Zinzi Bailey looks at Miami-Dade’s earliest wave of COVID-19 vaccinations and sees an unaddressed question. Why did so many paramedics, firefighters and hospital workers pass up a chance to get a shot?
Large numbers of Miami-Dade hospital workers, firefighters and paramedics who were offered early vaccinations for COVID-19 declined, and county leaders haven’t tried to figure out why.
Bailey, a research professor at the University of Miami who studies health inequities, said that’s a big problem, now and into the future. “There is a community and a culture around firefighters, healthcare workers,” she said. “If we’re not delving into that, we’re missing a key opportunity for the spread of information around this vaccine and disrupting some false visions of what that’s about.”
The lack of full acceptance by those key groups is likely to have implications when it comes to vaccine trust in the broader population, health experts say. Less than a quarter of Miami-Dade Fire Rescue’s 2,000 firefighters and EMS squads have gotten the vaccine — 458 people in an agency of about 2,000 people, as of Friday. At Jackson Health System, the county’s public hospital, about half of the initial front-line workers surveyed said they were interested in receiving doses last month, though that number increased as administrative workers and residents were also vaccinated.
As of last week, Jackson had inoculated more than 5,300 healthcare workers, though that total included residents and doctors who are not full-time employees at the hospital. The Jackson system has about 13,000 employees, though the 5,300 total includes others who don’t work directly for the hospital network.
Healthcare workers are important to survey because many are from communities of color that could be hit harder by a lack of trust in medicine, resulting in “vaccine hesitancy,” Bailey said. That mistrust in the vaccine is being perpetuated on social media and chat platforms like WhatsApp, Bailey added.
The paltry numbers of first responders wanting the vaccine doesn’t appear to have prompted a sense of urgency from Miami-Dade leaders.
Rachel Johnson, communications director for Miami-Dade, said the county hasn’t surveyed employees who declined vaccinations to learn more about their decisions. Instead, the county has shifted its focus to providing vaccinations to people 65 and over, who are flooding reservation sites to seek limited appointments, she said.
“We expect that interest in taking the vaccine will grow among all groups as more people get vaccinated and the vaccine becomes more widely available,” Johnson said.
But health inequities have long been propagated by those in power saying that would be a problem to be dealt with later, said Bailey, the University of Miami professor, “and that’s why we are always playing a catch-up game when it comes to usually lower-income, communities of color.”
“We have learned very little, even from COVID testing to the COVID vaccine,” Bailey said, pointing out that communities that were disproportionately hit by the virus were not prioritized for early access to testing. “And it seems like we’re continuing to approach these issues in the same way over and over again.”
The elected officials and health administrators overseeing Miami-Dade’s vaccine effort say they’re facing twin challenges: demand from some residents that currently seems overwhelming because of short supplies of vaccines, and evidence that portions of the broader population aren’t eager to be vaccinated.
“Right now we’re dealing with scarcity. But in a few months we’re going to have to deal with a reluctance to take the vaccine,” said Miami-Dade Commissioner Raquel Regalado. “If we have to launch a public relations campaign, why not do that sooner, rather than later?”
The mother of two children on the autism spectrum, Regalado told commissioners at a Jan. 14 meeting that they need to be ready to convince pockets of the population that the COVID-19 vaccine is safe.
“In the community of special needs that I serve, specifically parents of autistic children, there’s a tremendous fear of vaccines,” she said.
An initial survey of the county Fire Department found about half of the firefighters and paramedics were interested in getting the vaccine, though about 20% said they would want it “later.” About 45% chose “not interested” in the survey.
Omar Blanco, a 48-year-old lieutenant with the Fire Department, said he declined the vaccine for now because of the short supplies for people considered more at risk of severe illness from COVID-19.
“I’m willing to step back,” he said.
Hialeah’s fire department, which employs about 220 firefighters, had access to 70 two-part injections, and 70 firefighters accepted and took the first dose, according to the president of the firefighters’ union, Eric Johnson.
Johnson said a lot of members of the department have “played stubborn” and said they had no interest in the vaccine, with some saying they’ve already had COVID and didn’t want to use a vaccine that would otherwise go to someone over 65.
Bailey said she is attempting to start conversations about vaccine hesitancy in communities of color at her own workplace, the University of Miami, and she advocated for county leaders to retool their approach beyond press conferences.
Though vaccine hesitancy is characterized by a mistrust she traces back decades — to such horrific examples as the Tuskegee syphilis study in the 1930s, when the progress of the disease was tracked in Black men without their consent — Bailey said that can be overcome by conversations with communities of color that go beyond the superficial enlistment of celebrities and tap into real questions about proof the vaccines work.
The Tuskegee story and others may not resonate as much as people think they do, she added, and simply putting in the time and effort to answering questions might turn people around.
“I don’t think there was ever enough attention paid to asking people what their concerns were about,” she said. “I think there’s an assumption that [public health officials] know what their concerns are.”