Medical Racism and Black Distrust of the COVID-19 Vaccines: Not Just Tuskegee
We are over a year into the COVID-19 pandemic. Twelve months of bumbling and anemic federal responses regarding personal protective equipment (PPE) and grossly inadequate testing and contact tracing initiatives. Almost 30 million confirmed cases in the United States. Over 500,000 dead. For months, we have been hearing reports of the racial inequities in the number of diagnoses, severity of illness, hospitalizations, and deaths within Black communities.
So, what’s the good news?
Right now, we have three effective vaccines that have received emergency approval from the Food and Drug Administration (FDA), which may help us get out of this national infectious disease and public health quicksand in which we find ourselves mired. Yet the same federal response that was ready to fight the SARS-CoV-2 virus with an impotent concoction of hydroxychloroquine, bleach, and ultraviolet light never developed an adequate pipeline for delivering these vaccines. We now find ourselves trying to play catch up and implement distribution plans that should have been solidified months ago. All while witnessing equally devastating racial inequities in vaccine rollout and administration.
While we could be discussing how to dismantle the underpinnings of these inequities, we are instead stuck in a feedback loop of discussing “vaccine hesitancy” within Black communities. You’ve seen the think pieces and op-eds, as abundant in media outlets as weeds sprouting in unfertilized grass. They act like Black people are the only ones expressing reservations about taking the COVID-19 vaccine. They call it “mistrust.” They highlight Black people’s skepticism to these rapidly produced vaccines, often ignoring the political context which birthed them. Most mention the word “Tuskegee” several times per article, then lament over the awful history of medical racism in this country that we should all strive to get past. Many end on a hopeful note, applauding the inspirational mobilization of Black medical professionals and church folk for stepping up and educating our poor, misinformed communities who are merely disillusioned by post-Tuskegee trauma disorder (PTTD). Sound familiar?
I’m not sure when the “problem” with COVID-19 vaccine access and acceptance shifted from the foundational trunk of medical racism to the distrust that stems from it like strange fruit from poplar trees. Somehow, we lost our way in this conversation, resulting in a curious tone of rhetoric that pathologizes Black communities for daring to be so ungrateful as to distrust medicine and vaccines. But it’s not too late to get it right, as the esteemed Dr. Anthony Fauci often says.
As a start, we should retire the phrase “vaccine hesitancy” and replace it with “vaccine discernment,” which reflects a more deliberate acuteness in judgment and understanding. After all the lies about this pandemic that oozed from the White House’s porous walls in 2020, is anyone truly surprised that Black communities may not trust a vaccine process that emerged from this context? From a previous administration that also called the virus a hoax, said it would go away with warm weather, and discouraged the use of masks? Not trusting products peddled by a racist used car salesman appears to me as rational logic, not a fantastical delusion or conspiracy theory.
Legitimate questions about traditional and current racially discriminatory medical processes do not constitute “mistrust.” The prefix “mis” suggests that this lack of trust is somehow mistaken or incorrect. A more accurate descriptor is “distrust,” reflecting a sensible and expected reaction to the history and present of medical racism enacted against Black people in the United States. And this distrust does not always originate from thoughts about Tuskegee, contrary to popular belief. In fact, referring to it as “The Tuskegee Syphilis Study” should be considered by all of us to be a misnomer. The study was conducted by researchers from the United States Public Health Service in conjunction with the Tuskegee Institute, founded by Booker T. Washington as the first institute of higher learning for Black Americans. If any establishment should have the dishonor of having their name associated with that heinous experiment, it should be the United States Public Health Service, not the town and educational institution exploited by their research.
Medical racism is not some remote historical past only represented by Tuskegee, or an isolated event we should only remember so we can collectively remind ourselves of the need to move forward. It is a centuries-old legacy of scientific atrocities that has mutated into a far more insidious monster with which we must currently contend. It has evolved from overt horrific experiments on heatstroke and gynecological procedures among slaves to today’s more subtle (yet equally fatal) anti-Black apathy towards practicing accepted guidelines of care when it comes to cardiovascular procedures, pain management, and HIV prevention for Black patients. The current distrust of United States medical systems among Black communities may have its roots in the past, but this essence is nurtured and reinforced daily by present day practice.
We should celebrate that many Black medical professionals are stepping up to provide both vaccine education and lead grassroots distribution campaigns for Black communities in our cities and towns who would otherwise not be reached. The real work addressing racism and anti-Blackness in medical settings, however, has to be done by the white and non-Black medical staff who perpetuate it every day. It will take more than kneeling in a power fist stance while in a white coat or creating a diversity, equity, and inclusion (DEI) department in a health professional school. It starts with changing the question from “Why won’t Black people trust us?” to “What can we do to earn the trust of Black communities?” It involves listening first and talking later. It requires treating every patient equally. It means understanding that, for some Black people, a “wait and see” approach to getting the COVID-19 vaccination may not be such an unreasonable option after all.
If we are going to really talk about Black communities and our discerning approach towards the COVID-19 vaccines, let’s start by addressing what’s keeping us stuck here in the first place. Spoiler alert — it’s not just Tuskegee.