Sisyphus, a Safer COVID-19 Vaccine, and Susceptible Populations

America is now facing its second lockdown. Other countries are verging on a third. Repeated efforts at COVID-19 containment seem elusive. No respite seems in sight – other than hope of a vaccine. Along with concerted efforts in this direction, the vexing incidence of escalating vaccine resistance is raising its ugly head – yet again, stoked by a growlingly effective anti-vax movement and false prophets of vaccine doom. This trend seems to have hit the Black community particularly hard.  

There was once a King of ancient Ephya noted for his self-aggrandizing craftiness and deceitfulness. The King was punished by being forced to roll an immense boulder up a hill- only for it to roll down every time it neared the top, repeating this action for eternity. King Sisyphus and his punishment have become embedded as a culture adjective: Sisyphusian – doing something over and over with no effect. 

Several centuries after King Sisyphus came a new Olympian who crafted Operation Warp Speed – designed to produce a vaccine for COVID-19 faster than a speeding bullet, more powerful than a drug cocktail, and able to bypass physical and biological laws as never done before. Like King Sisyphus' boulder, as possible COVID-19 vaccines gained traction and neared the hill's crest, our effort at prevention and mitigation has begun to roll backward.  

Marching in lockstep with Operation Warp Speed is the Sisyphusian tragedy of rising level of vaccine resistance, stoked by a growingly effective anti-vax movement and false prophets of vaccine-doom (a la Andrew Wakefield and his fake measles-vaccine-autism connection). Take the 2018-2019 measles epidemic sickening over 1200 in the U.S. and 4300 in Israel (killing three) – manifesting a measles resistance movement encouraged by a few potent anti-vax organizations. New York Public Health authorities repeatedly tried for a full year to promote vaccination. Not until a court order required vaccination in NYC and NYS removed non-medical vaccine exemptions before school attendance did we see a behavioral change.

Back to COVID-19: we need to make sure that when (and if) a safe and effective vaccine is available, there is an ample demand – that people will line up and avail themselves of this preventive.  As a previous column stated, a COVID-19 vaccine is no good if people won't take it, and as it stands now, perhaps 40% of Americans aren't interested. That article suggests that celebrities and people of influence be recruited to lead the way. Great idea. Except even that might not work. Many in the influential class have already been co-opted by nefarious forces that we've let fester and multiply: the anti-vax industry.

Let's focus, for example, on vulnerable groups: folks both more susceptible to adverse consequences of COVID-19 and not always invited into the main-stream caucus for opinion-making, and certainly not drug-testing.  The Black community is one such group.  Traditionally, they (along with other marginalized groups such as women) have been excluded from FDA testing protocols. This omission decreases the confidence in the safety or efficacy of a drug (or vaccine) in the untested group. 

These marginalized groups are often denied or deprived of proper care, either because of financial impediments or lack of knowledge, or other access restrictions. Marginalized communities thus suffer indigenous co-morbidities – and sub-normal standards of care. It should not be surprising, then, to learn as the New England Journal of Medicine reports that "although Black people make up 13% of the U.S. population, they account for 21% of deaths from COVID-19 but only 3% of enrollees in vaccine trials." 

Recently, presidents of four historically Black U.S. medical schools correctly called for measures to increase Black patients' participation in clinical trials, rightly arguing that without such involvement, "there will be no proof that our patients should trust the vaccine." [1]

"The presidents of Dillard and Xavier Universities, two of the 104 historically Black colleges and universities (HBCUs) in the United States, recently wrote to their communities saying that they themselves were participating in one of the vaccine trials and asking their students, faculty, and staff to consider doing the same." [2]

The pushback from parents and students was enormous and extreme. One wrote on Xavier's Facebook page, 

"Our children are not lab rats for drug companies. I cannot believe that Xavier is participating in this. This is very disturbing given the history of drug trials in the black and brown communities." [2]

Certainly, this is a valid fear. The recent article in the New England Journal of Medicine sets out various approaches to gaining greater trust in the Black community, including placing the responsibility for generating "trustworthiness" in leadership. One would think that the school community would have enough faith in their presidents to respond in a less emotive fashion or accede to their leaders' greater knowledge and wisdom.  How would an essentially lay population become so encouraged to question their own (educated) leaders? 

Cultivating trust in leadership won't work if there is a systemic, nefarious, concerted, and pernicious effort at breaking down that trust. This external influence prevents the uptake of the verbal message in the host. The feedback generated by the Xavier parent-pushback is not original. That seed was planted months ago when notorious anti-vax leader Del Bigtree had taken to the airways, spouting: 

"that the true rationale for a phased release of a vaccine could be to observe its effects in black and brown people, turning them into unwitting test subjects….The United States of America has a history of testing on African American people…To all of my African American brothers and sisters, I want them to know, look — it looks like they might try to create a fear base in you to make you part of a safety trial." [3]

Even as far back as July, the Washington Post reported on

"a remarkable new alliance between the anti-vaccine movement and black leaders … who felt aligned with their themes: "a predatory pharmaceutical industry profiting from the ignorance of vulnerable people …." [3].

Promoting trust and trustworthiness will have no effect when the message of anti-vaxxers like Bigtree, Robert F. Kennedy Jr., a host of celebrities and reasonable-type sounding folks are dedicated to undermining that trust [4], sowing fake facts and junk science which are unrecognizable as such by a lay populace. The seeds of an unimpeded anti-vax industry have rooted and are flowering under the awning of the as -yet non-existent Corona-vaccines -- and they are not withering away. 

Efforts to legally muzzle these groups invite pushback from constitutionalists championing freedom of speech, even the right to spout lies (except in the guise of Commercial speech). [5] Until these anti-vax groups are muzzled, we can expect that innate vaccine resistance – especially in vulnerable and susceptible communities - will be stoked by these groups. 

I have previously made two suggestions to overcome these obstacles. First, teaching basic risk assessment, biology, and vaccine immunology in high schools serves as a continuing and informed bulwark against FEAR speech* spouted by the anti-vaxxers. [5] Second, governmentally mandated warnings are affixed to any publication, periodical, or conference advertising sponsored by these groups. [6]. Perhaps, then we might have a fighting chance to encourage vaccine uptake. That is assuming we don't embark on another slip-shod, Sisyphusian scheme like Operation Warp Speed.


[1] We need to recruit more Black Americans in vaccine trials. New York Times September 11, 2020 

[2] Trustworthiness before Trust — COVID-19 Vaccine Trials and the Black Community, New England Journal of Medicine, DOI: 10.1056/NEJMp2030033

[3] Anti-vaccination leaders fuel black mistrust of medical establishment as COVID-19 kills people of color, The Washington Post, July 18, 2020

[4] The Panic Virus, as reviewed in J Clin Invest. DOI: 10.1172/JCI57157

[5] Deoxyifying Anti-Vaxxer FEAR Speech (False, fraudulent, flawed, fake endangering and reckless)*  and First Amendment Obstacles, Social Sciences Research Network 

[6] Addressing the Effects of Anti-Vax FEAR Speech with Mandatory Public Health Education Social Sciences Research Network