BATON ROUGE, La. — Flossie West was not at all interested in taking the coronavirus vaccine.
Carla Brown, the nurse overseeing her care, was determined to change her mind.
Ms. West, 73, has ovarian cancer, congestive heart failure and breathing difficulties — conditions that place her at grave risk should she contract the virus. As it is, Covid-19 has killed far too many of her neighbors in Mid-City, a low-rise, predominantly Black community that sprawls to the east of the Louisiana state capital.
But Ms. West’s skepticism about the new vaccines overshadowed her fears of Covid-19. “I’m just not interested because everyone tells me the virus is a hoax,” Ms. West said. “And besides, that shot is going to make me more sick than I already am.”
On Thursday morning, Ms. Brown, 62, breezed into Ms. West’s apartment and delivered a stern lecture: The virus is real, the vaccines are harmless and Ms. West should get out of bed, grab her oxygen tank and get into her car.
“I’ll be darned if I’m going to let this coronavirus take you,” she said.
In recent weeks, Ms. Brown has been frenetically working to persuade her patients to get inoculated, and her one-woman campaign provides a glimpse into the obstacles that have contributed to the troublingly low rates of vaccination in the Black community.
Even as vaccine supplies become more plentiful, African-Americans are being inoculated at half the rate of whites, according to an analysis by The New York Times. The disparities are especially alarming given the disproportionate impact of the pandemic on communities of color, who have been dying at twice the rate of whites.
The racial gap in vaccination rates is no less stark in Louisiana, where African-Americans make up 32 percent of the population but just 23 percent of those who have been vaccinated.
Part of the problem is access. In Baton Rouge, the majority of mass vaccination sites are in white areas of the city, creating logistical challenges for older and poorer residents in Black neighborhoods like Mid-City who often lack access to transportation. Older residents have also been thwarted by online appointment systems that can be daunting for those without computers, smartphones or speedy internet connections.
But much of the racial disparity in vaccination rates, experts say, can be tied to a longstanding mistrust of medical institutions among African-Americans. Many Baton Rouge residents can readily cite the history of abuse: starting with the eugenics campaigns that forcibly sterilized Black women for nearly half of the 20th century, and the notorious government-run Tuskegee experiments in Alabama that withheld penicillin from hundreds of Black men with syphilis, some of whom later died of the disease.
“The distrust among Black Americans comes from a real place and to pretend it doesn’t exist or to question whether it’s rational is a recipe for failure,” said Thomas A. LaVeist, an expert on health equity and dean of the School of Public Health and Tropical Medicine at Tulane University. Dr. LaVeist has been advising Louisiana officials on ways to increase vaccination rates.
Ms. Brown, the hospice nurse, has a good idea about how to change the minds of vaccine skeptics: encouraging one-on-one conversations with respected figures in the Black community who can address the misgivings and provide reliable information while acknowledging what she describes as the scars of inherited trauma. “If you look back at our history, we have been lied to and there has been a lot racial pain so it’s all about building trust,” she said.
It also helps when she tells people she has already been vaccinated.
A Covid survivor, Ms. Brown has become a whirling dervish crusader against vaccine hesitancy in Baton Rouge. Her sense of mission is partly fueled by personal loss. Last May, while working as a hospital psychiatric nurse, Ms. Brown unknowingly brought the coronavirus into her home. Her husband, son and 90-year-old father all became seriously ill and ended up in the hospital. Her husband, a cancer survivor who she described as “the love of my life,” ended up on a ventilator. He died in July.
With a newfound determination to tend to the most vulnerable patients, she quit her job at the hospital and last January began working with the terminally ill.
“My husband couldn’t get the vaccine, but I’ll be darned if I’m not going to get every human being around me vaccinated,” she said. “I don’t care if you’re homeless. If I come to you, you’re getting in my car.”
On Thursday, she went into overdrive after learning that a pop-up vaccination site in East Baton Rouge had dozens of doses to spare.
Ms. Brown prefers to make her pitch in person, but with less than three hours before the site was scheduled to close, she pulled her cherry red Toyota Scion into the parking lot of the Hi Nabor Supermarket, took out her phone and opened up a thick binder with contact information for the 40 patients she manages as the director of nursing at Canon Hospice, a palliative care provider in Baton Rouge.
“Is that Miss Georgia?” she asked. “Have gotten the Covid shot yet? No? Well, then get dressed because we’re coming to get you.”
There were several rejections — “I’m still not convinced it’s safe to take,” one woman said — but in less than an hour she had persuaded five people to get vaccinated.
She then called the East Baton Rouge Council on Aging, the nonprofit group operating the vaccination site, and asked them to dispatch a few of their vans.
In addition to arranging transportation, Tasha Clark-Amar, the organization’s chief executive, tries to ease the logistical hurdles, arranging appointments by phone and having employees fill out the necessary paperwork in advance. Next week she hopes to begin sending out teams of health workers to vaccinate 4,000 residents across the city who are bed-bound.
Ms. Clark-Amar, too, is driven by a sense of urgency: During the past year, she said, more than 140 of her clients have died of Covid-19. Her strategy for winning over the hesitant is not unlike that of Ms. Brown, though she often tries to appeal to the leadership and respect that elders command in the Black community. “I tell them, ‘You are the matriarch or patriarch in the family, and you should lead by example,’” she said. When that doesn’t work, she is more blunt: “At your age, it’s the vaccine or the grave.”
Less than 30 minutes after Ms. Brown made her phone calls, a home health aide wheeled Dorothy Wells into the senior center’s brightly lit cafeteria. Ms. Wells, 84, a stroke patient, had initially resisted getting inoculated but she was overruled by her son.
Ms. Wells’s aide, Rashelle Green, 45, was also reluctant to be vaccinated. She recounted stories she had read on social media about people getting sick or dying after receiving the shots, though health authorities say adverse reactions to the coronavirus vaccine are exceedingly rare.
But after watching people get vaccinated and then walk out after 15 minutes of observation, Ms. Green changed her mind. As she waited her turn, she nervously bounced up and down. When it came time to roll up her sleeve she winced but barely noticed the prick of the needle. “That wasn’t bad at all,” she said.
Then there was Ms. West, the cancer patient whose home Ms. Brown had visited earlier that day. Over the past year, Ms. West, who lives alone and has no children, has looked forward to the twice weekly checkups with Ms. Brown. Besides the occasional appointment with her oncologist, their visits are about the only time she has face-to-face contact with another person. “I feel like Ms. Brown really does care about me,” she said.
Given the deep trust that has been cultivated over the past few months, it didn’t take long for Ms. Brown to win her over.
Sitting in the vaccine site’s observation area on Thursday, Ms. West said she was glad she had listened. “When I get home,” she said, “I’m going to text all my friends and tell them to go get the shot.”