Data upends some myths on race and vaccines

The collision of health care and technology.

Jan 26, 2022 View in browser   By Ben Leonard and Darius Tahir THE BIG IDEA A NEW COVID HEALTH LESSON: Conventional wisdom held that distrust of health systems and misinformation kept Covid vaccines from going into arms in Black communities. But new evidence shows that hesitancy there waned faster than in white communities — which could inform future appeals about new treatments. An Ohio State University-led team found that while Black and white individuals entered the nationwide vaccine rollout late last year with a comparable willingness to get the shots, Black individuals overcame their hesitancy faster, believing the inoculations were necessary protection. The study of 1,200 individuals in JAMA Network Open found about 38 percent of Black participants and 28 percent of white participants were hesitant at the study's start in December 2020. By June 2021, the rate among white patients barely budged — even as the percentage of hesitant Black patients fell by a dozen percentage points. One key takeaway, the authors say, is that community leaders and educators play a crucial role in convincing Black audiences how health innovations protect people. Steven Senne/AP Photo "Go ahead and provide those big universal messages as a foundation and then layer on top of that a lot of community level … so that people can actually bridge the gap between big picture information that's coming out of say, the CDC or the White House and their actual ability to act in their own spaces," said Tasleem Padamsee, the study's lead author, a sociologist and health equity researcher at Ohio State. Outside experts agree. Lisa Cooper, who leads the Johns Hopkins Center for Health Equity, said tailored outreach — whether it's partnering with churches or holding webinars with Black physicians and academics — is critical. The researchers note that historical traumas such as the Tuskegee Syphilis Study and the unethical use of cancer cells from Henrietta Lacks provide important context for understanding vaccine hesitancy in Black communities. And despite the documented shift in hesitancy, disparities persist. CDC data shows the vaccination rate among white individuals is higher than those for Black patients in all 40 states reporting data. One reason for those disparities: real-life barriers such as a lack of transportation, child care, or time off from work. Those logistical knots can exacerbate misconceptions and distrust among minority patients, said Jerome Adams, the surgeon general during the Trump administration. "What if I miss work due to vaccine side effects? Who will care for my kids while I go get vaccinated, and if I'm down for the count the day after my vaccine?" he asked. "If I'm already skeptical, for any reason, each small obstacle can turn into a mountain." Adams says the results explode some of the conventional wisdom explaining patients' choices. Many commentators attribute the United States' lagging vaccination rate to politics. They argue that partisan cable TV programming or heavily hyped medical fads distract patients from proven treatments. "As much as people want to frame hesitancy through the lens of politics, politics has little to nothing to do with the reasons minorities won't get vaccinated," he said. Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @samsabin923 , @_BenLeonard_. TWEET OF THE WEEK Christina Farr @chrissyfarr "A friend pointed out to me today that there are definitely to be startups popping up to serve patients with Long Covid. Haven't seen much there yet, but would not be surprised given the potential size of this population." AROUND THE NATION REAL BILLS FOR VIRTUAL CARE: Surprise bills for telehealth services are arriving for tens of millions of people in high-deductible, employer-sponsored health plans due to the expiration of a payment allowance Congress passed as part of the CARES Act relief package. POLITICO's Ben Leonard writes the legislation allowed certain plans to cover the costs of virtual visits before patients met their deductibles. With the provision's expiration on Dec. 31 and the Omicron variant still tearing across the country, some patients are seeing bills of $100 and more for tele-appointments. Lawmakers who wrote the language probably never counted on the pandemic lasting as long as two years and driving more demand for virtual services. Still, the failure to extend the language marks the first significant loss for telehealth interests, which have seen their field explode amid the pandemic's lockdowns and other public health restrictions. Mark Lennihan/AP Photo Groups, including the Alliance for Connected Care and the American Telemedicine Association, are eyeing an anticipated February stopgap spending bill to keep the government running, which could be used as a possible vehicle for renewing the allowance. But not everyone in Congress is on board. Many Democrats view high-deductible plans as a workaround to the Affordable Care Act and likely to be used by wealthier people who can afford to pay if they need pricey care, JoAnn Volk, a professor and co-director of the Center on Health Insurance Reforms at Georgetown University, said. House Ways and Means ChairRichard Neal (D-Mass.) is among those said to be skeptical of efforts to extend the provision. WASHINGTON WATCH A NEW PUSH ON CDC ACCOUNTABILITY: Top lawmakers on the Senate health committee are proposing to make the Centers for Disease Control and Prevention to have its director undergo Senate confirmation for the first time and subject the agency to new reporting requirements in health emergencies. The effort from Senate HELP Committee Chair Patty Murray (D-Wash.) and ranking Republican Richard Burr of North Carolina is part of a broad pandemic preparedness draft bill that comes amid heightened scrutiny of the agency and Director Rochelle Walensky over mixed messages on the Covid-19 crisis and their response. Murray and Burr propose "specific functions" for the CDC director — including communicating a proposed strategic plan every four years. Other parts of the draft call on the director to boost genomic sequencing and issue public health data standards to promote better information sharing. The lawmakers would also direct the Food and Drug Administration to issue three guidance documents to modernize clinical trials, with focuses on digital health technologies to improve recruitment, participation and data collection and decentralized trials to pilot the use of more flexible study designs. NO BENEFIT SEEN FROM USE OF HEART-SCREENING GADGETS: There's not enough evidence to justify the widespread screening for irregular heartbeat using devices like the Apple Watch, a new review from the U.S. Preventive Services Task Force concludes. POLITICO's Darius Tahir writes the news is a blow for manufacturers that have introduced consumer products that detect the condition. A favorable finding would have provided an imprimatur for the products: The task force's approval requires insurers to make services available without a copay. Atrial fibrillation is a type of heart rhythm irregularity that can suggest a risk for strokes. But it's currently diagnosed as a health problem in combination with other symptoms and risk factors, including chest pain and fatigue. Previously, the medical technology that spotted atrial fibrillations was expensive, inconvenient and prescribed by doctors. Products were given to at-risk patients at risk and any heart irregularities were likely negative indicators for health. The situation has changed with the influx of consumer-oriented, affordable products like Apple's Watch that are capable of spotting atrial fibrillation on their own. Relatively healthy and young patients might therefore be diagnosed with atrial fibrillation, raising the question of whether that's a meaningful health condition. The Task Force concludes that there's still no evidence of benefit of screening for those populations. IDEAS LAB QUITTING SMOKING? THERE'S AN APP FOR THAT: Need a cigarette break? A new study suggests a game might help you break that habit. According research in JAMA Internal Medicine, patients who aren't ready to quit smoking can be nudged into changing their habits, using a "gamification" approach. The study, a randomized controlled trial of 433 patients, featured a combination of games, texts, quizzes, gift cards, and counseling sessions targeted at patients who weren't ready to quit smoking at the outset of the research. At the end of the study, the cessation rate was eight points higher among the group treated with the game — though only 18 percent of patients in the gaming group had ceased to smoke at six months. "Sustaining engagement … is challenging," the authors note. WHAT WE'RE CLICKING What does Theranos tell us about venture capital? Mostly good things, argues financial journalist Sebastian Mallaby in The New York Times. The masterminds of a successful clinical trial structure for the pandemic want to export the model to other studies, writes STAT. Worrisome information is emerging on a mandatory health app for Winter Olympics athletes, the Guardian reports.   Follow us

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