Harnessing the Power of Community-Engaged Research

In July 2020 the United States was coping with the biggest public health crisis in a century: the COVID-19 pandemic, which led to more than 1 million deaths. The societal response of lockdown, mask wearing, and physical distancing was not a long-term sustainable solution. From the early days, it was clear that COVID-19 infections, hospitalizations, and mortality were proportionately communities of color, who were less able to self-isolate at home, telework, and avoid the consequences of infection. The science response co-led by the National Institutes of Health (NIH) produced a viable vaccine that used the new messenger-RNA platform after two decades of fundamental research. Subsidized by generous federal funding, the biotech company Moderna launched a 30 000-person randomized clinical trial. During the first month of recruitment, the overwhelming proportion of volunteers were White, and consequently a challenge was made. FrancisCollins, then director of NIH, called a meeting on Saturday, July 4, to ask for solutions. At that meeting, Moderna leadership, the surgeon general of the United States, and selected NIH leaders, including us, were present. How can we have clinical trial participants that represent the demographics of the United States, especially considering the disproportionate burden of the pandemic in communities of color? Every Saturday morning for the next 13 weeks, we participated in this meeting to discuss recruitment strategies, review the numbers of persons randomized to date, and provide specific advice on increasing diversity in the study participants.