Vaccine Distribution Requires That Medical Establishment Reckon With Institutional Racism

January 4, 2021January 4, 2021 Editor 2143 Views

By: Trina Shanks, Phd, LMSW; Marquan Jackson, MSW; Alize Asberry Payne; and Patrick Meehan, PhD, MSW

As the rollout of COVID-19 vaccines begins, it may appear that the end of the pandemic is in sight. However, vaccines alone do not save lives, vaccinations do. That is, individuals must choose to take the COVID-19 vaccine to benefit from it. In research we conducted over the summer, an alarming percentage of Black Americans indicated they would choose not take an eventual COVID-19 vaccine. Even though the pandemic was more likely to have personally affected them, Black Americans expressed deep skepticism that a COVID-19 vaccine would be safe and effective. Given the difficult history Black Americans have had with medicine, getting a significant percentage of them to take the vaccine will require a campaign of trust-building similar to the model Michigan adopted to build testing capacity.

From June 12 to August 21 of this year, our team at the Center for Equitable Family and Community Well-Being, Eastern Michigan University’s Family Empowerment Program, and the Washtenaw County Racial Equity Office surveyed 607 Ypsilanti, Michigan, residents on a series of questions regarding the impact of COVID-19. Our sample was 33% Black, 52% white, and 11% Latinx, and our findings revealed stark racial differences in acceptance of and willingness to take an eventual vaccine.

Only 38 percent of Black respondents indicated they would take an eventual COVID-19 vaccine. This was an alarmingly low percentage, particularly because 35 percent of Black respondents reported that a friend or family member had died of COVID-19. The proximity to COVID-related death among our Black respondents was similar to results published in June in The Washington Post.

Moreover, the unwillingness to take the COVID-19 vaccine can be explained in part by the skepticism Black respondents expressed regarding its safety.

Only 23 percent of Black respondents felt the eventual COVID-19 vaccine would be safe and effective, compared to 52 percent of White and 66 percent of Latinx respondents.

Vaccine skepticism represents a considerable concern: many Americans are likely to treat this medical breakthrough with apprehension, and even outright distrust, which may result in a considerable prolonging of the pandemic. However, Black skepticism is rooted in a troubling history with modern medicine that continues into the present day. Maternal and infant mortality for Black Americans, for example, is the highest in the developed world, according to the World Health Organization. Doctors routinely ignore pain within Black patients, or assume they have a higher pain tolerance than they do. This on top of a history of being experimented on without consent, and Black skepticism of a COVID-19 vaccine comes into focus.

The skepticism we observed in our Black respondents was robust across all levels of education.

That 44 percent of Black respondents with a Bachelor’s degree or higher were unwilling to take the vaccine suggests a shared history with medicine that will challenge public health campaigns to persuade individuals to take the vaccine.

Indeed, identifying messengers with the credibility to persuade Black Americans to take the vaccine may be difficult. We found few things related directly with Black respondents’ willingness to take the vaccine.

For example, elected officials can make all the speeches they want about the importance of taking the vaccine, but Black respondents’ willingness to do so in our sample was unrelated to elected officials’ responsiveness to COVID-19. Certain institutions actively dissuaded respondents on the vaccine. Specifically, the more antipathy Black respondents felt toward law enforcement the less likely they were to take the vaccine.

Here law enforcement may have been acting as a stand in for the medical establishment–which we did not ask about directly. That is, one institution Black respondents were disposed to think ill of may have a similar relationship to vaccines as the medical establishment. If this is the case, then the word of figures like Dr. Anthony Fauci will have little weight among Black Americans.

One promising example of an institutional commitment to addressing the concerns of Black residents is the Michigan Coronavirus Task Force on Racial Disparities. By building more than 20 free, no-cost testing centers in underserved neighborhoods in Michigan, the task force was able to test more than 24,000 residents and reduce new infections and deaths among Michigan’s Black residents, even amidst the recent nationwide surge.

The success of Michigan’s coronavirus task force would not have been possible without the involvement of trusted partners in the community. Leaning on community experts could help community health workers effectively communicate vaccine information to individual households.

Moreover, Michigan’s coronavirus task force built trust by following through on commitments. Similar consistency in message and mission matters greatly to the success of the COVID-19 vaccine. That means leaders acting first to take the vaccine, modeling its safety for everyone else. To allay fears and misinformation around side effects, it will also be important to transparently update symptoms in real time, as the vaccine is rolled out to more and more people.

The development and deployment of a safe and effective coronavirus vaccine represents a historic achievement. However, the consequences of failing to use the time available now to repair historical and contemporary injustices against the Black community could result in more preventable deaths, and may prolong the pandemic among the most vulnerable.

Trina Shanks is the Harold R. Johnson Collegiate Professor of Social Work at the University of Michigan, and the Director of the Center for Equitable Family and Community Well-Being