With COVID-19 whipping through populations across America, some demographic groups fare worse than others as a combination of factors, including the social determinants of health increase, or decrease risk factors. It’s known that African Americas are dying at about twice the rate as whites nationwide, for example. Native American (including non-Hispanic Indian and Alaska Native) account for about 0.7% of the U.S. population or approximately 2.3 million persons, they represent 1.3% of the COVID-19 cases, according to a recent CDC analysis. Washington State University (WSU) professor Lonnie Nelson makes moves to ensure that Native Americans are more represented in COVID-19 vaccine research.
The WSU College of Nursing professor, located in Spokane, WA, now evaluates a very important topic that is applicable to many different demographic groups generally as the government, the private sector, academic and health providers and non-profit research groups seek to better understand how to diversify clinical trials. That is, how to get more people traditionally considered “underrepresented” in clinical research involved with studies in the age of COVID-19. Native Americans are no exception with traditionally wide trust gaps associated with government (at all levels), health systems, academic research centers and industry sponsors on the one side and a proud and indigenous population that also happens to be one of the poorest (if not the poorest) demographic cohorts on the North American continent.
Recently Trinity Willsey, writing for The Daily Evergreen, introduces the work of associate professor Lonnie Nelson at WSU’s College of Nursing. With an goal of better understanding how Native American and Indigenous populations actually perceive the participation in clinical trials associated with COVID-19, the effort is part of a study panel underwritten by the National Institute of Allergy and Infectious Diseases (NIAID).
Goal of WSU Group
By reviewing a plethora of research-related artifacts (protocols for ongoing studies, informed consent, advertising material, etc.) the eastern Washington-based team seeks to better understand how these COVID-19 vaccine studies, for example, are perceived by Native Americans in a quest to better ensure these communities are more accurately represented, reported Celestina Barbosa-Leiker, vice chancellor for research and associate professor at WSU. Ultimately, this research overlaps with sociological and behavioral health studies to support greater empathy which can lead to buy in and participation on the part of these at risk communities. Ms. Willsey writes that Professor Nelson will not recommend a particular vaccine if the underlying clinical trials don’t include sufficient Native representation.
As discussed in The Daily Evergreen, Nelson and others seek oversampling of underrepresented groups such as Native Americans. Why? Because to ensure sufficient participation of an underrepresented group an oversampling or “subgroup analysis” can better ensure adequate participation.
Another key topic involves an education of health professionals on the need for cultural awareness. Health systems, academic medical centers, commercial trial site organizations and biopharmaceutical companies should embrace a deeper and more authentic understanding of various underrepresented groups in the United States (and beyond). Ms. Barbosa-Leiker suggests that a foundational prerequisite is the adequate education of the next generation of healthcare professionals to be more culturally aware: this will translate into more tailored and culturally aware care and engagement. Ultimately, more trust and understanding ensues.
Lonnie Nelson, PhD, Associate Professor, WSU College of Nursing professor
Call to Action: Interested in learning more about this study and WSU’s methodology of reviewing study artifacts, processes and assessment of cultural empathy in regards to COVID-19 vaccine clinical trials? Reach out to Professor Nelson.