Deneen Richmond hears a lot of confusion — and a lot of concern — about coronavirus vaccine boosters in this majority-Black suburb of Washington.

Some say vaccines don’t seem to work because vaccinated people are still getting sick. Others say it’s not worth taking time off to deal with the potential side effects. Or that no one clearly explained why guidance changed from two shots to three.

“We have to overcome the naysayers all over again,” said Richmond, who leads Luminis Health Doctors Community Medical Center, a hospital that was founded in Prince George’s County, Md., in 1975. “It’s like, ‘Hit replay, repeat.’ … That is what we are going to need to do with the booster.”

Across the country, the herculean efforts of advocates and health officials like Richmond brought shots to those who were initially resistant in churches, barber shops, homes and wherever people felt comfortable. Such nationwide campaigns helped narrow initially yawning gaps in vaccination rates between Black and white Americans.

But with the arrival of the booster, the disparity returned.

Public health experts say that many of the same issues that initially led to slower vaccine uptake among Black Americans, including difficulties obtaining shots and a sometimes deep-seated distrust of the medical system, are now behind lagging booster rates. Eligibility could also be a contributing factor, as people who got Pfizer or Moderna doses are not eligible for a booster until six months after their second shot.

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Because of waning immunity, scientists say, getting a booster is key to fighting the highly contagious omicron variant. That means many of the majority-Black communities that were devastated in earlier stages of the pandemic, like Prince George’s, could be especially vulnerable again. As of Tuesday, Prince George’s average daily case rate of 265.1 per 100,000 was dramatically higher than that of any other Maryland jurisdiction. The next highest was 169.3 cases per 100,000 in neighboring Charles County.

“If people don’t get boosted,” Richmond said, “our health-care system is going to be overwhelmed.”

In the greater Washington region, just 32% of Black Marylanders who were fully vaccinated have gotten a booster, compared with 44% of white residents; in Virginia, it’s 17% of Black residents and 25% of white residents; and in the District of Columbia, it’s 19% of Black residents and 32% of white residents. That trend is echoed across the country, according to a report from the Kaiser Family Foundation, although federal data is spottier because not all states and counties report the race of vaccine recipients.

“Policymakers should have anticipated this because we in very recent memory have the experience of disparities in our initial vaccine rollout,” said Neil Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health. “We have examples of what works … of actually getting vaccine-hesitant people to change their minds.”

The good news is that the gap will probably close again, Sehgal said, but it will take work. And it could already be too late for many, he said, as the omicron variant sweeps through the population.

Omar Neal, the former mayor of Tuskegee, Ala., blamed poor messaging from the federal government for lower booster rates among Black Americans. The government, Neal said, should do more to bridge the trust gap with Black communities, many of whom still recall the infamous four-decade-long government-backed syphilis experiment that took place in his hometown.

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“It is like, ‘You told me to do this, I did it. You told me to do this, I did it. Now you want me to do something more?’ ” said Neal, a radio personality whose uncle, great-uncle and cousin were among the 600 Black men who unknowingly participated in the study, in which treatment was deliberately withheld from them. “When will it ever end?”

Prince George’s, which has a concentration of Black professionals that makes it one of the wealthiest majority-Black jurisdictions in the country, saw so many COVID-19 patients when the virus first hit in spring 2020 that patients had to be treated in medical tents in a parking lot at one hospital. Yet when vaccines first became available, the county still had one of the lowest vaccination rates in the state.

Some in Prince George’s said they were not ready to get vaccinated, but others said they desperately wanted shots but did not know how to find them, or struggled to secure an appointment. Meanwhile, white residents from neighboring jurisdictions flocked to the county to get shots. Following widespread complaints about the inequitable distribution, Gov. Larry Hogan, R, launched a vaccine equity task force.

Richmond saw firsthand how many people from outside the county showed up at her hospital to get vaccinated. Dismayed by the low uptake in the community in which she was raised, she pivoted. She was among leaders in the county who formed partnerships with churches and other community groups to host vaccine clinics, determined to meet residents in places they knew and work with people they trusted.

Today, Prince George’s, which has a population that is about 85% Black and Latino, has vaccinated 68% of all residents — still slightly lower than some other jurisdictions in the region, but higher than neighboring Washington and many of the majority-white jurisdictions in Maryland that once posted dramatically higher rates.

Yet just 27% of fully vaccinated residents in the county have been boosted, according to its health department, putting the rate in Prince George’s even lower than the 32% statewide figure for Black residents. The health department did not provide a breakdown of racial demographics.

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“It is almost like we are at square one again,” said Katrina Randolph, who is part of a network of barbers and stylists trained as certified community health workers through a University of Maryland program that partners with Luminis Health.

Randolph estimated that about 90% of her regular clients have been vaccinated. Many of them, she helped convince. But only a fraction have gotten a booster.

Among the concerns she hears is that the booster shot is just a way for pharmaceutical companies to make money, Randolph said. She encourages them to trust the science and reminds them that getting boosted helps keep her safe, too.

“I can’t do my job if I’m more than 6 feet from you,” Randolph says at her salon in Capitol Heights.

Of roughly 50 people in her family, she said, around half are vaccinated. Only she and her husband are boosted.

For some Prince Georgians, figuring out where and how to get the booster shot is still an obstacle.

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Mae Grey, 82, acknowledged she might have missed news about the booster because of health challenges she and her family members have faced recently, including a mini stroke she suffered.

“I don’t even know where they are giving it out,” said Grey, who is partially blind. Grey, who struggled to secure a vaccine appointment in the spring, said she wished that this time around, it was easier.

“We have so many friends and families that have died from this COVID,” said Grey. “You’ve got to keep going and not give up.”

Maryland National Guard Brig. Gen. Janeen Birckhead, who has headed Maryland’s vaccine equity task force since its creation in January, said officials were so pleased with how much progress on vaccine equity had been made that they considered winding down the task force when the fiscal year ended Sept. 30.

But they scrapped those plans when they saw the early booster data, she said, realizing that this phase of vaccine distribution was going to pose its own set of challenges. Their “2.0 version,” Birckhead said, includes teams that have launched across the state that have targeted libraries, schools and the homebound.

This time around, she is more hopeful than last winter because officials know that meeting people where they are works — eventually.

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But the surge in cases and hospitalizations lends urgency to their efforts. The 2,781 new cases reported Tuesday in Prince George’s was about four times higher than the 692 reported on May 1, 2020, the highest single-day total outside of this month.

Luminis Health — which includes the hospital Richmond leads — shifted to an emergency operations plan after seeing a 325% increase in COVID-19 patients since Dec. 1. There were so many outbreaks in Prince George’s schools that officials moved to virtual schooling until Jan. 18, the first county in the region to do so. Prince George’s County Executive Angela D. Alsobrooks, D, who is vaccinated and boosted, announced last week that she had tested positive.

As Gregory Freeman, 73, evaluated whether to get a booster shot, he thought about the long history of exploitation of Black Americans by the medical system. But he also considered the surging cases and continued death around him.

Freeman, who lives in Hyattsville, said he and every Black man he knows has his own story about mistreatment by the medical system. They also carry with him the stories of their fathers and grandfathers. His own story, which he has shared with his children, involved being crippled after taking a polio vaccine. Freeman said he was so badly injured that he had to teach himself to walk again.

So for him, the biggest hurdle was placing his trust in getting that first shot. He made the leap in June, thinking not of himself — he said he figures his own time is limited — but about making sure he protects his grandchildren and great-grandchildren. Getting boosted was an easier decision, he said, since he figured he’d already ceded control.

“People are getting sick and dying all around,” he said as he waited the required 15 minutes after getting his booster at a Luminis clinics at First United Methodist Church in Hyattsville. “Since I started, there’s no use getting to the middle of the ocean and realizing you can’t swim.”

He brought his 87-year-old neighbor along with him to make sure the older man had a ride to and from the vaccine clinic to get boosted, too. Freeman planned to post about his decision on Facebook that afternoon.

He could only hope, he said, that friends and family would follow his lead.

The Washington Post’s Dan Keating contributed to this report.

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