At a time when a global pandemic is affecting and killing Black and brown Americans at a significantly higher rate than white Americans, reluctance to get inoculated can have especially dangerous consequences. Taking time to build trust in communities that are hesitant to get vaccinated is crucial—and when people are desperate to return to some semblance of normalcy, time is something there isn’t much of.
According to a December survey by The Associated Press-NORC Center for Public Affairs Research, 40% of Black Americans say they will not get the COVID-19 vaccine. Because of this apprehension, vaccine trials struggled to recruit Black participants.
Institutionalized racism, dangerous and dehumanizing health policies, and clinical experiments that harmed the Black community have fanned the distrust of the healthcare system, but some in the Black community have taken it upon themselves to change the narrative and ease fears.
Origins of the fears
An alarming number of Black Americans may be skeptical of the COVID-19 vaccine, but they shouldn’t be lumped in with broader anti-vaxxer groups that believe getting vaccinated can cause health defects, autism, or learning disabilities. The hesitancy of Black communities isn’t based on anti-science sentiment or ignorance, but rather a broader distrust of the government and the healthcare system rooted in historic and current-day racism. Though there isn’t one singular cause for this, much of it stems from years of harmful health policies, forced sterilizations of low-income people and people of color, mismanagement of coronavirus relief efforts, longtime disparities in health outcomes for Black and brown Americans, and misinformation circulating within the community.
“I find it very troubling that a lot of African Americans are hesitant to get the vaccine,” said Dr. Thomas LaVeist, dean of Tulane University School of Public Health and the co-chair of the COVID-19 Health Equity Task Force for Louisiana. “There’s no way mathematically that we will get to herd immunity in the country if we have such a large percentage of the Black community not taking the vaccine. Black communities will also be more vulnerable because they won’t get to herd immunity at the local level.”
Dahleen Glanton, a columnist who covers race and civil rights issues for the Chicago Tribune, wrote an op-ed in December explaining the reasons Black Americans are hesitant of vaccines and described the atrocities Black Americans have faced by the U.S. government that has brought them to this point. Glanton pointed to the 1932 Tuskegee Syphilis Trials—which used unsuspecting Black men with syphilis as guinea pigs and left them suffering and untreated—as a prime example of why many Black Americans have remained wary. Glanton says the Tuskegee Syphilis Trials have “long haunted African Americans. Now it has circled back to haunt America.”
“The reasoning is simple: ‘The government wants to experiment on Black people to see what could happen to white people. They don’t care if we get sick from it. They don’t care if we die,’” Glanton wrote.
In a follow-up column, Glanton argued that despite these valid fears, Black Americans must still get vaccinated. “We don’t all have to be the first in line, but we should make sure that we are the second or at least the third,” she wrote.
Dr. Georges Benjamin, executive director for the American Public Health Association, believes the Tuskegee Syphilis Trials aren’t equivalent to what’s happening now and shouldn’t be a deterrent for getting inoculated. “Tuskegee was terrible, but the misunderstanding about Tuskegee for a lot of people is they actually think that it was about giving people syphilis, but it was actually about denying people care,” said Benjamin in an interview with Prism. “Now, if you don’t take the vaccine, you’re denying yourself care.”
It isn’t just past mistreatment that has led to vaccine hesitancy by communities of color; the mishandling of the crisis by the Trump administration and ongoing inequities during the coronavirus response have exacerbated already-existing fears. Many testing sites during the pandemic were placed in white neighborhoods, making access for people of color more challenging.
“There were structural systems that, in my view, were not fixed early enough in the response even though we knew those were going to be issues,” said Benjamin. “We knew people of color who had chronic conditions would be disproportionately impacted and die sooner if they got COVID. We knew this. It wasn’t a secret. The fact that some of the first testing sites that were put in place weren’t in the hood—it’s problematic today.”
Some doctors have suggested that the Trump administration titling their coronavirus task force “Operation Warp Speed” may have played a role in vaccine hesitancy since it emphasized speed over effectiveness and care. The fact that the coronavirus vaccine was created and ready for distribution in only 10 months has also been a cause for concern by many people.
“When we needed tests, they weren’t available in our communities, but now there’s a lot of talk about pushing African Americans to the front of the line to get the vaccine because of the disproportionate impact of the disease,” LaVeist said. “The narrative is that when we needed testing, you didn’t bring testing to our communities and now you have this hastily prepared vaccine and you want to put us in the front of the line. I know that’s not what’s happening, but that’s the narrative that comes out of this.”
Being more transparent about how the vaccine was able to come together so quickly could have helped change this narrative, LaVeist said. Though experts carefully followed normal procedures to produce the vaccine, LaVeist feels the Trump administration was secretive about how they were able to get and distribute it so quickly.
“Once you explain it, people understand, but the fact that they really didn’t focus on educating the public on how they were creating this vaccine so fast, I think that leads to additional distrust,” LaVeist said.
Getting the word out
This week, LaVeist and Benjamin authored an op-ed for The New York Times urging people of color to get vaccinated. They called the misinformation around the vaccine “an assault on our people, and it threatens to destroy us.”
“Many of us fought our way into health professions specifically to care for the health of our community. We have devoted our careers to ensuring that everyone—regardless of race—receives the care required for optimal health,” they wrote. “This is why we support the COVID-19 vaccines.”
The Biden Administration is making efforts to quell vaccine hesitancy and address the racial disparities during the pandemic, but much of the work to combat vaccine misinformation is being done at the state and local levels. As the co-chair of the Louisiana governor’s task force, LaVeist and his team are currently working on a communications strategy directly targeted to the Black community. The National Governors Association has put together a network of COVID-19 health equity task forces, so LaVeist says they’ve been meeting to share best practices and information. LaVeist is also heading an initiative titled “The Skin You’re In,” which uses social media and grassroots-level marketing tactics to conduct outreach to communities of color and provide accurate information about COVID-19 and the vaccine.
The National Medical Association, a professional society of African American doctors, has also formed a group specifically aimed at reversing vaccine fears for the Black community and strategizing ways to personalize outreach through social media and community forums.
Dr. Lisa A. Cooper, Bloomberg distinguished professor and director of the Johns Hopkins Urban Health Institute and the Johns Hopkins Center for Health Equity, has been one of the healthcare leaders on the frontlines helping to combat the spread of misinformation and address vaccine fears. Cooper is the co-chair of the steering committee called the Community Engagement Alliance Against COVID-19 Disparities, which is funded by the National Institutes of Health, and says the teams have been doing door-to-door community outreach to provide people with accurate information, provide educational fact sheets, and participate in panel discussions organized by community leaders. Her team at the John Hopkins Urban Health Institute and the John Hopkins Center for Health Equity also hosted a forum with people who participated in the vaccine trials, one of the scientists who developed the vaccine, and Black and Latinx community leaders who answered questions about the vaccine and its effectiveness.
“It might also help for communities of color to see scientists and doctors who look like them on TV and on social media, and hear them on the radio, talking about how the vaccines were developed, who was included in the studies, how the studies were done to assure safety and effectiveness of the vaccines, and about their own personal experiences getting the vaccines themselves,” said Cooper in a statement to Prism. Cooper has also been working with her team to try to see if workers providing food for community organizations can also deliver vaccine information. The goal, she said, is to reach those who have limited internet access, don’t leave their homes much, or live in rural areas.
Using “trusted voices” in the Black community
Some communities have taken smaller approaches to reaching out to the Black community about the COVID-19 vaccine. In January, the Dallas City Council hosted a focus group webinar with a nurse who had already been vaccinated. The webinar was specifically aimed to build trust within Black community and ease concerns about the vaccine.
“The hesitancy of many in the Black community prompted the focus group discussion on the vaccine and the Black community,” said Dallas City Councilman Casey Thomas in a statement to Prism. “I think it was effective, however, the effectiveness of the vaccine will be determined over time. There were seven participants, and the biggest takeaway was a discussion of methods to utilize community and neighborhood trusted locations to get the vaccine out in the community.”
Thomas has said January’s webinar will be the first of many.
“We all have to take responsibility for building trust in the Black community,” said Thomas. “To build trust, it will take trusted voices in the Black community to not only talk about how safe the vaccine is, but to actually take the vaccine themselves. It is important to lead by example.”
LaVeist echoed Thomas’ statement, saying that before people of color can become comfortable with the idea of getting vaccinated, “influencers” with credibility in each community—such as pastors, celebrities, athletes, doctors, teachers, or trusted people with a large reach—must first come forward and use their platform to tell people that the vaccine is safe.
Benjamin believes targeted information to communities of color can help combat misinformation, but stressed that people with these platforms must also have correct information that can be verified by multiple sources.
“African American media and Hispanic media have got to get out there and through their sources bring trusted messengers,” Benjamin said. “Then, we need to see respected leaders in the community getting vaccinated because we’ve had some negative influences out there in this area early on. But to the extent we can get other trusted messengers out there is really helpful.”
For those concerned about having an allergic reaction to the vaccine, Vickie Mays, director of the University of California at Los Angeles’ center studying minority health disparities, has proposed putting systems in place to specifically study the reactions of Black Americans to the COVID-19 vaccine and publish those reports widely. Some people are taking a wait-and-see approach before getting vaccinated, but doctors are strongly advising against waiting too long.
“A lot of people just didn’t want to be first in line, but I do believe they’ll come on board later,” Benjamin said. “Having said that, we have to make sure that we strengthen the communications to communities of color, do a better job educating them about what the vaccine is and what it isn’t, and deal with many of the misconceptions and pieces of misinformation that are out there about the vaccine. We also have to emphasize that it’s safer than the disease, because that’s the comparison.” Even if the efforts to get more people of color vaccinated are successful, none of that will matter if they don’t have proper access to the vaccine. Since many parts of the country still have “pharmacy deserts,” LaVeist said it’s important for communities to take a proactive approach to anticipate where those inequalities will be, and plan accordingly.