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Understanding COVID-19 Vaccine Hesitancy in the Black Community

Vaccine hesitancy is growing in the Black community, and this is a valid response to the long history of mistreatment by medical institutions.

By Rachel Jones 

The recent announcement of two viable COVID-19 vaccine candidates has brought the close to a seemingly endless pandemic into view for many. However, a cultural temperature check on vaccine sentiment may challenge that hope. Recent studies have shown that only about half of Americans would get a coronavirus vaccine. In attempting to account for the other half, it’s easy to trace how arguments of personal freedom used to reject masks could give way to similar rejection of vaccines. The portrait of the anti-vaxxer and the anti-masker are almost identical, both hostile to science, bolstered by Facebook conspiracies, and likely named Karen. 

But that portrait of those who may fear a rushed vaccine leaves out an important group: Black Americans. Vaccine hesitancy is growing in the Black community, and it isn’t limited to just online conspiracy theorists. Black activists, public figures and elected officials have been among those voicing distrust for vaccines. This year alone, Black activists in Colorado rallied against a pro-vaccine bill, and a DC council member made statements casting doubt on the trustworthiness of vaccines for his constituents. And recently, Black Panther actress Letitia Wright shared a 69-minute anti-vaccine video (that was unfortunately filled with misinformation and transphobia). 

Black primary care provider and Stanford Health Care Chief of Staff, Dr. Megan Ruth Mahoney has witnessed these attitudes among her own patients. She knows well that the stakes when it comes to the Black community’s acceptance of a COVID-19 vaccine are incredibly high. 

“This vaccine is most likely not going to be 100 percent effective. And so, that is the reason we need to get as many people vaccinated as possible,” Dr. Mahoney says. “If it’s only 50% effective and only 50% of the population ends up being vaccinated, that means that 25% of people are immune – and we’re now at 9%. It’s not like that would be a substantial improvement. We’d still have to wear masks, we’d never get out of this.” 

Because Black Americans have been hit disproportionately hard by the virus, the community’s acceptance of a vaccine will have a rippling impact on the country’s recovery overall. To deal with these anxieties and reckon with their potential hand in getting us all back to normal, Dr. Mahoney suggests that we first seek to understand where they’re coming from. 

“There is this general acceptance that there’s some legitimacy behind the mistrust,” she offers. “There’s some historical context, and then it’s compounded by the fact that we have a president, a White House, an administration that has already demonstrated reasons to be cautious.” 

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As Dr. Mahoney notes, distaste for President Trump has sparked skepticism on the safety of a vaccine rushed through under his administration. In the 2020 election, Trump won only 8% of the Black vote, signaling that the community at large does not trust his leadership. Vice President-Elect, Kamala Harris, has cast doubt on a Trump administration vaccine, replying, “Well, I think that’s going to be an issue for all of us,” when asked if she’d get a vaccine approved under Trump’s regime. Though Pfizer was swift to deny association with the President’s Operation Warp Speed, it’s hard for some folks to look at the quickness of this vaccine and not feel a little suspicious. 

It’s not just the current administration that has Black people wary of vaccines. Distrust for the medical establishment has deep roots in the Black community, and with good reason. As Dr. Mahoney outlines, “There’s been this long legacy of Black Americans being mistreated in trials, in vaccine delivery, and in the history of medicine in general.”

The most well-known example of this mistreatment in medicine is likely the Tuskegee Syphilis Study, wherein 600 participants were infected with syphilis and refused treatment. Originally recruited by the US Public Health Service under the promise of free healthcare, the men were left to go blind or suffer other serious health issues as the researchers tracked the progression of the disease. 

This case has become synonymous with medical racism, though there are many more examples that outline the legacy of bias in healthcare. Many medical fields and instruments still in use today have origins in the days of the slave trade. Dr. Mahoney outlines one example:

Spirometry, which is a commonly used device to measure our lung function. I use it when I diagnose anybody with asthma. So the guy who developed that used differences in spirometry measurements among slaves to then come to the conclusion that forced labor was good for black people’s health.”

Similarly, modern gynecology would not exist without extensive tests done on enslaved women without anesthesia. Knowing the disregard the medical establishment has historically shown for Black life, it should be no surprise that Black folks aren’t vying to be first in line for a new vaccine. These stories of medical mistreatment aren’t little-known urban legends, they’re ugly histories repeated often among Black family members, and echoed in the bias they themselves face when seeking medical treatment today. 

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With these entrenched and merited forces behind vaccine hesitancy, how do we tackle this issue and set the community up for a solid bounce back? Dr. Mahoney has suggestions for her fellow healthcare professionals, and the Black community at large, which start with building understanding. 

She advocates for a reframing of the doctor/patient relationship, where the two are partners rather than one being a source or truth and direction for the other. Far from approaches where patients sit in silence while doctors dispense orders, this method of medicine allows the two to make health decisions together. When it comes to COVID-19, it’s then the job of healthcare professionals to outline the benefits and safety measures of a vaccine. 

“Make it a little bit more honest and transparent. Like we’re not trying to spin something, like we’re not trying to sell something. It’s just, ‘here are the facts’ and then really through a shared decision-making process the partitioner and the patient can decide if that’s the right thing for them,” Dr. Mahoney says. 

To effectively counsel patients on the COVID-19 vaccine, Dr. Mahoney says it’s vital to first build an understanding of the reasons behind the skepticism, and a knowledge of the history of racism in medicine. Validating patients’ concerns sets the stage for the presentation of facts, and increases the likelihood they’ll be received. When individuals feel they’re being given the chance to participate in a decision, rather than the decision being made for them, their trust in that decision tends to increase. 

Dr. Mahoney suggests a similar approach for Black communities at large. Rather than shaming or bullying people into taking a vaccine, communities can act as validators, recognizing people’s fears and disseminating quality information to help them come to their own decisions. The National Medical Association, a professional organization of Black physicians, is filling that role in their own work. They launched a task force this fall to help encourage Black communities to accept a vaccine. Capitalizing on the trust and respect that already exists in the community, they’re in a great position to encourage vaccine uptake. 

For individuals struggling with hoteps on Twitter, or fresh off a Thanksgiving debate with that conspiracy theorist uncle, the guidance is the same: respect the reasoning, present the facts transparently and without coercion, and avoid blame. 

Dr. Mahoney offers this guidance :“Meet each other at a place where we’re like, ‘I hear your concerns about this vaccine, and that makes a lot of sense,’ and kind of mirror back, repeat back what they said, and then really go back to helping them make an informed decision, talking about the chances of benefit and the chances of harm, and then you make a decision and you respect them instead of trying to coerce them or make them feel bad.” 

Looking for the latest tools for combatting coronavirus misinformation? Turns out, they’re mutual respect and understanding. Fear and mistrust are bound to spread in an environment with such a storied history, and so much present uncertainty. But the way to challenge this isn’t through public shaming or force. Rather, through meeting people where they are in their fear, and showing them their own power to make decisions, we can chart a path forward. 

Rachel Jones is a digital content creator and strategist. She believes firmly in the power of storytelling to build community and create change. You can read more of her work on Medium.

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