Of Course Black Americans Are Wary Of The COVID Vaccines. Here’s A Path Forward

Photo: Mark Lennihan/Pool/Getty Images.
On Monday, December 14, the U.S. officially commenced the largest vaccination effort of its citizens since the poliomyelitis outbreak of the mid-20th century. On the same day, the nation officially surpassed 300,000 deaths attributed to the coronavirus pathogen. As the COVID-19 pandemic rages on, the Pfizer-BioNTech vaccine and the Moderna vaccine have both been approved for mass distribution in the United States. The vaccines have offered immense hope to many who have lost their loved ones, livelihoods, and quality of life due to COVID-19’s year-long destruction. But Black Americans are understandably wary of accepting the words of the medical community, public health officials, and the government at face value. 
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From the very beginning of this pandemic, we have witnessed the glaring intersections of racial and social inequity in healthcare. We saw policies that could lead to the unequal distribution of dwindling hospital resources amongst Black patients; we heard from people who reported that medical professionals discounted their symptoms; this summer, there was fear that medical personnel might even refuse treatment for Black Lives Matter protestors. The phenomenon of medical racism has been amplified in the COVID-19 era, but it is by no means Black America’s first introduction to it. Ask almost any Black person in America of any age to quantify their distrust for Western medicine or the United States government, and they will immediately cite multiple infamous racial injustices. 
Medical racism is not just a talking point of the historical injustices perpetuated against people of color in this country. It is the bedside warnings from our mothers before we visit the doctor for the first time. It is the tales of our elders, regaled almost like ghost stories in their believability that such cruelty could be inflicted upon a person. My own biological mother, who gave me up for adoption at birth, was only given Tylenol for what was later diagnosed as Stage IV colon cancer; she was then given less than a year to live. These stories are not rare. Between the 1900s and 1970s, thousands of Black women and other women of color were sterilized without their consent and sometimes without their knowledge due to the forced sterilization authorizations that existed in more than 30 states. In North Carolina involuntary eugenics was practiced until 2003; the Eugenics Compensation Act of 2015 allowed the approximately 220 living victims to receive compensatory damages.      
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In Washington, D.C., the theft of Henrietta Lacks’ cell line by Johns Hopkins’ Hospital researchers revolutionized medicine by creating immortal “HeLa cells”, but compromised its donor’s treatment for cervical cancer. Her family was completely unaware that her biological material was being used for unethical scientific research for over six decades, nor were they compensated. In Alabama, the Tuskegee syphilis experiments, a four-decade study on untreated syphilis conducted on illiterate Black male sharecroppers without their informed consent and under the deception that they would be given free medical care, irrevocably damaged Black Americans’ trust in the medical community. A research study from 1999 found that around 80% of Black men surveyed believe the men were deliberately injected with syphilis. 
These wounds will never truly heal, these sins will never be forgotten, and the hesitancy of the Black community to place a profound amount of trust in these same systems that have proven themselves untrustworthy time and time again is completely rational. Therefore, it is up to us as healthcare professionals to earn the public trust that this massive stride towards herd immunity against COVID-19 demands. 
As a Black epidemiologist, I have often said that the difference between the fields of public health and medicine is that public health is primarily focused on prevention. Prevention efforts require not only education but also coordinated efforts for the proper dissemination of information. In our nation’s history, when public health and medicine have come together as they are now, we have accomplished the seemingly impossible, like the elimination of measles and rubella in the early 2000s. How do we attempt to replicate these previous feats in the age of “fake news” and inspire the necessary public trust? 
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These wounds will never truly heal, these sins will never be forgotten, and the hesitancy of the Black community to place a profound amount of trust in these same systems that have proven themselves untrustworthy time and time again is completely rational.

First, bring everyone to the table, and I do mean everyone. Answer every question. Educate. Don’t ask minority communities, especially ones scarred by generations of trauma at the hands of medical racism, to come to us. Go to them. Work with trusted leaders within that community. An example of this is how my city of New Orleans, a predominantly Black metropolis, has handled the COVID-19 pandemic this year. Once on track to become a COVID-19 epicenter, New Orleans was able to lower both its incidence and prevalence rates by holding nightly COVID-19 informational sessions on the local news with Black doctors and healthcare providers, disseminating testing availability information through the city’s Department of Health, and asking local community leaders, such as the two deans of the two largest Historically Black Colleges and Universities (HBCU) in the city, to explain and solicit participation in the COVID-19 vaccine clinical trials at the state’s best hospital. When people are not only educated but also included in decisions about their health and safety, the community is safer. That is community health. 
Fortunately, we are seeing these approaches replicated on a national scale. Back in April, the world met Kizzmekia Corbett, PhD, the Black viral immunologist at the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, via a CNN interview with Anderson Cooper. She informed us that help was on the way and a COVID-19 vaccine was on track for December of this year. She kept her promise. In December, vaccines created by both Moderna and Pfizer were granted emergency use approval. Americans even watched as a Black intensive care unit nurse in New York City became one of the first in the country to receive the Pfizer vaccine, which was administered by another Black healthcare professional. 
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That visual will live forever, as it is so indicative of how we as Black people have been at the forefront of every health-based fight that bears upon our community. Per the CDC, 60% of issues that lead to premature death in the U.S. are caused by social and environmental factors; only 10% of those factors are caused by faulty clinical care. As a result, concentrated efforts by public health officials and the medical community to engage and partner with minority communities in addressing our questions, concerns, morbidities, and mortalities — and training and community members to be part of their own community’s frontline defense — have long been a vital part of our path forward.
That is how diseases and ailments that have disproportionately affected the Black community in recent decades all the way to the present day have come to be addressed. That is how the HIV-1 virus, once a death sentence in the U.S., has now become widely acknowledged in the medical community as a treatable, chronic condition with a life expectancy into the 70s. That is how successful strides in decreasing viral hepatitis C transmission, and, in turn, intravenous drug usage within the community, have been made. That is how the creation of a human papillomavirus virus (HPV) vaccine in 2015 that specifically targets and stops the “high grade” strains that lead to increased cervical cancer diagnoses in Black women and girls came about. From the vaccine booster shots of your childhood as you sat in your mama’s lap to the groundbreaking medical advancement we have just witnessed at the hands of a Black woman, I can see no better time than the present to rely upon our community. 
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With 49% of Black Americans polled refusing to be vaccinated even if it's deemed safe and is free, it is my sincerest hope that Black healthcare providers and epidemiologists like myself use this time to speak to the communities around us and dispel fact from fiction. Like Dr. Corbett, we have dedicated our lives to science and the healing of our communities. Explain to your loved ones that it takes approximately two weeks for the body to establish immunity to a pathogen upon vaccination. Explain that you still need to practice social distancing and wear a mask after vaccination, because so far we only know that the vaccines prevent you from contracting the virus or developing severe symptoms, not whether it keeps you from spreading the virus. Explain that vaccines are not created out of thin air, but are constantly being developed, so the brevity of the COVID-19 vaccine production doesn’t have an effect on its effectiveness in any way. 
It’s like the elders always say, “We all we got.” Stopping a pandemic that has been bolstered by ineptitudes in leadership, societal apathy, and systemic medical racism has been the perfect storm of destruction upon our community, which has not even begun to heal from the transgressions of this nation’s past. With 2021 quickly approaching, nothing will change unless we as a community help to facilitate that change. Because by January 1, it is projected that 1 in 500 Black Americans will have died of COVID-19. We truly are all we got. 
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Gabrielle A. Perry is an infectious disease epidemiologist based in Louisiana 

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