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The New York Times

A Hospital Encounters Vaccine Hesitation: 'I'm Just Not Rushing'

NEW YORK — When it was the Rev. Al Sharpton’s turn to get inoculated against COVID-19 last month, he did so on camera at NYC Health + Hospitals/Harlem — a city institution well known for providing health care to the Black community. Sharpton was trying to send a message to his community: The vaccine is safe and effective. But that message was aimed at the hospital’s staff, too. At one point, the facility’s staff had the lowest vaccination rate among hospitals in the city. Even after steady improvement, as of mid-March, the hospital still had a rate well below the average for hospitals in the state. Sign up for The Morning newsletter from the New York Times In New York state, African Americans make up about 17% of the adult population but have received only 10% of the shots. That is because of difficulties gaining access to the shots but also because of a lingering reluctance — and that has rung true at Harlem Hospital, where a majority of the staff is Black, administrators said. The situation at Harlem Hospital underscores how entrenched this mistrust can be: Even workers at a hospital where the vaccine is readily available are wary of getting inoculated. But it also shows how it is possible to make progress in changing attitudes about the vaccines, even if slowly. At Harlem Hospital and nationally, confidence in the vaccines has been rising among Black Americans. Recent polls show that Black Americans, though initially more skeptical, are now about as likely to want to get vaccinated as white Americans, and that politics, not race, is emerging as a larger divide. Republicans are now the group with the highest degree of skepticism: In a late February CBS News poll, 34% of Republicans said they would not be vaccinated against COVID-19, compared with 10% of Democrats. Brazil Rice, 54, who has worked at Harlem Hospital for 21 years in cleaning and maintenance, was among those who said they were going to wait. “It wasn’t properly field-tested,” he said. “It usually takes years to field-test a vaccine.” He stressed that his distrust had nothing to do with the hospital, which has made getting vaccinated “pretty convenient.” “I have every intention of getting it; I’m just not rushing,” he said. And when the halls are quiet on the night shift, he keeps an eye on his friend who has been vaccinated and so far is doing well, he said. Harlem Hospital’s low vaccination rate did not come as a surprise to its leaders. A poll taken at the institution in late 2020 before the vaccines were approved, showed that only 30% of workers there were willing to be vaccinated, said Eboné Carrington, the hospital’s chief executive officer. Black workers cited concern rooted in the legacy of medical injustices like the Tuskegee experiment, a study by the U.S. government that withheld syphilis treatment from Black men, and general skepticism of a vaccine developed quickly, under a presidential administration they did not trust. “The staff reflects a population of people who traditionally are reluctant to vaccinate, and not just hesitant, but rightfully fearful, at having been wronged,” she said. The hospital is known as a historic training ground for Black medical staff, and for saving the life of the Rev. Dr. Martin Luther King Jr. after a woman suddenly stabbed him in the chest in 1958 at a Harlem department store. Drawn to its prominence, local celebrities have been getting vaccinated there. Neil deGrasse Tyson, the astrophysicist, posted on Twitter about his recent inoculation at the hospital. “If we can inspire people, as we have countless times, to protest certain social ills, I hope we can inspire them to do what is necessary to have a healthy environment in our community,” Sharpton said in an interview about his vaccination. Keisha Wisdom, Harlem Hospital’s nursing chief who spent time in an intensive care unit in 2020 after contracting the coronavirus, also publicized her shot. “I think that the history of medical experimentation on Black people plays a role in some of the decision making,” Wisdom said of why about half her nursing staff remained unvaccinated. “It is real, and it is something we have to talk about. And then find a way to continue that dialogue.” The early weeks of the vaccine rollout saw widespread hesitancy among hospital workers in the nation and New York state, with less than half of eligible workers vaccinated by early January. In the city’s public hospitals, the number was even lower, at 31%. That earned the ire of Gov. Andrew Cuomo. “This is a management issue for the hospitals,” he said at a Jan. 4 news conference. While other hospitals’ vaccination rates improved, Harlem Hospital was among those that lagged. In late January, Cuomo singled out the institution repeatedly at news conferences for having the lowest rate in the city, 37%. The approach rankled Carrington, who felt she was being punished for having a Black and brown staff whose worries she was trying to address. Her mother called to express concern when she heard the governor’s harsh words. “Mom, I don’t care,” Carrington said she told her. Harlem Hospital has been trying to get the rate up with an “outreach blitz” that includes publicity, town halls and one-on-one conversations. Its current vaccination rate among staff, 51%, puts it in “the middle” of the 11 hospitals in the city’s public system, the city said, but still well below the near 80% average vaccination rate for hospitals in New York state as a whole. Some nurses told their supervisors that they didn’t feel a pressing need to get the vaccine, because they already had COVID-19, Wisdom said. The hospital was hit hard by the virus, with about 200 patient deaths from last March to September. The fatality rate was 36.6%, among the highest in the city, according to data the hospital reported to the state. There is now no shortage of personal protective equipment so some staff said they felt more secure. “Staff are saying, ‘I almost died in the first wave, I’m good,’” Carrington said. “There is this invincibility that it’s hard for me to offset.” Dr. Mitchell Katz, the chief executive officer of the city’s public hospital system, said last month that about 40% of nurses in the city’s public hospitals remained unvaccinated. But rather than express alarm, he said that he was willing to be patient in the coming months and focus on personal outreach, like one-on-one conversations, to increase the rate. Extra resources did not flood into Harlem Hospital after Cuomo’s criticism, nor did Katz seek to reprimand Carrington. Katz said he was not tracking vaccination rates by hospital because he believed the rate was not a management issue but related to the percentage of Black and brown staff in each institution. “To me, there are very understandable reasons people don’t want to get vaccinated yet,” he said, naming the lack of long-term studies about the COVID vaccines, and the negative experiences many Black and brown New Yorkers have had with doctors. “I find it surprising that so many people are surprised.” Jasmine Travers, an assistant professor at the Rory Meyers College of Nursing at New York University, who studies vaccine hesitancy, said that empathizing with staff reluctance was a good start, but not enough. The goal, she said, should be 70% to 80% uptake, and a determined effort by leadership to get there. “We should not just chalk up a refusal to that person’s own wishes; we also need to look into ourselves and understand how we are approaching it,” she said. “We can’t tiptoe around the subject. It’s one thing to want to be respectful, but we have to interrogate people around how we can better support them. What is the work that needs to be done?” Warren Davis, 54, a transporter at Harlem Hospital, was among those who overcame their concerns, and he made an appointment for a vaccine in late February. Davis believes he had the coronavirus in May but was never tested. He said he was worried about the vaccine’s short-term and long-term side effects. He also heard a variety of conspiracy theories, including that the vaccine was designed to hurt Black people, and for a while, he said, got caught up in them. Then he reconsidered. “A lot of people are receptive to the bull crap they are hearing, the rhetoric people are telling them,” he said. Sharpton said he had heard that conspiracy theory and many others. He advises leaders to take on such ideas directly, he said, because the vaccine is needed to keep people safe. “When you see all these whites lining up to take this vaccine, do you really think they are sacrificing all these people just to kill a few of us?” he said. “When we are the ones that are not getting access?” This article originally appeared in The New York Times. © 2021 The New York Times Company

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