By: Custis Bunn, NBC News

 Dr. NanaEfua B. Afoh-Manin, an emergency room physician, was baffled. A Black man in his 30s arrived at her hospital in Southern California this month struggling to breathe. He tested positive for Covid-19, which he said he believed he contracted from his brother, who had been diagnosed with the coronavirus earlier. When Afoh-Manin asked whether he and his brother had been vaccinated against Covid-19, the man said: “No. We want to think about getting” the shots. In the emergency room, however, fraught with anxiety over his condition, the man, who also has diabetes, told her that he wanted to take the Covid-19 monoclonal antibody treatment, which was recently authorized for emergency use to help prevent those who have been exposed to the coronavirus from contracting Covid-19 or developing severe symptoms.  Afoh-Manin shook her head. “I was like: ‘We know less about the monoclonal antibody than we know about the vaccine. But you’re willing to put yourself at risk by not taking the vaccine, and now you want to receive an experimental drug to get better? And you’re still on the fence about the vaccine?’ “That’s why I say we’re in a quandary, because it’s perplexing,” she said. Afoh-Manin is an advocate for equity in public health whose organization, Shared Harvest, launched myCovidMD. The initiative, which offers free coronavirus testing through mobile sites, has a network of “culturally competent health care volunteers” to respond to Covid-related needs in Black communities and other communities of color. “You see this day in and day out, and you don’t know how to convince people to take the vaccine, because there’s literally a block,” she said. “We politicized the vaccine. We polarized the nation before it came out, and now there’s much work to do to just build trust together as a unit, as a nation. It’s a battle. We can’t get folks vaccinated, and it has nothing to do with the vaccine now.” Afoh-Manin’s exasperation mirrors that of many Black health officials who are contending with myths and misinformation about Covid-19 and an often unquantifiable aversion to the three vaccine options the Centers for Disease Control and Prevention and other medical organizations say have proven their effectiveness in preventing Covid-19 or minimizing its effects. According to the CDC, about 63 percent of fully vaccinated people in the U.S. were identified by race or ethnicity. Within that, about 9.3 percent of all fully vaccinated people are Black; 12.4 percent of the general population is Black. Black Americans are also getting vaccinated at a rate slightly higher than their share of the population in recent weeks, according to the CDC, at 14.6 percent.  Still, misinformation has been a hurdle in getting people comfortable with the vaccines more broadly. A World Health Organization study this year said that nearly 6,000 people around the world were hospitalized in the first three months of 2020 and that 800 died because of coronavirus misinformation. Linda Goler Blount, an epidemiologist who is president and CEO of the Black Women’s Health Imperative, said, “Black women fear the vaccine was developed too quickly to be safe — emergency authorization approval, versus full FDA approval,” she said. “Fear that the vaccine is/will be harmful or not effective; fear that Black people are not getting the ‘real’ vaccine but something weaker, less effective, noneffective than what is offered to white people; fear that scientists, CDC, doctors are not telling the truth about Covid-19 and it’s not as dangerous as portrayed — that the statistics are being fabricated; fear that Covid-19 was engineered by the Chinese, National Institutes of Health or some other institution and nothing can be done to stop it — once again not being told the truth.” Goler Blount said fear and doubt stem from consistent chatter about Black people’s reluctance to get the shots before they were developed. Studies indicated a fear or strong reluctance among Black people, and the media reports influenced people, “Initially, vaccine hesitancy was not the issue. There was lots of press about it in late December/early January, which served to seed doubt in Black people, causing them to be hesitant when they would have  got vaccinated had that not happened,” she said. “So, the 20 to 35 percent vaccine rates we’re seeing across the U.S. among Black people would have been higher, perhaps 45 to 60 percent, had there not been so much coverage about hesitancy that was not actually happening at the time.” Dr. Jayne Morgan, clinical director of the Covid Task Force at Piedmont Healthcare in Atlanta, combats the myths and misunderstandings around the coronavirus by posting YouTube videos that answer pandemic-related questions, using “plain and easily digestible language.” Some of her videos get thousands of views, some fewer than 500. She said she has heard from many viewers who thank her for the information. And yet, she said, she continues to hear an array of theories about the vaccines’ effectiveness and the origins of the vaccines themselves that make Black patients uneasy.  “And on and on,” Morgan said. “My people have been so horribly abused by the medicine, science and research of this country until we would rather buy into conspiracy. That’s more believable than to believe that the United States government, and medicine and research, might actually help us.” She said government involvement has not helped ease Black people’s concerns or minimized their notions of plots against them. “We had ‘Operation Warp Speed,’ and the government provided the funding to get these things moving quickly,” she said. “And the government is distributing the vaccines. You talk about the very little trust with the health system, and then we talk about research where we almost have no trust at all, and then there’s the government. So it’s much more believable to embrace a conspiracy that someone is out to do harm to us.” The Food and Drug Administration elevated the Pfizer vaccine from emergency approval to full approval on Monday, a development that could lead to mandatory vaccination requirements. Dr. Timothy Quinn, a primary care physician in the Jackson, Mississippi, area, said he expects the announcement to influence those who have been hesitant to get the shots. “Once these mandates take place, more people will get vaccinated,” he said. “That’s the bottom line. I’m not going to take a side on it. I just hope that as more people get vaccinated, it will provide a better scenario for all Americans. Full FDA authorization also relieves a lot of the hesitancy, because what I’m receiving from patients is a lot of them have been saying that the vaccine was not fully FDA approved, that it was a test.”  Like Quinn, Afoh-Manin, the Southern California emergency room doctor, said she was not in favor of making the shots mandatory. “It feeds the argument that we are forcing people to do things,” she said. “But more importantly, it makes it sad that we have to force people to solve the underlying problem. Why can’t we come to the middle ground to help people understand that comfort on their own? “Public health and medicine are two polar opposites. Medicine focuses on the individual. Public health focuses on the community. So public health does not care what you, as an individual, feel about your health. It cares about the population being healthy. And so, from a public health standpoint, mandates are absolutely where we need to get to, because that’s the only way we can decrease the numbers and ultimately decrease the likelihood of another variant.”