Georgia Today: Grady Doctor Combats Vaccine Mistrust Among Communities Of Color
On Georgia Today, host Steve Fennessy talks with Grady Memorial Hospital physician Kimberly Manning on the roots of distrust amid the COVID-19 vaccine rollout, and her personal mission to persuade communities of color to take the vaccine. Dr. Manning is also associate vice chair of diversity, equity and inclusion at Emory University's Department of Medicine.
Steve Fennessy: This is Georgia Today. I'm Steve Fennessy. It's Friday, Jan. 22nd, 2021. This week, as the Biden administration takes charge in Washington, the death toll from COVID-19 has soared past 400,000.
Joe Biden: We need all our strength to persevere through this dark winter. We're entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.
Steve Fennessy: President Joe Biden's ambitious goal of 100 million vaccine doses in his first 100 days in office faces logistical obstacles, but also historical ones among communities of color. Centuries of oppression and inequities are contributing to vaccine resistance and skepticism that, paradoxically, could marginalize these communities even more. Today, I'm joined by Dr. Kimberly Manning, a physician at Grady Memorial Hospital and associate vice chair of diversity, equity and inclusion at Emory's Department of Medicine. Dr. Manning grew up in Los Angeles but came to the South for college at Tuskegee University in Alabama, for medical school in Tennessee and finally to Atlanta to build her career.
Steve Fennessy: I read that you're the fourth generation that attended — in your family — that attended Tuskegee University, is that correct?
Kimberly Manning: Absolutely. My great-grandmother went to Tuskegee. My grandparents met at Tuskegee and fell in love there — my maternal grandparents. So they were actually college students on the campus of Tuskegee, then Tuskegee Institute, during the time that in Macon County, Alabama, the untreated syphilis study was happening. And I always like to make the distinction that it was happening in Macon County, Alabama, but not at the — the institution to which my family's connected.
NPR Newscast: "Criminal" is just one of the words being used now to describe a study of syphilis, a study reported by the Associated Press this way, quote: “For 40 years, the U.S. Public Health Service has conducted a study in which human guinea pigs were denied proper medical treatment in order to study the long-term effects of syphilis and its side effects,” unquote.
The patients in this study were all Black, poor, uneducated, mostly from Macon County in Alabama. Tuskegee is the county seat.
Steve Fennessy: When you were attending Tuskegee University, what was sort of the understanding about the — the untreated syphilis experiment that had gone on for so many decades, about which many Americans probably didn't know much about at all until recent months when we've been talking more and more about vaccine resistance in terms of not — not wanting to take it. Can you talk a little bit about your own memory of what you understood about it?
Kimberly Manning: I would say the biggest thing I remember is that it happened. But it's interesting: If — if you are in circles where the people that, you know, attended historically Black colleges, right. When somebody says “Tuskegee” to me, even when I was in high school, even when I'd read about the untreated syphilis study, the first thought in my head was always Booker T. Washington. Black excellence. Veterinarians. The Tuskegee Airmen. That's what always came to my head. And it broke my heart, you know? When I when I got to medical school — or actually, more residency — and people made the word “Tuskegee” synonymous with this horrific study. And so we were aware of it, but we never really felt like it was related to us, we just felt like it was related to our people. And it just so happened that it happened — that it was geographically near our school.
Steve Fennessy: So that experiment has been invoked many times in recent months.
Newscast: In the midst of a global pandemic, Dr. Laolu Fayanju says he's finding a chance to build trust.
Laolu Fayanju: It's an opportunity for us to really try to change the course of how minority communities perceive health care institutions and health care providers.
Newscast: History has given minority groups, specifically African Americans, plenty of reasons to be skeptical. Medical experiments on that population date back to colonial times, but the Tuskegee syphilis study might be the most well-known.
Steve Fennessy: Whenever I am reading a story about equity and in terms of the equitable application of the vaccine, and we talk about skepticism among communities who are Black and brown, that that is something that — that is in their mind. Can you talk a little bit about that generalization, and to what degree that's — that's an accurate one?
Kimberly Manning: I think it's really important to — to think about where people's mistrust comes from now. As I think about the conversations I have with my patients and with people that I know of, they aren’t really uttering things about the untreated syphilis study. What they're talking about is social injustice. You know, if you turn on the TV and you see someone who looks like you or your dad or your brother or your sister get shot, you know, and who's unarmed, right? And the reaction is that nothing happens, right? There is no recourse or anything. What that says to you as it happens over and over and over again, is that, you know, the system doesn't care about me. And the broader system, it begins to like blend and bleed into health care, too.
Some folks feel like, well, you might allow me to take one for the team, because the same way that you would gas me and rubber bullet me and then shoot me, why — why would you — why would you not also be willing to let something happen to me if there was a bad thing about this vaccine?
Steve Fennessy: Dr. Manning, you've worked at Grady Hospital, which is Atlanta’s safety net hospital for the past 20 years or so. How has your perception about how we treat Americans in the health care system changed in that time? What have you learned?
Kimberly Manning: Well, you know, Grady Memorial Hospital is really a place that draws a certain type of people to work there. And I always say that working there feels like ministry.
You're surrounded by all these like-minded people who want to serve the underserved, and so I actually feel like I see some of the very best of humanity of all races working inside of the building. With my patients, what I've learned the most from working there is that, you know, I came there thinking that I was going to save people's lives and — our patients, they save OUR lives.
You know, they show us and teach us some of the most important lessons that you could never read in a book or a journal in medical school. Just some of — just some of the wisdom and resilience that you see in our patients. People catching buses and, you know, all of the things people go through to — to get health care. And yet they still have a smile on their face and remember the name of your kids. I just think I think I see some of the best of humanity at Grady, and people misunderstand that about safety net hospitals, I think.
Steve Fennessy: Well, is there a — a patient that comes to mind in the 20 years or so that you've worked there that — that maybe illustrates what you're — what you're talking about?
Kimberly Manning: Yes, there are so many. But one — one experience I had that always stands out and I'mma — I'mma do my very best to tell you this and not cry because I'm a crier.
In 2012, unfortunately, my older sister, Deanna, died of a sudden cardiac death out of the blue. She was 44. She lived in Atlanta. She was an educator, actually, after she left engineering. She taught middle school science and math. And she was a daily part of my life and losing her — I mean, it just like gutted my family to the core, right? And when I came back to work, I was grieving and I needed to find some things to do to help me, you know, to be able to kind of go forward. And I made up my mind to become a runner. I'm running and running and running and running and running and developed a stress fracture. So one day I'm in clinic and I'm limping in clinic. And one of the patients that had been — we’d been caring for four years — and one of the Grady Elders, as I affectionately call them — he asked me what was wrong with my ankle, and I told him.
About four years later, I was in the Grady lobby one day, coming through the lobby. Huh — gosh — and it was just it was just a regular day and just hustle, bustle, busy. And I hear somebody calling my name and it's him. And he's sitting on a little — a little metal chair, waiting for the Grady Transportation to come and get him. And I come over to talk to him and he's telling me that he just left dermatology and he was pulling up his leg — pants leg to show me this little rash on his leg.
And we're chatting. And it had been years since I'd seen him. And I was like, “Oh, so good to see you.” And he goes, How — how was your run? And he says, “Looks like your leg got better because you're not hobbling anymore.” And he said, “You remember your run, for your sister that went to glory?”
And I just — I just stood there staring at him with all these people all in the lobby walking around me. I'm late to clinic, I have all these things I have to do — here is this 80-something-year-old man in Atlanta, Georgia, who is on a fixed income, who's waiting for Grady Transportation, who has probably seen the absolute worst of what you can see in the southern United States. Yet he still has it in him to remember ME? And in my head, I was walking away from him thinking, I am going to work harder at seeing and stopping and remembering my patients, because they're doing that for me, too. This is a — this is a bidirectional thing here. And I'm — and I'm finding that those relationships, those therapeutic alliances that we've built, it's not, it's not just for the patient; it’s for us. And I think those are the things that we need as we try to help our patients feel trust in this time.
Newscast: Grady Memorial Hospital in downtown Atlanta is known for a lot of things. The trauma and burn centers are both life-saving and busy — and more recently, the hospital has been filled with COVID-19 patients.
Newscast: Just ask Dr. Kimberly Manning. The doctor decided to celebrate a milestone birthday by raising money to help fight coronavirus.
Steve Fennessy: Just ahead: how Dr. Kimberly Manning decided to take part in a coronavirus vaccine trial and why the decision for her was so important. This is Georgia Today.
Steve Fennessy: This is Georgia Today. I'm Steve Fennessy.
Raphael Warnock: I'm grateful to work alongside you as we address these long-term health disparities that have plagued our communities for far too long.
Steve Fennessy: That's Reverend Raphael Warnock this week, days before he was sworn in as one of Georgia's United States senators. He spoke during an event to shed light on COVID-19's impact in the Black community.
Raphael Warnock: These comorbidities that we've been dealing with: hypertension, diabetes, stroke, all of these things exacerbate the impact of COVID-19 in communities of color. So we are dying, more likely to die, die more often.
Steve Fennessy: And that is weighing heavily on Dr. Kimberly Manning, a physician at Atlanta's Grady Memorial Hospital. Dr. Manning is my guest this week and we're discussing the impact of COVID-19 on the communities that she often serves.
Kimberly Manning: When people talk about COVID-19 disproportionately impacting the Black community, what that translates to, if you are a Black person who, you know, is sort of steeped in the Black community, you are the doctor in the family for a lot of people.
I basically since March have had, you know, in my phone like a list, a running list of virtual rounds. People that I wake up in the morning and I text them, hey, what's going on? How's your breathing? Are you turned over on your stomach? What are you doing? How's your mom? And at one point it was just text after text after text. Hey, I can't breathe. Hey, so-and-so lost their smell. Hey, I'm trying to decide if my mom should go to the hospital. Hey, what should I do?
And I had a near peer that went to college with me that was in the ICU for, you know, more than 40 days. Same age as me, a parent, someone who doesn't have a bunch of medical problems. And it was terrifying. So I think more of what I'm saying is that this air quotes “a disproportionate impact” — it is palpable in my lived experience in terms of who's calling me, who's worrying, who's asking for my advice, who's trying to navigate systems. Furthermore, with people who get admitted to the hospital and who can't go see their loved ones, people are just grabbing at anything they can get to try to understand what's happening. And so I'm getting a lot of those calls as well. So I'm feeling that a lot, too.
Steve Fennessy: You made a decision to take part in a vaccine trial. Can you talk a little bit about about what that meant and how you decided to make that decision?
Kimberly Manning: In addition to being a Black American, I'm a descendant of slavery. And the significance of that is that slaves were, were — you know, there's things described to people describing slaves and Black people as better than lab animals. There were people who looked like me who could not say no, they couldn’t be consented. They couldn't be given all the information and allowed to sign forms, to pull out of something if they didn't want to do it, to decide if they wanted to participate. They were often sold to somebody just for them to be experimented on.
And that is not lost on me. You know, it isn't lost on me that I was born into a time where I get to make choices, where I — not only that; I get to make choices and I'm a medical doctor working at a major leading medical school where I actually know a lot of the primary investigators. And I'm in a position to try to ask as many questions as possible.
And I just sort of thought, you know, this is a great way to honor my ancestors. I — you know, I am going to step into this space and I am going to listen to all of the information. And then I will choose to consent or I will choose to refuse. And I chose to consent, knowing also that one of the big issues we have as physicians when we and clinician educators is that we look at studies and often there are not many Black people in the study and we try to apply it to our patient population. But there weren't many Black people studied.
So I also liked the idea of honoring my patients by saying, hey, you know what, I know for sure there was somebody Black in this study because you're looking at her. I got to just say that to somebody at the car wash the other day who said, “There wasn’t no Black people in the study!” I'm like, “No, that's not true!”
Kimberly Manning: [SINGING] Who are we? My sisters and me, we are the vaccinated soros of DST. We have strived to use our hands to get these vaccines into as many as we can.
Steve Fennessy: I noticed that on your Twitter account and you have many, many thousands of followers. Oftentimes you will talk about experiences you've had with members of the public and it feels like you're almost you've almost become kind of an ambassador for getting vaccinated for COVID. Is that — is that an accurate representation?
Kimberly Manning: I'm smiling at that word, “ambassador,” because I've never heard that — myself call it that. But what I will say is I'm an ambassador for whatever is going to protect my folk.
When you live in a place like Georgia where, you know, Black folks make up 30.5% of the population, yet you’re more than 80% of the people in the hospital, that's real. And I don't — I don't want that to happen. I don't want to see people disabled. I don't want to see people losing their mamas and their daddies unnecessarily. And so, you know, I like people and since I like people, what I normally do when I'm out and about in my day, which is what I would normally do: chat people up about things. Now, I'm just dropping in, “Hey, what you think about this COVID vaccine?”
And, you know, the same way I would probably give somebody, you know, a little medical tip here and there if I'm in the grocery store or if I'm at the car wash or the pizza shop or wherever I am, now, I'm finding I'm exploring people's reasons why. And I am part of this sort of air quotes “ambassadorship,” if you will, I think, is that I want people to know that with a Black person says, no, it is not just because of medical mistrust. It's not. It's a whole bunch of reasons.
Some people have misinformation. Some people have questions that have not been answered. Some people are afraid of needles. Some people just don't logistically, physically know how to go get it. They don't even — that's a big barrier for people. There's a lot of different reasons. And so a lot of what I talk about on social media is, “What's your ‘why’?” You know, Black, Black ‘whys” matter. Ask why.
If I say no, ask me why. Don't just say, “You said no, it's because you don't have a college education and because of Tuskegee.” No, it's because you did not explain and you were — you were rude. You were 20 minutes late to my visit. You were rushing me. You were typing on the computer the whole time you were talking to me. You didn't make eye contact with me. I don't feel safe with you. And then you turn and ask me, do I want this vaccine? Guess what? No.
Steve Fennessy: President Biden has outlined a very aggressive attack plan for COVID-19.
Joe Biden: A hundred million shots in the first 100 days and we’ll follow the guidance of science to get the vaccines to those most at risk.
Steve Fennessy: At the same time, we're hearing from — I saw a story the other day in Kaiser Health News that, so far, Black Americans are receiving COVID vaccinations at lower rates than white Americans — at least where we have the data in the states that do break that down by race. What would you tell President Biden in terms of trying to make those numbers more equitable in terms of administering the vaccine?
Kimberly Manning: Oh, well. You know, I think, one, there has to be easier ways for people to register. You know, I’ve volunteered and administered some vaccines. And so as we think about some of our high-risk groups — I tried to register my mother to get her vaccine at one of our health departments and one of the sites that was vaccinating. And, you know, it really required you to be tech-savvy. And if I had not been there with my mom to do this, I just don't know how she would have done this.
There are lots of things kind of like similar to some of the things that's making it difficult for for children with remote learning right now. It's just all of these things that kind of require too many steps. So, I think that one thing that would help would be to come into the community if there is a way that you could show up with ID and there would be people there very similar to how when we register people to vote, sometimes, like we do all the work for you to help people get registered on in and just kind of have them come on through. And there are some places that are doing this well, you know. I've participated in some — some vaccination volunteer things where we've had people come through and cars and it's worked really well.
But there has to be some of those speed breakers to get registered, these sites crashing, needing good Internet, you know, needing, you know, really, really good vision because the font is so small. You just should be able to show up in your community. I think that's what I would say: Meet people where they are, try our best to try to see if we can have some — some racial concordance with some of the people working in the communities, too. Right? So if you see me in the community and you're Black and I grew up speaking African American vernacular and I'm talking to you in a way that makes you feel comfortable, you know, you might feel safe.
And so I think that that's something that we can do. I think at some places we are doing that. We just need to do it more.
Steve Fennessy: My thanks to Dr. Kimberly Manning, professor of medicine at Emory University and a physician at Grady Memorial Hospital. After the study for which she volunteered was unblinded, Dr. Manning learned that she had, in fact, received the placebo and so was offered the real vaccine in exchange for her participation. She got her first shot this month and will get her second dose in early February.
As to those who are still hesitant about getting the vaccine, she had this to say.
Kimberly Manning: I promise you, if you change your mind and decide you are ready to be vaccinated, I will not “nanny nanny boo boo” you at all. I will be the first one to greet you with open arms.
Steve Fennessy: I'm Steve Fennessy. This is Georgia Today, a production of Georgia Public Broadcasting. You can subscribe to our show anywhere you get podcasts. Please leave us a rating and review on Apple. Our producer is Sean Powers. Thanks for listening. We'll see you next week.