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Breakthrough infections have become normal, challenging some Houstonians’ trust in COVID vaccine

Portrait of an African American man, woman and baby sitting on a church pew at Boynton Chapel United Methodist Church. The man is leaning forward, with hands in prayer position. The woman sits beside him, looking towards the man, while the baby in her arms looks into the camera.
Elizabeth Conley, Houston Chronicle / Staff photographer

By Julian Gill, Staff writer at the Houston Chronicle

August 12, 2022 | Houston, TX

Texas Southern University student Ayeisha Mitchell acknowledges her competing mindsets around the COVID-19 vaccine.

The 21-year-old sociology major knows they offer protection. She received the primary Pfizer series last year, partly for her mother, a breast cancer survivor who has a weakened immune system. Then she got COVID — twice — and her vaccinated mother still became sick.

Even as Mitchell continues to wear a mask and take other precautions against the virus, she’s still unsure about the booster shot.

“For me, it’s almost damned if you do, damned if you don’t,” she said. “I’m trying to see if it’s something I will benefit from.”

As COVID vaccine protection wanes and the virus develops new ways to dodge immunity, the growing number of breakthrough infections has complicated the already difficult prospect of inoculating millions of Americans who remain hesitant about the shot. People who watch vaccinated friends and relatives battle infections find new reasons to doubt their effectiveness, despite evidence showing the vaccines still guard against severe illness.

In Houston’s communities of color, where COVID has been disproportionately fatal, breakthrough infections fuel the deeper, more complex reasons for vaccine hesitancy. Even people once open to the shot now show signs of frustration, said Dr. Ezemenari Obasi, a researcher at the University of Houston who for six months has been studying vaccine hesitancy in the city’s most vulnerable neighborhoods.

“It’s easy to believe, ‘Everything I’ve done has been effective because it lasted two and a half years,’” said Obasi, who leads the university’s HEALTH Center for Addictions Research and Cancer Prevention. “‘And then when I finally get it, I get the hard part of it.’ So I think there hasn’t been a whole lot of conversation around the level of frustration that builds up because this thing is still persisting, especially for those that tried to do the right thing for such a long time.”

Immunity gaps

Pfizer and Moderna are both working on updated booster shots to better target the omicron subvariants BA.4 and BA.5, the latest highly contagious strains. But the virus still has opportunities to evolve.

Nearly 20 percent of the country has not received a single dose, and it’s unclear whether the new shots will be enough to encourage people already reluctant to seek a booster. Only 27 percent of Americans between 18 and 49, the largest age group tracked by the Centers for Disease Control and Prevention, have their booster shot.

The rate of primary vaccination also has slowed nationwide. In Harris County, weekly vaccinations hover between 27,000 and 18,000, compared with a high of 320,000 one week in April 2021, according to the Texas Department of State Health Services.

Roughly 63 percent of eligible Harris County residents — anyone over 6 months old — have completed their primary series. That number drops to 53 percent in underserved communities, according to the Houston Health Department, while Black and Latino populations make up 73 percent of COVID deaths.

Most of the neighborhoods in the UH study — Third Ward, Fifth Ward, Acres Homes, Greenspoint, Gulfton and East End — are among the least vaccinated in the city. In focus groups, residents spoke to broad reasons for vaccine hesitancy: cultural mistrust and racism within the health care system; inappropriate political involvement in health care; misinformation and disinformation; vaccine side effects; and perceived ineffectiveness.

One participant asked, “Why bother getting vaccinated if you can still be infected with COVID?”

Unreliable information

Obasi believes stronger education is necessary.

He criticizes the apparent lack of updated public health messaging around the newer vaccines and evolving variants. The original message led many to believe that vaccinations stave off infections, but “we’re so many variants away from that original strain,” he said.

“I think that nuanced shift hasn’t really happened effectively,” he said.

Misinformation and disinformation, meanwhile, continue to fill the void on social media, where many young people find their health information. Facebook and Twitter have taken steps to curb falsehoods shared on their platforms. But the same misleading information shared by right-wing groups still finds its way to communities of color, said Dr. Shanice Hudson, chairperson of the Hood Medicine Initiative, a nonprofit that combats health care inequity and disinformation.

While right-wing groups embrace conspiracy theories based on “this notion of freedom and not infringing upon their right as anti-vaxxers,” she said, people of color who don’t align with right-wing ideologies often come from a place of fear and mistrust of the government.

Dr. Peter Hotez, the Houston infectious disease expert who has fought to untangle COVID vaccine misinformation, said the years leading up to the pandemic saw a wave of damaging anti-vaccine efforts targeting the Black community and other groups.

In 2017, anti-vaccine activists helped spur a large measles outbreak in Minnesota among Somali immigrants by pushing the false theory that the vaccine causes autism. The same thing happened two years later in New York City, this time concentrated in the Orthodox Jewish community.

More recent anti-vaccine efforts have used “phony documentaries” to draw comparisons between mRNA vaccines and the infamous Tuskegee syphilis study, he said.

“The point being, it’s not a random distrust of government,” he said. “It’s more specific than that. And we don’t really talk about that enough.”

‘They trust me’

The UH study will soon enter a new phase, in which health workers will discuss their findings in community forums to find better ways to navigate future public health emergencies.

Hotez and other experts note that Houston has made significant progress in vaccinating people of color since the start of the pandemic. But reaching the final holdouts continues to be a struggle.

A one-on-one approach has proven most effective when discussing barriers to vaccination, community health workers say, but it will take time to reach a mostly younger population that rarely interacts with health care professionals.

The Rev. Linda Davis of Boynton United Methodist Church in Third Ward has done her part to educate every corner of her community.

At the start of the pandemic, Davis helped vaccinate more than 200 people through the church’s partnership with Houston Methodist Hospital. The church continues to offer vaccinations at its food pantry every second Saturday of the month. Davis also works with Change Happens to provide vaccine education at other churches and food pantries in underserved neighborhoods.

“They trust me,” she said.

Most of the 120 people in her congregation are vaccinated, she said. But during a recent midday prayer service that included Mitchell, the TSU student, a handful of attendees gave nuanced opinions about the shots.

Lewis Omike, who came to the U.S. from Nigeria during the pandemic, received the vaccine only because it was mandatory for the immigration process. He didn’t trust a shot pushed by the Nigerian government or the pharmaceutical industry there.

He and his wife do not plan on vaccinating their young children, but Omike still knows the shots are beneficial.

“I would advise the young people to take the vaccines because they’ve got older ones around,” he said. “They got families to take care of.”

Another churchgoer, Carlita Gray, is vaccinated and boosted but thought hard about her second booster dose, recommended for her age group. She doesn’t feel the protection lasts long enough. She asked herself: How many do I need? What are we putting into our bodies?

“That’s my concern,” she said. “But I have decided to take another, because those who are getting it aren’t as sick as they were before.”

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