- In the past, racist, and sometimes dangerous, health policies and clinical experiments have targeted particularly vulnerable Black and brown communities.
- In addition to this history, a lot of mistrust around the COVID-19 vaccine has also been generated by the overall chaotic messaging around the pandemic.
- Experts say we need to work directly with community leaders and amplify the voices of people of color to ease fears, build trust, and disseminate proper information about the vaccines.
By the end of 2020, we find ourselves at an important inflection point in combatting the COVID-19 pandemic.
As of publication, the Food and Drug Administration (FDA) has granted emergency approval for distribution of the Pfizer-BioNTech COVID-19 vaccine in the United States.
A similar approval is expected shortly for Moderna’s vaccine.
While this is positive news, there are some communities that might not automatically embrace or feel at ease over the announcement of a population-wide, mass inoculation program.
In the past, racist, and at times dangerous, health policies and clinical experiments have targeted particularly vulnerable Black and brown communities.
From the Tuskegee experiments — one of the most disturbing parts of American medical history — to the economic and cultural inequities in the U.S. healthcare system that disproportionately harm Black and Latinx communities, there are very real reasons why some people might look askance with skepticism and fear at the new vaccines.
Experts say this requires a great deal of nuance.
Public health and medical officials, media figures and politicians alike have to communicate clearly to these communities how important the vaccine is, that it is vetted and safe, and make it accessible to everyone who needs it.
How do we reckon with the past while ensuring that these new vaccinations are safely distributed in a way with outreach that is intersectional and inclusive?
A recent report from UnidosUS, the NAACP, and COVID Collaborative revealed that just 14 percent of Black Americans and 34 percent of Latinx Americans say they have trust in the safety of a new COVID-19 vaccine.
The study also found that 18 percent of Black and 40 percent of Latinx respondents say they trust COVID-19 vaccine effectiveness.
Additionally, 28 percent of Black participants said they have trust in “culturally specific testing and safety” practices. The number among Latinx people was higher, at 47 percent.
Why are these numbers relatively low? Just looking at the recent 20th century past offers some reasons why.
The realities of how Black and brown people have been treated by the U.S. medical establishment is one that is, at many times, bleak.
One of the main examples often pointed to is the Tuskegee experiments, which ran for 40 years, from 1932 to 1972.
The goal was to track the natural progression of syphilis. Researchers initially recruited 600 Black men — 399 with the disease, 201 without it — and conducted the study without the informed consent of these participants.
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, researchers justified the study by telling these men they were being treated for “bad blood,” which referred to conditions like anemia and fatigue as well as syphilis.
What happened? The men never received treatment to cure syphilis.
This example of using Black patients as medical guinea pigs, if you will, putting their bodies and health on the line, is just one of the reasons why members of these communities might be apprehensive about new vaccines, said Diana Grigsby-Toussaint, PhD, an associate professor in the department of behavioral and social sciences and the department of epidemiology at the Brown University School of Public Health in Providence, Rhode Island.
“If you think historically for African Americans in the U.S. in terms of what the history has been with respect to their interaction with the healthcare system, of course we know the Tuskegee study. Tuskegee was not that long ago. The last surviving member died in 2004. It’s not something that is far removed. It’s still in people’s memory,” Grigsby-Toussaint told Healthline.
She also cited “the eugenics movement” that “saw African Americans sterilized in places across the country,” as well as birth control pill trials in Puerto Rico that were “not performed in a way that would stand up to the standards we have today in respect to clinical trials.”
In the case of the latter example, she said side effects exhibited in women studied weren’t properly monitored, leading to actual deaths of some participants.
Grigsby-Toussaint added that all these examples point to a dehumanization and commodification of people who were essentially used and discarded by medical officials.
Rather than having value placed on their lives, the emphasis was on expedience, data, and experimentation, not human life.
According to Steven Lopez, director of health policy at UnidosUS, a nonpartisan advocacy group for the greater Latinx community, a lot of mistrust around the vaccine is also generated by the overall chaotic messaging around the pandemic from early in the year to today.
Demonizing of protective masks, confusing mixed messages over lockdown protocols and the need to adhere to physical distancing contributed to an environment where even the most informed and health-literate person in the country might not know quite what to make of the seriousness of the new coronavirus.
This was especially true in the early days of COVID-19, and of course, it doesn’t help that a lot of this stemmed directly from President Donald Trump and his administration’s approach to the health crisis.
Lopez told Healthline that this didn’t necessarily make Latinx Americans comfortable with efforts to fight the pandemic to begin with.
But coupled with community-specific concerns, it created something of a perfect storm of mistrust and confusion right as the vaccine rollouts begin.
“There are maybe two key words to focus on: transparency and trust,” Lopez said.
He said it’s important to first have transparency when it comes to data on the virus and a vaccine itself, helping the greater public know “how we get from point A to point Z” in vaccine development, and be honest about any possible side effects.
Lopez added that while this would normally appear to be a no-brainer for a public health crisis like this one, “unfortunately, transparency has not been a hallmark” when it comes to COVID-19.
Lopez explained that signs are hopeful that we’re moving to a period of more transparency with the public, especially as we transition from a Trump response to a President-elect Joe Biden response to the pandemic.
He said “trust” is the other important word because Black and brown communities have been hit hard by the virus.
Statistics have shown just how heavily affected Black communities have been, while Lopez pointed to the fact that “Latinos are among the sick and the dying disproportionately,” standing at about 1 in every 4 cases of COVID-19.
Lopez said another crucial issue at the top of mind for many Latinx households is immigration.
“Some underlying community hesitancy might be among our immigrant families and families who have mixed immigration status in their households,” he explained.
“The past few years have been incredibly toxic in both rhetoric and policy, and there’s been a level of fear and anxiety among those in immigrant households around the process of going for a vaccine, and if health data is collected, how will it be used?” Lopez said.
Lopez stressed that there has to be messaging and distribution efforts that ensure everyone who needs a vaccination “gets an equitable opportunity” to get it.
A big part of this has to be reassurances to families that might have members who have concerns over their immigration status that they will be safe.
“This is especially important given so many of our immigrant families are on the front lines as essential workers, of keeping our country going,” he added. “We have to make sure we are sensitive and responsive to their unique circumstances.”
For Ernest Grant, PhD, RN, FAAN, president of the American Nurses Association, it’s been crucial that we effectively get the word out about the new vaccines, especially as COVID-19 diagnoses and deaths continue to skyrocket domestically.
Grant finds himself in an interesting position. Not only is he a leading medical figure in the United States, but he also participated in the Moderna vaccine trial.
As a Black man, he said it was also crucial that he lent his voice behind the vaccine development process, demystifying it for those who might be concerned and raising awareness about why vaccinations are important.
“For me, I feel I’m contributing to science and an important body of work,” Grant told Healthline.
“First, I knew there was a need for more Black and brown people to participate in the clinical trials. If it proved that the vaccines were effective, I could use my testimony to build a bridge for the Black and brown community that the vaccine is safe and they shouldn’t have anything to fear about,” he said.
Grant said he hasn’t experienced any side effects. As the president of an organization that represents more than 4 million registered nurses, he said it’s also important that he’s visible to the nurses who put their lives on the line every day.
“I wanted to stand in solidarity with my colleagues to alleviate any concerns and issues they may have, to see that their national leader has put his life on the line, who didn’t know at the time how effective the vaccines would be, who didn’t know if he would get the vaccine or a placebo,” Grant said. “I wanted to step up and do my part.”
Grant wanted to also emphasize that given there is a slow rollout, which means healthcare workers and high-risk older adults will be among the first groups to receive the vaccine, it will take a bit of time before life goes back “to normal.”
Everyone will need to get two doses of the vaccine, and everyone will still have to wear masks and physically distance to get society anywhere close to “normal.”
There are other Black medical leaders who are also putting themselves out there in the public sphere right now in addition to Grant.
Grigsby-Toussaint pointed to the National Medical Association, an organization of Black doctors originally formed to counter white-dominated medical institutions that historically excluded African American physicians. The association created a committee to vet the science behind the new COVID-19 vaccines.
The committee’s creation was to specifically counter the concerns that history could repeat itself with another Tuskegee experiment.
She also spotlighted “A Love Letter to Black America” from Howard University, Morehouse School of Medicine, Meharry Medical College, Charles Drew University, the National Medical Association, the National Black Nurses Association, and the National Urban League as an effective campaign to respond directly to Black Americans and their concerns around COVID-19.
Lopez said that when it comes to Latinx people nationwide, it involves more than just having “Spanish voices” in translated materials or advertisements.
Officials have to interface directly with community leaders and amplify the voices and concerns of people of color, as well as provide needed resources to disseminate proper information about the vaccines.
Grigsby-Toussaint echoed that point, and also stressed that while seeing former President Barack Obama eventually receive the vaccine on camera or celebrating the accomplishments of Dr. Kizzmekia Corbett (who has been praised as one of the main researchers behind the vaccine development) will help this effort, those benchmarks in and of themselves won’t quell community concerns.
“It isn’t sufficient to just stop at, ‘There is a Black or brown person working on this, so it’s all OK.’ You have to still work to address and acknowledge people’s concerns,” Grigsby-Toussaint said.
“It’s not enough to just say people who look like you worked on this. What are the additional steps we can take to allay these fears? Are officials going to say, ‘We want you as partners as we roll out this vaccine?’ This is all important parts of the conversation,” she said.