Health and Healthcare Systems

How a history of ‘medical racism’ may fuel mistrust in COVID-19 vaccines

Eunice Rivers and two colleagues visit a patient during the Tuskegee Syphilis Study in Macon County, Alabama. Image courtesy of the CDC.

Eunice Rivers and two colleagues visit a patient during the Tuskegee Syphilis Study. Image courtesy of the CDC.

John Letzing
Digital Editor, World Economic Forum
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  • A history of neglect and deception has been cited for the skepticism many Black Americans feel about COVID-19 vaccines.
  • A similar dynamic has affected ethnic groups in other countries.
  • That may pose a challenge to health officials trying to save lives and vaccinate sufficient portions of the population.

A Black cast member of the American comedy mainstay “Saturday Night Live” recently quipped that while he’s skeptical about taking a COVID-19 vaccine, “on the other hand I’m on a white TV show so I might actually get the real one.”

The joke trenchantly summarized the fear and mistrust many members of marginalized groups feel when it comes to vaccination, and to healthcare more generally – feelings that are built on a very real historical foundation.

Now, as the UK administers its first COVID-19 vaccine doses and other countries gear up for distribution, this hesitancy shaped by neglect may present a challenge to public health officials trying to save lives and achieve herd immunity.

Recent survey results in the US showed that just 42% of Black respondents would want to take a COVID-19 vaccine if it was available, compared with 61% of white respondents. The same survey results showed that Black respondents were far more likely to say they know someone who has been hospitalized or died from having the coronavirus (71%) than white respondents (49%).

One often-cited reason for the poisoned relationship between Black Americans and the medical establishment was known officially as the “Tuskegee Study of Untreated Syphilis in the Negro Male.” For four decades beginning in 1932, hundreds of participating Black men were told by the federal government they were being treated for “bad blood,” when in fact they were being ravaged by untreated syphilis – and providing researchers with insights into what the disease does to a human body unchecked. Survivors of the Tuskegee study later sued and received a settlement.

This pattern of medical racism has been threaded throughout US history – from a government study that exposed mostly Black and completely unaware cancer patients to extreme levels radiation during the Cold War, to the “father of modern gynecology” who conducted his research on enslaved Black women without anesthesia in the 19th century.

Image: World Economic Forum

A similar record of neglect has been established in other countries, and may have a comparable effect on efforts to administer vaccinations. In the UK, where (as in the US) Black people have been disproportionately impacted by COVID-19, evidence suggests that varying levels of vaccine skepticism may also follow a racial outline.

According to survey results published last month, just 39% of Black and Minority Ethnic Londoners said they were likely to take a COVID-19 vaccine, compared with 70% of white Londoners. A professor at the university behind the survey called the result unsurprising: “Would you trust a government that accepts you’re more likely to die of COVID-19 than your white neighbours and does nothing very much about it?”

In Australia, uptake for influenza vaccines has been relatively low among the country’s First Peoples. One study published earlier this year suggested that “a lack of cultural safety” may be a related barrier, given that First Peoples feel discriminated against in healthcare settings – and noted that COVID-19 made the need for higher vaccine coverage more urgent.

Examples of heightened sensitivity tied to race, ethnicity and vaccination have surfaced around the world – from the French doctor who apologized after being criticized for his suggestion that a repurposed tuberculosis vaccine be tested on Africans for use against COVID-19, to a protest in South Africa against using the continent as a “dumping ground” for vaccine testing.

Image: World Economic Forum

There’s a fear that cynical anti-vaxxer movements will further exploit race-specific sensitivities for their own purposes – a phenomenon that predates COVID-19.

For more context, here are links to further reading from the World Economic Forum’s Strategic Intelligence platform:

  • Several science communication initiatives have focused on COVID-19 misinformation, but according to this analysis health professionals must begin 2021 by acknowledging, appreciating, and discussing mistrust. (NiemanLab)
  • Skepticism could be countered by making COVID-19 vaccines mandatory. One expert in this piece argues that it’s inconsistent to accept mandatory lockdown but reject mandatory vaccination; the other says counterproductive government mandates would be weaponized by anti-vaxxers. (The Conversation)
  • We’ve known that COVID-19 has been disproportionately fatal for Black Americans, and now researchers from the Princeton School of Public and International Affairs have found that low-income Black households also experienced greater uncertainty about accessing food and medical resources. (Big Think)
  • Another illustration of how inadequate services put Black Americans at greater risk – this recent study found that once hospitalized, Black patients with COVID-19 have a lower risk of death than white patients. (Science Daily)
  • The skepticism of many Black people in the UK and the US towards taking a new COVID-19 vaccine isn’t just an “anti-vaxxer” response not only for historical reasons, according to this analysis, but also because Black people continue be the victims of poor and neglectful treatment. (The Conversation)
  • Just about every minority group in the US can point to what feels like a reasonable basis for suspicion of vaccines, according to this analysis. Latinos, for example, can point to a syphilis study perhaps even more unethical than the Tuskegee experiment. (Wired)
  • Recently-published data underline the disproportionate effects COVID-19 has had on people of colour in the US, and this piece includes two charts that help illustrate that outsized impact. (Mother Jones)

On the Strategic Intelligence platform, you can find feeds of expert analysis related to COVID-19, Systemic Racism and hundreds of additional topics. You’ll need to register to view.

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