Black Belt Barriers
Exploring health care inequities facing African Americans in the region

Since the appearance of COVID-19 three years ago, the virus has gone from a complete and terrifying unknown to something we now better understand and know we must live with every day. That transition came on the back of groundbreaking and innovative research into therapeutics and vaccines.

As we turn the corner to a new phase in the pandemic, the focus of many investigators shifts to studying health habits. Among these investigators is Dr. Surachat Ngorsuraches, associate professor in the Harrison College of Pharmacy’s Department of Health Outcomes Research and Policy.

The recipient of a pair of grants from the Collaborative Actions to Reach Equity, or CAREs, established by Pharmaceutical Research and Manufacturers of America, or PhRMA, and the PhRMA Foundation, he is looking into barriers to vaccination and a novel element in the value assessment of healthcare technologies against COVID-19.

For his project titled “Barriers to COVID 19 vaccination in the Black Belt,” Ngorsuraches partnered with Dr. C. Edward Chou, associate professor in the Department of Health Outcomes Research and Policy, to study the issue as part of PhRMA CAREs. The program is made up of community-based researchers working to address inequities in screenings, prevention and treatment of or vaccinations for COVID-19 and other diseases disproportionately impacting underserved communities.

As part of the project, the pair is looking at the Black Belt, a string of counties in an 11-state region that includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas and Virginia. They are analyzing policies in those states to determine barriers to COVID-19 vaccinations for African Americans living in the region.

“These states, with the exception of North Carolina and Virginia, in the Black Belt Region had higher cumulative deaths caused by COVID-19 than the national level,” Ngorsuraches said. “The COVID-19 vaccinated rates among adults in these states, except Florida and Virginia, were below the national rate.

“Various reasons were assumed or studied. However, previous studies did not focus on African Americans living in the Black Belt Region, which have different social determinants of health.”

Using Best-Worst Scaling, or BWS, a more rigorous method than the approaches of previous studies, Ngorsuraches and Chou worked to prioritize barriers to COVID-19 vaccination. Nearing the end of the study, Ngorsuraches is intrigued by some of the data coming in.

“What surprised me is I thought distrust, such as in government agencies, pharmaceutical agencies or clinical trials, should be a major issue,” Ngorsuraches said. “It turned out that the important barriers to COVID-19 vaccination for African Americans living in the Black Belt Region centered around issues like safety concerns, ingredients, emergency use authorization, inconsistent information of COVID-19 vaccines and the rapid mutation [about] COVID-19, which could be overcome by effective and trusted communication.”

Additionally, Ngorsuraches is working on a project titled “Measuring the Value of Fear Contagion in COVID-19 Care” as part of PhRMA’s Value Assessment Initiative.

The objective of the study is to obtain a quantitative measure of the value of fear of contagion in COVID-19 care.

“An International Society of Pharmacoeconomics and Outcomes Research Special Task Force identified ‘fear of contagion’ as a novel value element, especially for pharmaceuticals or health care for any infectious diseases,” Ngorsuraches said. “I proposed to measure how people value the fear of contagion in COVID-19 care.

Basically, the findings will reflect how much people are willing to pay for the fear in addition to for the other treatment or health care attributes for COVID-19. Based on patient preference, the findings will also predict the uptake of treatments or interventions like vaccines as well.”

His research aims to determine the value of reducing the fear of contagion from COVID-19, conducting a discrete choice experiment to elicit the willingness-to-pay of adults with and without COVID-19 infection for reducing the possibility of disease exposure. He is also examining the value of fear of contagion based on preference heterogeneity in this study.

“Pharmaceutical industry and payers are interested in these elements,” Ngorsuraches said. “The findings tell us what people care about and or which attributes of technologies and treatments are important to people. So, policy makers can work around those attributes.”

Using a self-administered, web-based questionnaire survey containing various choice sets, participants are presented with multiple attributes and levels. Study participants are asked to consider each choice set and choose their most preferred alternatives. Willingness to pay for each attribute’s level change is calculated to reflect the value of the attribute.

Not surprisingly, participants were willing to pay relatively high for reducing fear of COVID-19 contagion. For pharmaceutical companies and government agencies, this kind of data can prove invaluable when faced with future pandemics or health care crises, incorporating the value of fear of contagion in health technology assessment.

The task force identified fear of contagion as a novel element that should be incorporated into the value framework when we assess health care technologies for infectious diseases,” Ngorsuraches said. “So, studying fear of contagion will allow scientists to include this new element in their future health technology assessments, leading to the improvement of patient access to care. “