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Black, Hispanic, and Native American people are about 4 times more likely to be hospitalized and nearly 3 times more likely to die of COVID-19 than white people.
Yet African Americans have the lowest rate of vaccination among any ethnic group. In fact, white Americans are being vaccinated at a rate 3 times higher than Black Americans. New CDC figures show that just 5.4% of Blacks had received the vaccine, compared to 60% of whites. According to a recent Kaiser Family Foundation poll, about 35% of Black Americans said they don't plan to get the vaccine, citing fears about safety and concerns that the vaccines are so new.
Wynne Stovall-Johnson is one of them. The 54-year-old mathematics teacher from Elkins Park, PA, is hesitant about getting vaccinated right now. The mother of two says even though her asthma puts her in a high-risk category, it isn't enough to sway her.
"It's really an emotional thing. Trust is based on emotions, and I just don't trust right now," she says. "I'm educated. I have a graduate degree. I read a lot. I'm informed. I'm not a person who clings on to conspiracy theories, but I simply do not trust the government at this point."
She says her husband and half of her close friends plan to get it. But the stain of the Tuskegee Study, the Henrietta Lacks case, and other examples of how Black people have been treated, and in many cases still are treated, by the medical community, makes her skeptical. In the Tuskegee experiments, Black men with syphilis were promised treatment but didn't receive it. Many of the men died, went blind, or developed other serious health issues. Henrietta Lacks' cancer cells were used for medical research without her or her family's knowledge, and without financial compensation.
An African American male is tested and treated during the Tuskegee Study of Untreated Syphilis in the Negro Male.
But it's not just her lack of trust; she's concerned about future problems.
"I just think there will be some long-term negative effects caused by the vaccine that we can't know now because the vaccine is new. I think in 2 years, or 3 years, or 4 years, there will be side effects that people get who got the vaccine that could not have been foreseen because not enough time has passed."
"I know everyone says the vaccine is safe," she says. "I've heard that from a lot of people. I've heard that from the establishment, both political and scientific, they've had all kinds of Black people getting shots on TV. None of that means anything to me. The vaccine just hasn't been out there long enough for scientists and doctors to really know the long-term effects of people getting the vaccine…so I'm hesitant."
Anthony Hardy Sr. is not hesitant. The 32-year-old from Glen Burnie, MD, is a flat-out no.
"I've seen death from it. A sorority sister of my wife lost her baby after getting the vaccine," Hardy says. "I've read about lingering effects as far as coughing, your throat or ribs or kidneys hurting, headaches, drowsiness. I've read and heard about other effects as far as reading it off of the VAERS (Vaccine Adverse Event Reporting System) website, and I don't think I should get it. It's not a chance I'm willing to take."
Nor does his family plan to get a COVID-19 vaccine.
"We've had conversations about it, we've talked about it. I do have some family that are inside the medical field as far as nursing, as far as doctor's assistants and stuff like that, but they don't plan to get it."
Hardy feels the benefits simply do not outweigh the risks and uses a football analogy to make his point.
"It's not a fourth and inches. I don't have to go for it right now, it's not the end of the game. It's the first quarter, second quarter. I don't have to really go for it. I know I'm going to get the ball back. That's the way I'm seeing it."
While data about the safety of COVID-19 vaccines for pregnant women is limited right now, there's no evidence the vaccines are linked to infertility or miscarriage, experts say. There is no increase in miscarriage rates among pregnant women with COVID, and women with COVID would generate the same antibodies as a COVID vaccine.
In addition, there's no evidence to date that COVID vaccines may have serious side effects long-term. Testing of the vaccines has been ongoing since summer 2020. Out of millions of doses, a handful of severe side effects have bene reported, mostly severe allergic reactions. Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia and a member of the FDA advisory panel that recommended approval, says there's no evidence the Pfizer vaccine can cause long-term effects, and serious rare side effects typically occur within 6 weeks of getting a vaccine.
James Hildreth, MD, president and CEO of Meharry Medical College, a historically Black medical school based in Nashville, says he understands why many African Americans are not comfortable getting the vaccine.
But unlike Tuskegee, he says, Black scientists had a major role in the development of both vaccines.
"Tuskegee was horrible," he says. "This is nothing like Tuskegee because we have been involved at every level of developing the vaccine from the beginning. The scientists who were involved in creating it to the ones involved in approving it, we've been involved at every level, at all phases."
Hildreth, also a voting member of the FDA committee that authorized emergency use of the Pfizer and Moderna vaccines, says the vaccines are safe.
"None of the steps typically involved in evaluating the safety of a vaccine were omitted," he says. "They're all there, they're all done to completion, and they all demonstrate that the vaccine is safe and effective."
Hildreth says the school acknowledges that the hesitancy is well-founded, and it offers information to people, specifically minority communities, to help them understand that the vaccines are safe.
"This idea of DNA being damaged or our genes being changed, that's been addressed," he says. "There are no microchips to monitor people and where they go; it would be impossible to do in a biological vaccine like this. But I think what health care professionals should do, they should get the information they need to feel comfortable about the vaccine and then share that with their patients."
But Tuskegee is only part of why so many African Americans are not getting vaccinated. A historical lack of access to care and disparities in care are other reasons.
An Investment in Access and Equality
"As a nation, we need to invest in Black serving institutions to offset disparities in health outcomes," says Leon McDougle, MD, president of the National Medical Association and a professor of family medicine at Ohio State University College of Medicine. The association, the largest and oldest national organization of African American doctors in the country, recently released a report that found the pandemic has highlighted disparities in the Black community.
He calls for expanding vaccine sites to include office space practices and locations that are easy to get to by people in the African American, Hispanic, and Indigenous tribal communities.
Marcella Nunez-Smith, MD, chair of the Biden-Harris COVID-19 Health Equity Task Force, says in order to get to equity in vaccination in this country, we're going to have to double down on access and acceptance.
"When people say, ‘I have skepticism, I have questions,' I honor that. For many people, this is grounded in reality. Many folks don't have to look back to Tuskegee or Henrietta Lacks; they can look to an experience they or their family members have had interacting with the health care system this week, or this month, that left them feeling that perhaps there is bias in the system against them."
"I want to be sure that we don't get so lost in conversations about hesitancy and vaccine acceptance that we forget about the structural barriers that also exist. What motivates me every day is saying, when it's somebody's turn and they are a yes for the vaccine, we have to make sure there are no structural barriers that stand in the way of them getting vaccinated."
Equity, Nunez-Smith says, does not happen by default.
"If you were someone who didn't have access to a vehicle or a car, then testing was out of reach, and many of those testing sites were in, quite frankly, affluent communities, not in communities of color. So we know that unless we center on equity, we won't get there."
"We're also seeing that people residing in higher-income ZIP codes are getting a disproportionate, higher share of vaccination than that of the general population." Nunez-Smith says. "Unfortunately, for so many communities — and many of these are communities of color — for many low-income communities, rural, and others, inequity has been the narrative of this pandemic so far; we have to disrupt that."
She also says tackling disinformation and misinformation is a high priority.
"It's really disappointing, quite frankly, that there are some out there who are taking advantage of this moment to try to push political agendas when we are in a public health national emergency, the likes of which we haven't seen before. And we just need to be anchoring in science and evidence and data every day; that's the only way we'll get through to the other side of the pandemic."
Putting a Focus on Gaining Trust
Dorothy Roberts, JD, pushes back on how the issue has been framed.
"It's not that Black people have an irrational fear of new medical technologies, it's that they have an awareness of a long history of being disrespected, mistreated, and violated by the government and by health care professionals," she says.
"If we start out with the assumption that Black people have to be convinced to trust the vaccine because there's a problem with Black people's attitude toward medicine and science, that's the wrong approach," says Roberts, founding director of the University of Pennsylvania Program on Race, Science & Society. "The approach should be how can medicine and science be made more deserving of Black people's trust."
"It's not just that there was a past history of medical experimentation on Black people that makes them suspicious of new technologies today. There is a continuing practice of racism in medicine and government policies that many Black people have experienced themselves. That's why there's a skepticism about the government rollout of the vaccine. It's a rational skepticism, and the only way to address it is to work toward ending the racism in medicine and health care that caused the skepticism in the first place."
Stovall-Johnson, the mathematics teacher, agrees.
"There's been a whole lot of effort that has gone into portraying this vaccine as being safe, yet the same amount of thought, effort, and concern has not been put into figuring out how to get the vaccine to Black people and Black communities. That's a disconnect, but it's not surprising. Black people don't have equal access to things like quality education, good health care, safe communities; the vaccine is no different. It's like everything else in our society. There is never equal access for Black people."
Marcella Nunez-Smith, MD, associate professor of internal medicine, public health and management, Yale University; co-chair, President Joe Biden's COVID-19 advisory board; chair, Biden-Harris COVID-19 Health Equity Task Force.
Leon McDougle, MD, president, National Medical Association; professor, family medicine, Ohio State University College of Medicine.
James Hildreth, MD, PhD, president and CEO, Meharry Medical College; FDA temporary voting member, Vaccines & Related Biological Products Advisory Committee.
Dorothy Roberts, JD, George A. Weiss University professor of law and sociology, University of Pennsylvania; founding director, Penn Program on Race, Science & Society
Wynne Stovall-Johnson, Elkins Park, PA.
Anthony Hardy Sr., Glen Burnie, MD.
News release, National Medical Association.
CDC: "COVID-19 Hospitalization and Death by Race/Ethnicity," "Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program — United States, December 14, 2020-January 14, 2021."
Kaiser Family Foundation: "Kaiser Family Foundation COVID-19 Vaccine Monitor."
Choose Healthy Life.
NAACP: "Coronavirus Equity Considerations: The Imperative for Civil Rights Advocacy, Monitoring, and Enforcement," "Coronavirus Policy Briefs, Statements, and Letters."
Kaiser Health News: "Black Americans are getting vaccinated at lower rates than white Americans."
News release, Yale University.
Business Insider: "A Black scientist who approved the coronavirus vaccine says it is ‘nothing
like Tuskegee' and people of color will not be ‘guinea pigs.'"
Journal of General Internal Medicine: "Understanding African Americans' Views of the Trustworthiness of Physicians."
Mayo Clinic: "COVID-19 vaccine myths debunked."
Ohio State University Wexner Medical Center: "COVID-19 vaccine side effects: Should we be concerned? How does mRNA work?
WebMD Health News © 2021
Cite this: Black COVID-19 Vaccine Hesitancy Rooted in Mistrust, Fear - Medscape - Feb 03, 2021.