COVID-19 Vaccine Hesitancy in the Black Community

Introduction

There is no doubt whatsoever that COVID-19 has wreaked havoc around the globe. With over 3 million people dead worldwide and the United States having registered more than half a million deaths, this is a pandemic unlike any other the world has encountered in recent times. In an attempt to contain the spread of the virus, various measures have been undertaken by governments, agencies, and private entities across the world. One of the most promising developments has been the creation of the COVID-19 vaccine by a number of pharmaceutical companies. At present, vaccinations are ongoing in various parts of the world. It is important to note, however, that efforts to combat the pandemic have in some instances been hampered by the hesitancy or outright refusal by some segments of society to take the COVID-19 vaccine. This paper concerns itself primarily with the refusal or hesitancy by African Americans regarding the COVID-19 vaccine.

COVID-19 remains one of the worst pandemics to have hit the world over the last few decades, affecting millions of people in one way or another. Most of those affected are disproportionately minorities. With the development of COVID-19 vaccines, there has been considerable discussion about the apprehension that many minority groups feel toward receiving a vaccine that could protect them from the coronavirus. It is important to note from the outset that, as Tuckson (2020) points out, many Black people are extremely uncomfortable with receiving the coronavirus vaccine. This discomfort stems largely from a long-standing feeling of being medically neglected by the healthcare establishment. Minorities often feel that their healthcare is not a priority for White doctors and that they are left on the back burner while white patients receive superior care. Tuckson (2020) further explains how, several decades ago, J. Marion Sims — an award-winning Caucasian physician — operated on Black individuals without any anesthesia. Pain medications were withheld because Black individuals were believed to be capable of tolerating extremely high levels of pain and were thought not to require as much medication as other racial groups.

Summary and Research Questions

With minorities believing that their health is not taken seriously by White doctors, their overall wellbeing suffers because they are less likely to seek healthcare when unwell. The health of minority groups — predominantly Black people — tends to suffer the most because, in addition to being economically disadvantaged, trust is one of the fundamental building blocks of the patient-provider relationship. Given this context, it is understandable why a minority individual might be reluctant to visit a doctor and risk being subjected to unfair treatment. Tuckson (2020) argues that in order to convince minorities to trust the coronavirus vaccine, doctors must first work on building that trust. Minority groups' health needs must also be taken more seriously by White healthcare professionals. A genuine change in perspective regarding how the healthcare system has treated Black Americans is what will ultimately be required for them to feel more confident in the coronavirus vaccine.

This paper therefore asks: In what ways have Caucasian health professionals lost the trust of African American individuals? And in what ways could trust be rebuilt so that minorities feel better treated and become more confident in receiving the coronavirus vaccine? (Tuckson, 2020, p. 745)

Available data indicates that among those hit hardest by the present pandemic are Black Americans. According to Soucheray (2020), data from Johns Hopkins University shows that African Americans are nearly three times more likely to contract COVID-19 than their White counterparts. The same data also demonstrates that African Americans have a higher probability of dying from COVID-19 than White Americans — a finding corroborated by Jahomi and Hamidianjahromi (2020), who observe that "ethnic minorities, in particular African American or Black populations, are more vulnerable to COVID-19 infection and mortality" (p. 47). Given these statistics, one might expect African Americans to be among the most eager to receive the vaccine. This has not been the case since the nationwide vaccination program was launched (Reverby, 2021). A review of available literature reveals a wide range of reasons why vaccine uptake among African Americans has been unsatisfactory.

One consistently identified reason for hesitancy is the historical injustices that Black people have suffered at the hands of the U.S. healthcare system (Ferdinand, 2021). These injustices include, but are not limited to, unethical experimentation, unjust exploitation, and outright abuse of members of the Black community by the healthcare establishment. In the past, as Valscho (2010) points out, there have been documented instances of African American women being deceived into sterilization, thereby being denied the opportunity to have children. With this kind of documented betrayal by a system that should have been protecting their health and wellbeing, African Americans have developed a deep-rooted sense of mistrust that has persisted to the present day.

Literature Review

Perhaps the most infamous example of unethical experimentation is the 1932 Tuskegee Syphilis Study. In this case, dozens of poor and uneducated Black men infected with syphilis were left untreated despite the U.S. Public Health Service possessing a cure for the disease (Green et al., 2021). Although the experiment was later wholly condemned upon its public exposure, and a presidential apology was issued by President Clinton in 1997, the events remain etched in the memories of most African Americans — effectively fueling significant mistrust of the healthcare system (Anderson, 2021).

While Tuskegee is perhaps the most widely recalled injustice, it is far from the only one. Such injustices can be traced as far back as the slave trade era. In the words of Ross (2012), "medical treatment aboard the ships was based on violence and terror threaded through the entire Middle Passage experience… though some doctors were professional, many took a cruel approach in treating sick Africans" (p. 311). There are also documented instances of enslaved African American women being forced to participate in reproductive procedures with no anesthesia. Taken together, these and many other events may have produced a deeply ingrained belief that White doctors — and the broader White establishment — did not have the best interests of African Americans at heart, a belief further reinforced by events like the Tuskegee Syphilis Study.

The reluctance of many Black Americans to take the COVID-19 vaccine may also reflect what Hoq (2021) refers to as "the darker underbelly of our social fabric: the longstanding, deep-rooted racism towards Black Americans." For a long period of time, African Americans have been exposed to systemic discrimination across diverse domains, resulting in serious health and economic disparities. Very few significant investments have been made to increase the African American community's access to healthcare. This has inevitably affected access to the vaccine. With this in mind, Biden-Harris COVID-19 Health Equity Task Force Chairperson Marcella Nunez-Smith has called for improved vaccine access in African American communities (Young, 2021). The National Medical Association's president, Leon McDougle, is similarly categorical that disparities within the African American community have hindered both COVID-19 vaccine access and acceptance (Young, 2021). McDougle argues there is an urgent need to expand 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" (Young, 2021).

This point is reinforced by Reverby (2021), who observes that COVID-19 deaths are higher among people of color due to both vaccine refusal and lack of access. The author argues that while hesitancy must be addressed, the fact that vaccine access itself perpetuates systemic discrimination cannot be ignored. For instance, in some cities such as Chicago, vaccines were made available primarily through large pharmacy chains — a distribution strategy that, as Reverby (2021) notes, entirely overlooked "the fact that many of the city's minority communities are 'pharmacy deserts' or are populated not by the big chains but by independent stores that do not have the capacity to vaccinate right now" (p. 107). A further barrier is the requirement that vaccine appointments be booked online, which fails to account for the reality that many poor African American neighborhoods lack reliable internet access (Reverby, 2021).

The skepticism many African Americans feel toward the U.S. healthcare system is also a product of being systematically excluded from policy decisions. According to Hall et al. (2015), implicit bias against minorities — particularly African Americans — among healthcare professionals has been well documented. In a systematic review assessing the presence and extent of this bias, the authors find that "most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color" (Hall et al., 2015, p. 64). For many African Americans, therefore, bias in the healthcare system is an ongoing lived reality, not merely a historical concern. Their skepticism toward initiatives advanced by the same system is thus well founded.

It is also worth distinguishing between outright vaccine rejection and hesitancy, as these are meaningfully different phenomena. Hesitancy may be rooted in, among other things, conspiracy theories about vaccine safety. According to Khubchandani et al. (2021), hesitancy is significantly higher among African Americans than in any other racial group. More specifically, the authors find that "unadjusted group comparisons, compared to their counterparts, vaccine hesitancy was higher among African-Americans (34%), Hispanics (29%), those who had children at home (25%), rural dwellers (29%), people in the northeastern U.S. (25%), and those who identified as Republicans (29%)" (Khubchandani et al., 2021, p. 272). As opposed to outright rejection, hesitancy represents more of a wait-and-see approach. The authors are categorical that African Americans have concerns about the safety of the vaccine and have adopted this cautious posture accordingly.

Research Question: What causes African Americans to be hesitant about taking the COVID-19 vaccine?

Conclusion

CDC data indicates that across the 50 states, the vaccination rate among White people was nearly twice as high as the rate for Hispanic people (25% vs. 13%), and 1.7 times as high as the rate for Black people (25% vs. 15%). At a more granular level, White people had a higher vaccination rate than Black people in every reporting state except Alaska.

A large reason for this disparity is a general apprehension of the vaccine within the Black community. The COVID-19 pandemic has disproportionately harmed African American, Indigenous, and Hispanic communities relative to White members of society. Although there has been mixed messaging in the overall COVID-19 response, a significant element of African American mistrust is rooted in a history and pattern of unethical and abusive treatment by the medical establishment (Barker, 2021).

America has a long and troubling history of unethical treatment of African Americans (Carney, 2021). Harriet Washington, in her book Medical Apartheid, details the Tuskegee Syphilis Experiment, in which African American men were misled about the treatment of syphilis. The study was designed to observe the natural progression of syphilis in Black men and continued well into the 1960s, even after penicillin — an effective cure — became widely available in the 1950s. African American men were thus still subjected to experimentation nearly a decade after a solution had been discovered. According to research, the U.S. Public Health Service actively worked to prevent the treatment of these men with penicillin throughout the duration of the study.

Even as far back as the 1800s, enslaved Black people were experimented on without anesthesia or the standard of care available at the time. J. Marion Sims, for example, performed surgical experiments on enslaved Black women nearly 30 times without using the standard of care, reportedly operating under the prevailing belief that Black people experienced less pain than White people (Kelly, 2016).

Critics may argue that the world has changed dramatically over the past two centuries, and to a large extent they are correct — many of the most egregious historical medical practices have since been discontinued. However, the racial biases that African Americans still perceive in the healthcare system persist. Unfair and inequitable treatment has been the norm throughout history, and the community's trust has not recovered. African Americans often carry the collective memory of the medical abuses perpetrated over the last few centuries and remain wary of their implications for future treatments (Priest, 2020). As a result, many are reluctant to accept the vaccine.

In summary, there are a myriad of factors contributing to the refusal or hesitancy of African Americans to take the COVID-19 vaccine. Among the most prominent is the deep mistrust that this community holds toward the healthcare system — a mistrust born of a long series of historical injustices perpetrated by that system against Black Americans. If society is to succeed in bringing this pandemic under control, the concerns outlined in this paper must be acknowledged and addressed. Deliberate measures must also be taken to ensure equitable access to the vaccine across the nation. Both rebuilding trust and removing structural access barriers are essential steps toward improving vaccination rates in the African American community.

Anderson, J. (2021). America has a history of medically abusing Black people. No wonder many are wary of COVID-19 vaccines. USA Today.

Barker, C. J. (2021, February 4). Numbers reveal racial inequity in COVID vaccine distribution. New York Amsterdam News.

Brandt, A. (1978). Racism and research: The case of the Tuskegee Syphilis Study. The Hastings Center Report, 8(6), 21–29.

Carney, C. J. (2021, January 2). The role of experimentation and medical mistrust in COVID-19 vaccine skepticism. Diverse: Issues in Higher Education.

Cost, C. (2021, January 7). COVID vaccines, the Black community, many questions. New York Amsterdam News.

Ferdinand, K. C. (2021). Overcoming barriers to COVID-19 vaccination in African Americans: The need for cultural humility. American Journal of Public Health, 111(4), 586–588.

Green, L., Li, L., Morris, J. F., Gluzman, R., Davis, J. L., & Qi, M. (2021). Detailed knowledge of the Tuskegee Syphilis Study: Who knows what? A framework for health promotion strategies. Health Education and Behavior, 38(6), 629–636.

Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. C. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105(12), 60–76.

Hoq, R. (2021). Black Americans' distrust of the COVID-19 vaccine. Psychiatric Times.

Jahomi, A. H., & Hamidianjahromi, A. (2020). Why African Americans are a potential target for COVID-19 infection in the United States. Journal of Medical Internet Research, 22(6), 43–49.

Kelly, E. (2016). [Referenced in discussion of J. Marion Sims's surgical experiments on enslaved individuals].

Khubchandani, J., Sharma, S., Price, J. H., Wiblishauser, M. J., Sharma, M., & Webb, F. J. (2021). COVID-19 vaccination hesitancy in the United States: A rapid national assessment. Journal of Community Health, 46, 270–277.

Priest, J. B., McNeil Smith, S., Woods, S. B., & Roberson, P. N. E. (2020). Discrimination, family emotional climate, and African American health: An application of the BBFM. Journal of Family Psychology, 34(5), 598–609.

Reverby, S. M. (2021). Racism, disease, and vaccine refusal: People of color are dying for access to COVID-19 vaccines. PLOS Biology, 19(3), 104–109.

Ross, R. J. (2012). Racism and colonialism: Essays on ideology and social structure. Springer Science & Business Media.

Soucheray, S. (2020). US Blacks 3 times more likely than Whites to get COVID-19. CIDRAP.

Tuckson, R. V. (2020). The disease of distrust. Science, 370(6518), 745.

Valscho, T. W. (2010). Sterilization racism and pan-ethnic disparities of the past decade: The continued encroachment on reproductive rights. Wicazo Sa Review, 25(1), 17–31.

Young, S. (2021). Black vaccine hesitancy rooted in mistrust, doubts. WebMD.