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Why vaccination among Black Americans is so fraught

Rev. Jacques DeGraff receives a dose of the Pfizer-BioNTech vaccine against the coronavirus disease (COVID-19), at NYC Health + Hospitals Harlem Hospital in the Manhattan borough of New York City, New York, U.S., February 25, 2021.
REUTERS/Jeenah Moon
To understand Black people’s resistance, you have to understand history.
  • Shenell Tolson
By Shenell Tolson

DrPH and molecular biologist

The coronavirus has hit Black communities particularly hard, and yet, as the US rolls out vaccines to a widening group of people, some Black people are reluctant to get them. In the press and in public health circles, there is judgement lobbied against Black people for this reluctance; some say Black people have adopted conspiracy theories against the government and “Big Pharma.”

But much less time is spent discussing how we got here. These “theories” are actually based in hard, historically documented facts, and iatrophobia is warranted given the history of abuse against Black people at the hands of the medical profession.

For a Black person, being wary of getting the coronavirus vaccine is not an irrational fear. In every aspect of medicine, Black people have been marginalized and forced to be guinea pigs for experiments. Though the 1932 Tuskegee experiment is the most infamous example of medical mistreatment of Black people in the US (not to mention a standard against unethical research principles), others include so-called “treatment” experiments involving radiation, forced sterilization, lobotomies based on racial bias disguised as science, invasive gynecological procedures without anesthesia, and false vaccinations. Black people suffered the consequences of rampant misinformation about infant nutrition and decades of environmental injustice. What’s more, Black individuals have been compelled to be the messengers or “safe faces” sent to recruit or encourage peer participation in these abusive undertakings.

This isn’t ancient history; our parents and grandparents tell us these stories. And their lingering and insidious effects persist in accounts of the Black experience in healthcare today. Black women are at least two times as likely as white women to die during childbirth, and Black patients are consistently prescribed less efficacious drugs. One 2016 study found that about half of medical students and residents hold false beliefs that Black people do not feel pain the same as white people.

Yes, lots of people—Black or not—have doubts about the vaccine and other public health information that is floating around. This is because we are seeing science play out in real time. The public, which usually absorbs scientific findings after rigorous trials and via peer-reviewed data, is instead following the back-and-forth between public health departments, the conflicting guidances and data, and all the unanswered or partially-answered questions that are a normal part of the scientific process.

This conflicting information means something very different for Black people. When not enough time has elapsed for experts to understand the full effects of the vaccines, but the expectation is that Black people fully trust that the vaccines are safe, it looks like history is repeating itself. Ignoring the history does nothing to assuage these hesitant feelings. What’s worse, doctors and public health officials are seemingly ignoring these feelings. If the US is to return to “normal life,” it is critical to convince the vast majority of the population to get vaccinated in an effort to achieve herd immunity against this virus.

For Black communities, that means engaging them in real conversations about the safety and efficacy of the vaccine. Would it be beneficial if more Black scientists and public health officials started talking about the realities of the vaccine and of acquiring the virus? Yes. However, it also means being thoughtful about how the scientific community is framing the decision to get vaccinated. It’s time to stop talking in generalizations, and get past the false dichotomy of “vaccinated or not.” The choice is not as simple as getting the vaccine or getting Covid-19.

There are still unknowns about how individuals respond to being infected with the novel coronavirus, which could vary from mild symptoms to death; there are also still unknowns as to how the vaccine will affect individuals long term. Additionally, there are now multiple virus strains in the US to which current vaccines may be less effective. The great challenge here is communicating to the general public that the longer the virus circulates in the population, the more we are going to see additional—and potentially more virulent—mutations. However, despite 500,000 Covid-19 deaths in the US alone, some Black people would rather gamble with the virus than with the vaccine; given these variables and historical context, it’s not hard to understand why.

To get a handle on this dilemma we need to have real conversations that acknowledge the significance of hesitating to trust a medical community that has a documented and continued history of abuse when it comes to Black people. However, we need to be very clear that a conversation does not magically erase centuries of medical mistreatment, some of which continues to be prevalent today. Building trust takes time. The scientific and medical communities may need to build trust with the Black community by working with the population on other issues that directly affect our communities beyond Covid-19. The World Health Organization defines health as: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” We weren’t there before the pandemic. Systematic disparities, food deserts/swamps, violence prevention, eviction/foreclosure protection, mental health resources, and unemployment assistance—these resources support a healthy population. Perhaps working on these pressing issues that affect Black communities will begin to foster trust while giving Black people time to change their minds about the vaccine, or at the very least time for the acquisition of the clear, longitudinal data necessary for them to make an informed decision.

I do not have all the answers, but as both a Black person and a member of the scientific community, my lived experience provides a unique understanding to both sides. I believe the path forward looks like this: 1) The medical community acknowledges that the fear of this vaccine among the Black population is valid; 2) Doctors and scientists have patience, with the understanding that building trust is not an overnight process, even in the face of this pandemic; 3) They will continue generating data on the effects of the vaccine; 4) Establish community health worker teams from the most impacted communities to work diligently to reduce incidence rates in those specific areas; and 5) Individual accountability – it can’t go both ways – if you are waiting for more data before deciding to get the vaccine, the very least you can do in the meantime is continue to wear your mask (properly) and practice social distancing to prevent the continued spread of the virus.

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