna Henderson last spring had to surmount two hurdles to get vaccinated — registering online and driving 86 miles to the appointment.
“It was a deterrent,” said Henderson, owner of Henderson’s Highland Park Funeral Home, one of two Black-owned funeral homes in the state. “It was so hard to get — so hard to schedule.”
Complex reasons factor into low vaccination rates for Black Iowans, including concerns about the nation’s legacy of unethical medical treatment of Blacks, lack of access to transportation, internet or vaccination sites in their neighborhoods, limited outreach, misinformation and disinformation and a host of other barriers, Blacks, health experts and a critic agreed.
“The rollout for the vaccine was problematic at best — impossible at the beginning — with no encouragement for marginalized communities,” Henderson said.
“We are very concerned about hesitancy,” said Jacquie Easley McGhee, state area health chair for the Iowa-Nebraska NAACP Conference of Branches. “We're going to have to use any means necessary — and then we're going to have to talk about the remaining myths that are still out there.”
COVID-19 infections have disproportionately infected more than 12,158 Black Iowans in the last 16 months, according to the Iowa COVID-19 Tracker, an independent tracking site. Now, Blacks’ vaccination rate is much lower than whites. According to a Kaiser Family Foundation analysis, white Iowans have been vaccinated at twice the rate of Blacks, 47% to 23%, respectively. Overall, 46.6% of Iowans are fully vaccinated, according to the state’s COVID-19 website, which is updated once a week.
A gap in vaccination rates is also present in Iowa’s prisons, a repeated source of outbreaks and deaths. Blacks make up 25% of the prison population, but just 21% of those who are fully vaccinated, a spokesperson from the Iowa Department of Corrections said in an email.
“From start to finish, the state has done a really bad job of managing mitigation, trying to educate Iowans, and then having a rollout for vaccines with an education plan to say these vaccines are different from the vaccines you're used to, and that's why they're safer and better, but that has been completely absent,” said Sara Anne Willette, founder and CEO of Iowa COVID-19 Tracker, an independent site tracking Iowa’s COVID-19 data.
Nationally, the delta variant, a highly contagious coronavirus mutation, represents more than 83% of the virus circulating and has caused a spike in the number of COVID-19 cases, hospitalizations and deaths, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, during the July 22 White House press briefing. White House officials said unvaccinated individuals account for 97% of COVID-19 hospitalizations and deaths in the nation — making vaccination vitally important.
The spike has also prompted renewed discussions about face mask mandates, which Iowa outlawed in schools, cities and counties.
“So, if you’re in an area that has a high case rate and low rates of vaccination where delta cases are rising, you should certainly be wearing a mask if you are unvaccinated,” said Walensky during the White House press briefing. “If you are vaccinated, you get exceptional protection from the vaccines. But you have the opportunity to make the personal choice to add extra layers of protection if you so choose.”
A person’s choice to get vaccinated can vary by geographical location, political affiliation and news source,” said Dr. Jasmine Marcelin, assistant professor, department of internal medicine at the University of Nebraska Medical Center, during the Culturally Responsive Health Care conference held in June by the University of Iowa’s Carver College of Medicine.
“So these reasons might resonate among Blacks, Indigenous and people of color who are thinking about vaccines but they also wrestle with the historical and contemporaneous complicated relationship that they have with the medical establishment which, quite frankly, has just not demonstrated itself to be trustworthy,” she said, in the keynote speech.
The coronavirus pandemic ripped through the country, infecting, hospitalizing and killing a disproportionate number of Blacks, triggering an economic crisis and heaping untold worry and grief as more than 606,190 Americans died of COVID-19 — more than 90,917 of them Black. Existing health disparities and COVID-19 made for a deadly mix that led to a disproportionate toll on Black communities and contributed to a drop in Blacks’ life expectancy. A Pew Research Center study found 78% of Blacks know someone who has died of COVID-19, compared to 67% of U.S. adults.
Now, delta poses a grave threat and grim reminder the pandemic is not over.
For 10 scary days, Henderson hovered close to death last spring as COVID-19 and pneumonia hampered her ability to breathe. That’s why she tells everyone who’ll listen not to be afraid and to get vaccinated against COVID-19.
“I’ve got all of the risk factors. I was a prime candidate to go out of here, but the Lord let me live,” said Henderson, who is fully vaccinated with the Moderna vaccine.
She wants more people to do their own research and get vaccinated.
“Everybody says: ‘Oh, no. I'm still waiting,’” Henderson said. “What are you waiting for? To get COVID?”
Nationally, Blacks make up 12.4% of the U.S. population, but 9.4% of those who have received at least one dose and 9.0% of those who are fully vaccinated against COVID-19, according to the CDC. Data for race and ethnicity was available for just 57.8% of those with one dose and 62.9% of those fully vaccinated, a problem identified by President Joe Biden’s administration last January.
Health experts say the vaccines are safe, effective and — important
Vaccines, which stimulate an immune response in the body to protect a person against disease, are readily available in Iowa for free at pharmacies, through county health departments, mobile vaccination clinics, schools and at many other locations. People ages 12 and up are eligible for vaccination. Clinical trials are underway for children under the age of 12, according to the CDC.
Iowa’s COVID-19 tests, cases, hospitalizations and deaths are trending upward, according to the latest data from the New York Times coronavirus website. An AP analysis found nearly all COVID-19 deaths in the U.S. are among the unvaccinated — a problem that could heap more misery onto Black communities still reeling from the protracted crisis. Delta, dubbed “COVID on steroids” by a former White House adviser, is dominant in the U.S. and poses a significant risk to the unvaccinated — and young people.
Remaining unvaccinated is becoming a very dangerous choice, health experts agreed.
“The effects of having the vaccine is pretty mild compared to actually having the virus,” said Dr. Nicole Del Castillo, director of the office of diversity, equity and inclusion at the University of Iowa Carver College of Medicine.
9% of Black adults
15% of white adults
2% of Democrats
23% of Republicans
22% of white evangelical christians
24% of rural residents
Doctors of color said they’ve worked hard to talk with Blacks who are hesitant, answer questions, dispel myths and promote the vaccines’ safety — even among their own family members.
“I’m trying to be persistent without being too pushy in having those conversations but really trying to get out what are some of their concerns, what are some of their fears,” Del Castillo said. “What are the things that are preventing them from getting the vaccine and trying to talk through that and work through that.”
Asking questions without judgement can help.
“Rather than just saying: ‘You should just get it done,’ but trying to get at what are some of the reasons why,” Del Castillo said.
Getting vaccinated has lifted a weight from Coy Bundy, a Des Moines grandmother who became a TikTok sensation during the pandemic and has 2.8 million followers for her viral dance videos. She hadn’t been able to visit her mother since last year, and it’s all she wants.
“I get to see my mom,” she said.
As soon as Pediatric Psychologist Joyce Goins-Fernandez, a clinical assistant professor and vice chair for diversity, equity and inclusion in the Stead Family Department of Pediatrics at the University of Iowa, got vaccinated, she posted about it on Facebook to help raise awareness. She also created a video encouraging others to get vaccinated.
“I think if we can get more positive messages out there, that might help,” she said.
Monica Goodlett, an RN who earned her B.A. in nursing in 2005 and who is working on her master’s degree, said she is worried that people have become too relaxed and are not taking the virus as seriously as they were when it began. She agreed that representation and transparency will have a “greater impact” on raising low vaccination rates.
“I believe in representation, and if more people can see that more and more Black people have received the vaccine and are doing fine, I believe that has a more significant impact,” she said.
Iowa’s ‘frustrating’ vaccine response
Just months into the pandemic last year, Henderson, the funeral director, offered to help Polk County, home to about 38,000 Blacks, develop a public service announcement to promote the vaccines to Black communities. She also posted a video encouraging her Facebook friends.
The advice she gave Black Iowans: “Go get vaccinated.”
“People in February were frustrated because not a lot of vaccines were available. They didn’t know where to get them . . . It was all very, very frustrating,” said Easley McGhee of the NAACP and who is also director of health equity and community and diversity resources for MercyOne Des Moines Medical Center.
State and Polk County health officials said they partnered with Black organizations, a Black church in Des Moines and other human services agencies to help Blacks get vaccinated. Now, seven months after the first vaccination in the state, the Iowa Department of Public Health has launched a vaccination awareness campaign and a grant program. Polk County, Black Hawk County, employers and other groups have incentivized the vaccines by offering cash prizes, gift cards — even free food — to boost vaccination rates.
Sarah Ekstrand, public information officer for the Iowa Department of Public Health, said in an email the state worked with the Iowa Department of Human Rights and governor’s office to conduct “extensive outreach” to community organizations that serve minority populations to “support them in their vaccination efforts.”
“We are committed to getting as many Iowans vaccinated as possible and will continue to message about the importance of getting vaccinated for COVID-19 for the foreseeable future,” said Ekstrand.
Iowa Department of Public Health, in conjunction with Broadlawns Medical Center, United Way of Central Iowa and the Polk County Health Department, assisted with a March 27 vaccination clinic at Corinthian Baptist Church, which vaccinated 1,200 people. About 60% of those vaccinated were Black, said Easley-McGhee, a church member.
“The location helped people feel comfortable,” she said.
In addition to testing and vaccinating residents, Nola Aigner Davis, public health communications officer for the Polk County Health Department, said they trained two people as advocates to help educate community members about the vaccine and put up billboards in Black neighborhoods to promote its call center, which helped register people who don’t have access to the internet or a computer. The department also held a vaccination clinic this week outside the department in Des Moines featuring free corn dogs, funnel cakes and Fair-themed foods.
Easley McGhee said the national NAACP last year pushed for Black representation in vaccine clinical trials because of a lack of trust in “government leadership.” She said trusted messengers, like churches, the NAACP and other Black organizations have prioritized educating Blacks and securing vaccination locations that Blacks feel comfortable at.
“You can’t just say, ‘Hello, we’re the health department. We’re here,’” said Easley-McGhee. “There are a lot of people who have never set foot in the public health department. Going to the public health department probably isn’t their first choice.”
Billboards aren’t enough either, Henderson said.
“Most of the time unless it’s something I’m interested in, (billboards) don’t even register with me,” Henderson said.
Aigner Davis said Polk County is working with the United Way of Central Iowa on vaccination efforts in the Des Moines zip codes with the most Blacks, which include 50311, 50313, 50314, 50315, 50316, 50317 and 50320.
Easley McGhee, who serves on several health-related committees, said hearing from county health officials about the scarcity of the state’s vaccine supply last winter and spring helped allay some concerns.
“Because otherwise you would think, once again, we're being suppressed,” she said. “We're being kept from getting vaccines that could save our lives.”
In Iowa, the NAACP held town halls on social media featuring Black health experts to push the vaccines and debunk misinformation, and more than 1,500 people participated. The national association created the campaign “COVID. KNOW. MORE.” with barber shops and beauty salons to serve as host sites for vaccine clinics and to disseminate materials about the vaccines to their clientele.
“We knew we would have to do a lot of awareness and education,” she said. “We were disproportionately impacted by the virus.”
Last winter, when demand far outpaced the state’s vaccine allotment, Iowans turned to Hy-Vee, which received a large supply of weekly vaccine allocations through an agreement with the CDC and the National Association of Chain Drug Stores. Millions of people were vaccinated against COVID-19 at Hy-Vee, which operates more than 280 grocery stores — and 270 in-store and freestanding pharmacies — in an eight-state region. Hy-Vee also operates nine mobile buses and had the special freezer units needed to store the Pfizer vaccine, a spokesperson said.
“We already had trained staff in place,” said Christina Gayman, director of public relations. “We’ve been vaccinating people for years.”
During the Iowa State Fair, which runs Aug 12-22, Hy-Vee will hold a daily walk-up mobile vaccination clinic from 10 a.m.- 6 p.m. at the West Grand Exhibit Area. COVID-19 and Flu vaccinations will be available. Also, people who get vaccinated at a Hy-Vee pharmacy or pop-up Hy-Vee vaccination clinic through Nov. 1, will receive a $10 Hy-Vee gift card.
Some criticized the state’s efforts to reach Blacks.
Goodlett said she’s not aware of every official state effort to vaccinate Blacks, but believes those efforts could have been better, such as more partnering with community organizations, public figures, Black-owned businesses and prominent Black health care professionals.
“I believe there are many reasons why priority was not given, but ultimately it begins with the initial response and handling of this virus in the beginning by leadership,” she said. “This virus was not taken seriously until it became a real problem and posed a fatal risk to human lives.”
Medical mistreatment of Blacks is real
Blacks already have a tough time trusting the health care establishment. COVID-19 disparities can make it even harder.
Many medical experts cited underlying health conditions as an explanation when the pandemic began decimating Black communities during the spring of 2020. Marcelin, in her conference keynote speech, said the disparities are a “manifestation of systemic differences” like food insecurity, housing insecurity and low-income status that “predisposes” people to these health outcomes.
“There’s definitely a long history of health care disparities in this country that are directly related to racism and white supremacy,” Marcelin said during the keynote.
Tuskegee “is not the only thing,” Marcelin said. “There are a lot of us folks who can give you stories about things that are happening today that make us question whether or not the people that we’re encountering within the health care establishment actually have our best interests in mind.”
“The Tuskegee experiment, I think, has colored public health for forever to come,” she said. “So I see why we might be hesitant or suspicious.”
So is the health care system broken?
“The system is, in fact, flawed, but it is acting exactly in the way it was designed,” Marcelin said, in the keynote. “The system was created from racism and structural inequities.”
Why is getting vaccinated still difficult?
Goins-Fernandez, whose work includes diversity, equity and inclusion, said vaccine access is a real problem.
“There are some people who want it, but don’t have access to it,” she said. “So we have to help people get it and make it more accessible.”
Marcellin said during the keynote she saw access issues in Omaha, Nebraska, where she works. Vaccine sites were mostly situated in wealthy white areas, and fewer existed in poor areas with “Black and Brown folks,” she said. Poor neighborhoods didn’t have pharmacies and were “retail pharmacy deserts” so the push by officials to use that system to vaccinate those populations didn’t work, she said.
As a community leader, Henderson, who beat COVID-19 twice before getting fully vaccinated, said last spring’s large vaccination clinics had drawbacks because Blacks were wary of catching COVID-19 in a crowded site with hundreds of strangers.
Early on, the state should have said: ‘We’re holding a clinic today from 9-5,’ and whoever lines up, give them a shot. Why do you have to schedule it?”
N’yla Whitson, 31, of Des Moines, an adult mental health care provider, is aware of the dangers associated with the virus but doesn't plan to get a shot. Whitson said she caught the flu three years ago after being vaccinated for it and is skeptical about the COVID-19 vaccines.
“There's not enough education out there on it,” said Whitson, as she walked with two of her clients at a downtown Des Moines park.
Couple Andre Crosby, 34, and Brandee Harris, 37, didn’t notice the state’s media or billboard vaccination campaigns. Stress and money worries dominated their thoughts while staying at a homeless shelter last spring. Harris has high blood pressure and said she doesn’t know how the vaccines will work with her medication.
“I probably just need to be educated,” she said.
After spending more than a year away from family and friends, Bundy, a social media influencer, wanted to end the isolation but had lingering concerns about the vaccines.
“Mainly because I didn’t know what was in it,” she said.
Bundy’s doctor assured her she’d be OK getting vaccinated but told her to visit the CDC’s website when she asked questions about the ingredients.
“I didn’t get any real clear answers,” she said. “I know they don’t have the time to answer, but it’s my body. It’s my health so you should answer.”
Dr. Michihiko Goto is an assistant professor in the division of infectious diseases at the University of Iowa Carver College of Medicine whose work includes limiting infections in hospital systems and nursing homes. Goto said the vaccines contain “natural substances that the body creates” such as lipids and salt. Learn more about vaccine ingredients: J&J, Moderna and Pfizer.
The online registration process for the vaccines also served as a barrier, Henderson and health experts said.
“You had to do it online and some folks don't have those resources or the technology to be able to schedule an appointment, so there's barriers or disparities there, too,” said Del Castillo, of the University of Iowa Carver College of Medicine.
She joined Twitter specifically to find Iowa Vaccine Alerts, created by an Iowan during a time of high demand. Finding little official help elsewhere, tens of thousands of Iowans last winter relied on the site, which ceased operating last month, to schedule their appointments.
Once Bundy committed to the idea of getting vaccinated, she knew she didn’t want to get vaccinated at crowded vaccination clinic. Fortunately, she heard about Vaxi Taxi.
“I called them and they came to our house, so that made it so much easier,” said Bundy, who became fully vaccinated as of July 1, with the Pfizer vaccine.
Now, life is opening up.
“The only thing that I’m looking forward to is seeing my mom,” she said.
False or misleading information about the vaccines is “an urgent threat” that is prolonging the pandemic and is a roadblock in the fight to vaccinate more Americans, according to U.S. Surgeon General, Dr. Vivek Murthy, who last week issued his first advisory, Confronting Health Misinformation.
“Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort,” the report stated.
Being exposed to even brief misinformation made people less likely to want a vaccine, according to the report.
After seven months, Goodlett, the nurse, is still clarifying misinformation about the vaccines that she sees on Facebook.
“Honestly, I am somewhat tired and exhausted with people’s continued resistance and ignorance to COVID and the importance of vaccinations,” she said. “At this point, they are choosing to remain unknowledgeable from reputable sources.”
Goins-Fernandez has also noticed misinformation on social media. A family member posted on Facebook about a person who got vaccinated but then died a week later.
“Correlation doesn't equal causation,” she said.
Henderson understands vaccine hesitancy, but she scoffs at myths and conspiracy theories.
“Stories being told of magnets sticking to people’s arms because of tracking devices being inserted,” she said. “People aren’t comfortable with the (vaccine) ingredients but don’t know what’s in the chicken nuggets they eat everyday or the taco meat.”
Del Castillo has heard the magnet tale, plus many others. For months, she and others at the medical college have worked to combat misinformation:
Some people think certain vaccines are for Blacks, and other vaccines aren’t, Del Castillo said. FALSE. Health experts said Blacks were included in clinical trials of all three vaccines, which received emergency approval by the Food and Drug Administration last December and are considered safe and effective.
An African priest told Easley McGhee that his congregants preferred a one-dose vaccine because they believed that one of the doses in two-dose vaccines actually contained the coronavirus. FALSE. Health experts said none of the vaccines contain live coronavirus. Moderna and Pfizer use mRNA technology. J&J uses adenovirus. “Both of those technologies have been studied for many years,” Goto said.
Since the coronavirus originated overseas, Blacks can’t get it because they don’t travel overseas, Easley McGhee has heard. FALSE. Health experts said anyone can get COVID-19.
55% of Blacks in a Kaiser Poll cited vaccines’ “newness” for refusing the vaccines, which is a reason Del Castillo and Goto both have heard. FALSE. Del Castillo and Goto said the technology behind the vaccines has been studied for years.
Some people have raised concerns that vaccines cause fertility issues. FALSE. Goto said the data does not confirm those concerns.
“There's years and years and years of research and science behind understanding the virus and as well as creating a vaccine,” Del Castillo said. “So this is not just something they just came up with in a couple of months but years of work and research.”
Del Castillo said there are a host of other reasons people may not want to get vaccinated.
Seeing someone have a panic attack while getting the vaccine can be triggering, Del Castillo said.
That’s what happened to Crosby and Harris. They saw a few people at the homeless shelter where they were staying get vaccinated and become “woozy,” they said.
“We saw people have reactions,” Crosby said. “They got on it real fast, but everybody was looking.”
Most people report mild to no side effects after taking a COVID-19 vaccine, but some people just don’t want to risk feeling sick at all, Del Castillo said.
“Some people say, ‘You know every time I get the flu vaccine, I get sick afterward, and this vaccine is already making people sick, and I don't want to get sick afterward,’” she said.
Others might be afraid of needles. Goins-Fernandez said phobias are irrational fears but relaxation and other techniques can help.
Two-dose vaccines can also deter people, Del Castillo said. Some people have skipped out on their second doses, which lowers the overall effectiveness, a recent study found.
“You’ve got to do it not just one time, but then you’ve got to go back and get it a second time, which might be overwhelming for somebody,” Del Castillo said.
That’s why health experts said it’s important for unvaccinated people to talk through their concerns with trusted messengers, health care providers and knowledgeable family and friends.
“So I think you just you just have to weigh the risks,” Goins-Fernandez said. “So I can go and get stuck by the needle, or what if I become sick and then I have an extended hospital stay that might end in death?”
The Path to Normalcy
Del Castillo experienced a sore arm, a “creeping headache,” a slight temperature and fatigue when she got the Pfizer vaccine last spring. She kept telling herself: “I’ll feel better tomorrow. This is only temporary. This will pass.”
Now, there is less fear, more hope.
She doesn’t have to worry about giving her mom a hug. She and her husband can plan a vacation to Disney World for their children, ages 2 and 5.
“As far as me getting the vaccine, it is not only something that is beneficial for myself, but also beneficial for my community, and for my children, my family, and just the ripple down effects of getting the vaccine not only impacts us individually, but the public good,” she said.
That’s a sentiment that resonates with Henderson.
“We all took vaccinations as a child, and we made sure our kids took them,” she said. “Why wouldn’t we do this one, too?”