Carlos Bárcenas has made a few connections over the years in his hometown of Grand Island, Nebraska.
He has worked as a translator, and he now operates his own firm focused on leadership development. He also is a member of the Grand Island Public Schools board.
Not long ago, Dr. Adam Brosz, a high school classmate, asked Bárcenas for help in getting the word out about the need for Latinos to participate in clinical trials for COVID-19 vaccines.
Brosz serves as principal investigator for Meridian Clinical Research’s Grand Island site. Meridian, based in Omaha, is among a number of research groups recruiting volunteers in communities across the country for trials of vaccine candidates.
As Brosz explained to Bárcenas, researchers and vaccine developers want to make sure trial participants reflect all portions of the nation’s population, including people of color.
While researchers have sought for some time to increase the diversity of clinical trial participants, they’re turning more than ever to people like Bárcenas who have connections and are trusted voices in their communities.
Bárcenas signed up for a trial of a vaccine developed by the National Institutes of Health and the biotechnology firm Moderna Inc. He has since gotten his two shots, but doesn’t yet know whether he got the real thing or a placebo. He posted a short video of himself going through the process — in Spanish — on his Facebook pages.
Bárcenas said he’s not persuading, just answering questions. Many of the people with whom he speaks are concerned about getting sick. He explains that people can’t get the virus from the vaccine.
“It’s just a way to see if we can help our community,” said Bárcenas, who came to Nebraska from Mexico when he was 14.
The push to make sure the trials reflect the population comes in the face of a virus that has disproportionately affected many Black, Latino and Native American communities. That’s not because of inherent biological differences but because people from those groups may have less access to health care, more underlying health conditions that can worsen COVID-19 and work higher-risk jobs at places like grocery stores, hospitals, nursing homes and factories.
Once vaccines have been successfully developed, people of color need to feel confident that the shots have been tested on a diverse sample of the U.S. and world population, said Sandra Quinn, a professor at the University of Maryland’s School of Public Health and senior associate director of the Maryland Center for Health Equity.
“We need to be confident and they need to be confident they’ve been reflected in these trials and that it will be safe for them,” she said.
Early research on heart disease and heart attacks, for example, focused heavily on white men. But women’s heart attack symptoms, such as nausea or back pain, can be different from men’s symptoms.
With a vaccine, it’s critical to know whether an 80-year-old needs a different dose than a 25-year-old.
Researchers and pharmaceutical companies also will need to work hard to gain the trust of minorities who have not always had positive experiences with the medical community, Quinn said. She pointed to historical examples such as the Tuskegee Syphilis Study that failed to properly inform or treat the Black men in the study.
Chris Rodgers, president of the Douglas County Board of Health, said the legacy of Tuskegee, President Donald Trump’s politicization of the vaccine development process and heightened awareness of racial injustice are significant hurdles.
Rodgers also serves on the board of the pro-research group Nebraska Coalition for Lifesaving Cures, which also is working with Meridian and others to get out accurate information about vaccines and vaccine trials.
“You have to have long-term trust,” Rodgers said. “We’re trying to address that locally.”
Amanda McGill Johnson, the coalition’s executive director, also is participating in a trial. She said she signed up on one of the last days Meridian was accepting white participants.
“If you want people to feel comfortable about getting the vaccine, the trials have to reflect the population,” said McGill Johnson, a Millard school board member and former state senator from Lincoln.
Meridian officials also have spoken at a meeting of Norfolk Mayor Josh Moenning’s diversity council and worked with a Nebraska union that represents roughly 10,000 meatpacking and food-processing workers.
Ellen Price, Meridian’s director of patient engagement, said the company had a surprisingly good response to early ads for the trials.
The company changed the look and feel of those ads after Moderna and Pfizer, the other developer for which it is conducting trials, began prioritizing more diverse participants.
But ads without advocates who can answer questions and allay fears can go only so far, she said.
“Slowly but surely, we are building trust and connecting with these participants,” she said.
Dr. Brandon Essink, Meridian’s principal investigator and medical director, said the company has always done well in terms of recruiting diverse participants in Omaha.
But different communities require different approaches. He said he hopes the efforts to diversify participants will carry over to future trials.
“Researchers think this is a really good thing to have as many diverse patients as possible,” he said. “Hopefully that will continue. That’s where I’m super excited about it.”
For COVID-19, in particular, people who are interested in participating in trials will have plenty of other opportunities, he said. Meridian expects to offer trials for several other vaccines before the end of the year.
The company also is recruiting younger people, down to age 16 for now, for the trials. And dozens more vaccine candidates are in the development pipeline, according to the New York Times vaccine tracker.
The workforce at many meatpacking plants is strikingly diverse — workers may be white, Latino, East African or Southeast Asian, among other groups.
Eric Reeder, president of United Food & Commercial Workers Local 293, sent text messages to an estimated 7,000 workers and put up fliers in several plants and the union hall. It wasn’t an endorsement of the trials, and no one was pressured to sign up, Reeder said. The effort was just a way to inform workers who might be interested in volunteering.
“If it’s approved, they’d be at the front of the line for getting the regular vaccine,” he said.
Multiple companies running vaccine trials have been trying to recruit not only a representative sampling of participants from different ages and backgrounds but also essential workers in higher-risk environments, like health care providers, meatpackers and teachers, who potentially could be exposed to the virus more than those who aren’t leaving the house much.
Reeder knows workers who volunteered for the trial from Grand Island, Omaha, Fremont and Crete.
Not everyone was on board.
Some Somali and Latino workers expressed deep skepticism of experimental vaccines.
“Some of those workers thought the government or the (meat) company was trying to kill them,” Reeder said. “That’s how much distrust there is with this government. … Some of the responses I got said, ‘There’s no way I’m putting that in my body.’ ‘There’s no way I’m letting the government track me.’ Others said, ‘Yeah, thank you.’ ”
Reeder himself is participating in the clinical trial.
He said he has suffered no adverse effects, but he doesn’t know whether he received a dose of the vaccine or a placebo. He got the second dose in early October.
“I did have some reservations,” he said.
Reeder has a few underlying conditions, is 57 years old and routinely visits meatpacking plants where workers have tested positive. Even if the vaccine currently being tested is only 50% effective, he said, “I think I’d rather roll the dice with the 50% than risk the virus.”
State Sen. Tony Vargas of Omaha said he thinks people need to see everyday people in their communities participating. He just got his first shot through a Meridian trial and posted a short video about the experience.
Before signing up, Vargas, who lost his father to COVID-19 earlier this year, spoke with his mom in New York. She was concerned, he said, but she understood.
“We cannot confront or fight against this by doing nothing,” he said. “I want people to see somebody in the community, a person of color, who is trying to do their part.”
Bárcenas, the Grand Island participant, estimated that about 10 people, those he has spoken with and some of their contacts, have signed up. His sister did, too.
As a former community health educator, he’s aware of the health disparities faced by members of his community.
“Hopefully, it comes up with a vaccine,” he said. “And we need to be a part of it.”