Vaccine Hesitancy in Communities of Color: How We Got Here + Q&A on the COVID-19 Vaccine
Vaccine Hesitancy is a tendency to avoid getting a vaccine, particularly when it is still new to the market. This may affect any demographic group but is amplified by issues such as systemic racism (historical and present), a consistently inequitable health care system, worries about immigration status, and the spreading of false information, all of which may increase vaccine hesitancy in communities of color.
A 2020 survey by Pew Research Center demonstrated intense sentiments of vaccine hesitancy among Black Americans, as only 42% of this demographic said they would get such a vaccine if it were available at that time, despite the fact that 71% of Black Americans had known someone who had been hospitalized or died of COVID-19 at that point. Comparatively, over 60% of White and Hispanic adults said they would immediately take the vaccine. Why the disparities in vaccine hesitancy? To answer this, let’s take a walk down a rather gruesome memory lane.
Historical Background of American Medicine
Medical Abuse During Slavery
The history of medical abuse towards Black individuals dates back to the Middle Passage. Before Africans even arrived in America, they were severely mistreated by doctors, who threw ill Africans overboard so owners could collect insurance money on their lost “property.” Doctors also forced Africans to take medication or food without explanation or warrant, under the threat of torture.
On land, overseers of large plantations made everyday health decisions for enslaved peoples, including prescription of medicine and vaccinations, further stripping Africans of agency over their own bodies, which were in the hands of unqualified, ill-intentioned White men. Some slaveholders forced enslaved people to take medicine they did not need for dehumanizing entertainment and/or cruel torture.
Outside of plantations, some colleges stole cadavers from slave cemeteries for use in scientific experiments or study, prioritizing the needs of White Americans over the dignity or humanity of Black Americans: a recurring trend in US medicine.
According to Occidental College history professor Sharla Fett, physicians and slaveholders forced Black women to have painful reproductive surgery without anesthesia or consent. Cesarean sections were also done on Black women in situations that would be considered “too risky” for White women— aka women whose lives mattered to those in power. This abuse and neglect of female bodies of color, particularly those of Black women, still persist today.
Forced Sterilization & The Eugenics Movement
The U.S. government has consistently neglected the medical needs of the BIPOC population and has gone to such lengths as forced sterilization, particularly during the Eugenics Movement from the late 19th century to the mid 20th century, to inhibit people of color from reproducing. In the early 20th century, individual states, including Puerto Rico, made laws that upheld the legality of forced sterilization: this targeted BIPOC women, “criminals,” and people of lower classes. In the 1927 case Buck vs. Bell, the Supreme Court officially legalized forced sterilization of those deemed genetically inferior, leaving this designation up to biased physicians. The sterilization of poor Black women and girls, often taking advantage of patients’ lack of education or money, became customary throughout the South; this was brought to public consciousness throughout the ’60s and ’70s by activists like Fannie Lou Hamer, who received a nonconsensual hysterectomy upon seeing the doctor to have a tumor removed from her uterus. Instead of helping her, the doctors harmed her: she spoke out against this racially motivated cruelty and fought against medical and political injustices throughout her life.
Indigenous women faced similar injustices, as “about 25%﹘50% of Native American women were believed to be sterilized up until 1976.” According to Washington Post contributor Dan Royles, “involuntary sterilizations targeting poor women and women of color continued into at least the 1970s in a number of states… and has continued up until the present day in women’s prisons,” which contain an overrepresented population of Black and Latinx women. Women held in ICE detention centers, largely Latinas, have also been forcibly sterilized as recently as last year.
State of American Medicine Today
Today, “Black patients are sicker and suffer higher mortality than their White counterparts;” this harsh truth was amplified by COVID-19. The medical system reinforces stereotypes that contribute to this harmful disparity in health, such as: Black patients typically seek painkillers, are incompetent in following doctor’s orders, or have a higher tolerance for pain. Racial inequities are particularly noticeable in maternity wards, as “Black new mothers are three times as likely to die during or after childbirth compared with White mothers.”
In addition to the harsh realities of today, one historical event in particular gives many African Americans understandable pause when deciding whether or not to receive the COVID-19 vaccine: The Tuskegee Syphilis Study. In this ~40 year experiment beginning in the 1930s, “U.S. Public Health Service employees recruited hundreds of poor, uneducated African American men with syphilis and watched them die avoidable deaths over time, even after a cure was found.” These humans were used like guinea pigs: they were not informed that the medical professionals never intended to provide them with treatment. Their suffering, their death was part of the plan.
However, Theilene Williams of Tuskegee, granddaughter of a Tuskegee subject, sees the COVID-19 vaccine as a very different situation. Regarding the Tuskegee subjects, she stated, "They didn't know what they were getting into,” whereas she had open conversations with her doctor about the vaccine. "I went on and got it — the first shot," Williams said. "We know about it. We've been hearing, talking about it. It's not like 'come on, we're going to do this' without knowing anything about it like they did.” Although her words may provide comfort to some, weariness resides in others.
In light of the disturbing history of American medicine, it comes as no surprise that many BIPOC Americans are hesitant to get their COVID-19 vaccine. In the words of medical ethicist Harriet Washington, “the same factors that create vulnerability have not changed. And until they do change, until our health care system does a better job of protecting people, we're going to keep seeing these ethnic patterns of disease that affect people of color, marginalized ethnic groups, much more heavily than whites.”
Thus, even if all Americans were convinced to get the COVID-19 vaccine, deep-rooted mistrust and systemic inequities in the American healthcare system would persist. To combat this virus with vaccinations for all, to protect the communities of color that have been disproportionately affected by COVID-19 in the long run, we must acknowledge and address the bigger picture. We must demand equity in healthcare—heck, we should be able to expect it!
With this context in mind, I invite you to look ahead to the following Q&A section, which addresses common concerns about COVID-19 vaccines among communities of color.
COVID-19 Vaccines for BIPOC Q&A:
Were the vaccines made too quickly to be safe and effective?
No, all three vaccines (Pfizer, Moderna, and Johnson & Johnson) were thoroughly tested with ample trials. Safety protocols were followed for the development and testing of all three vaccines. Vaccine safety experts from the FDA, CDC, and Mayo Clinic have evaluated data to ensure the safety and effectiveness of COVID-19 vaccines and continue to do so.
Were any doctors of color involved in the development of the vaccines?
There were doctors and volunteers of color involved in the development and testing of the vaccines. One notable African American medical professional that contributed to the development of the COVID-19 vaccines was Dr. Kizzmekia Corbett.
Who was tested in trials for COVID-19 vaccines?
People of various demographics were included in the trials, all on a voluntary and informed basis. Leaders and members from communities of color volunteered to be a part of the trials to test the vaccine; thus, we do have data on how the vaccines affected people of color, affirming the safety of the vaccines for all races and ethnicities. Below are statistics from Johns Hopkins Medicine for the percentages of different demographics involved in the vaccine trials:
Pfizer: 10% Black, 26% Latinx, 5% Asian
Moderna: 10% Black, 20% Latinx, 5% Asian
Johnson & Johnson: 13% Black/African American; 15% Hispanic/Latinx; 6% Asian and 1% Native American.
Will the vaccine alter my DNA?
COVID 19 vaccines do not alter DNA in any way: DNA is located in the nucleus of our cells, and the vaccines do not affect the nuclei.
Pfizer, Moderna, and Johnson & Johnson are all mRNA (which stands for messenger RNA) vaccines: as the name implies, this type of vaccine works as a messenger. According to the CDC, “mRNA vaccines work by instructing cells in the body how to make a protein that triggers an immune response.” In other words, the material in the vaccine sends instructions to your body on how to fight COVID-19, so that if the virus later enters your system, your body will be ready and prepared to fight it. “Injecting mRNA into your body will not interact or do anything to the DNA of your cells. Human cells break down and get rid of the mRNA soon after they have finished using the instructions.” So, once your body finishes the “dress rehearsal” for combatting COVID-19, it destroys the material from the vaccine; in other words, the mRNA won’t stay in your system for long!
Will the vaccine sterilize me? Can it cause a miscarriage or abortion?
According to the Mayo Clinic, “COVID-19 infection has not been linked to infertility,” and no other virus or vaccination similar to the COVID-19 vaccines has caused infertility. “While data clearly indicate pregnant women are at higher risk of hospitalization due to COVID-19 infection, there is no evidence of increased miscarriage rates.”
Also, our immune systems release the same antibodies that combat illness when we get COVID-19 as those released upon vaccination. “Thus, if COVID-19 [or COVID-19 vaccines] affected fertility, there already would be an increase in miscarriage rates in women infected with COVID-19. This has not happened.”
Can your immigration status prevent you from receiving the vaccine?
No. “Information about vaccine recipients [will] not be used for any civil or criminal prosecution or immigration enforcement.” Furthermore, neither the HHS (U.S. Department of Health and Human Services) nor the CDC (Centers for Disease Control and Prevention) will gain access to your patient information or be able to share it. Also, “The U.S. Department of Homeland Security has stated that it will not conduct immigration enforcement at vaccintion sites and that it wants all immigrants, including people who are undocumented, to be vaccinated.”
If you are uninsured, you may be asked for your social security number or an ID, but these will not be required to receive a vaccine. Additionally, depending on the state or locality you live in, you may need to provide proof of residency to receive a vaccine, but you do not have to be a citizen or documented immigrant to be vaccinated.
How much does the COVID-19 vaccine cost?
There is no charge for receiving any of the COVID-19 vaccines. “The US government is providing the COVID-19 vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status. As a vaccine recipient, you cannot be charged for the COVID-19 vaccine.”
Will I receive insurance to cover any lingering effects of the vaccine?
Side effects from the vaccines are short-term symptoms, lasting just a few days at most. They are non-life-threatening, normal, and to be expected. Different individuals experience different side effects to varying degrees. These reactions “are indicators that your immune system is responding to the vaccine and are common when receiving vaccines.” In other words, even though the side effects may be unpleasant, they mean the vaccine is working! There is no data supporting long-term effects from COVID-19 vaccines.
However, Rueben Warren, director of the National Center for Bioethics in Research and Health Care at Tuskegee University, suggests that providing health coverage to uninsured individuals who receive the vaccine may help give weary Americans of color more peace of mind, confidence in the vaccine, and trust in the medical system. While there has not been a widespread effort to heed Warren’s advice, those who seek compensation for any vaccine-related injury may do so through the NVICP (National Vaccine Injury Compensation Program) or the CICP (Countermeasures Injury Compensation Program).
Can I get the COVID-19 virus from the vaccine?
The vaccines “cannot give someone COVID-19. mRNA vaccines do not use the live virus that causes COVID-19.” See “Will the vaccine alter my DNA?” above for a more detailed description of how the vaccine works.
“COVID-19 Vaccines and People of Color.” Johns Hopkins Medicine, 16 Apr. 2021, www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-vaccines-and-people-of-color.
Royles, Dan. “Years of Medical Abuse Make Black Americans Less Likely to Trust the Coronavirus Vaccine.” The Washington Post, WP Company, 15 Dec. 2020, www.washingtonpost.com/outlook/2020/12/15/years-medical-abuse-make-black-americans-less-likely-trust-covid-vaccine/
Anderson, Javonte. “America Has a History of Medically Abusing Black People. No Wonder Many Are Wary of COVID-19 Vaccines.” USA Today, Gannett Satellite Information Network, 3 Mar. 2021, www.usatoday.com/story/news/2021/02/16/black-history-covid-vaccine-fears-medical-experiments/4358844001/
Valerio, Fatima. “Forced Sterilization in the US.” Nuestra Verdad, 7 Oct. 2020, www.nuestraverdad.com/post/forced-sterilization-in-the-us.
Elliott, Debbie. “In Tuskegee, Painful History Shadows Efforts To Vaccinate African Americans.” NPR, 16 Feb. 2021, www.npr.org/2021/02/16/967011614/in-tuskegee-painful-history-shadows-efforts-to-vaccinate-african-americans.
Martin, Michel. “Race And The Roots Of Vaccine Skepticism.” NPR, 20 Dec. 2020, www.npr.org/2020/12/20/948614857/race-and-the-roots-of-vaccine-skepticism.
“COVID-19 Vaccine Myths Debunked.” Mayo Clinic Health System, 8 Dec. 2020, www.mayoclinichealthsystem.org/hometown-health/featured-topic/covid-19-vaccine-myths-debunked.
D’Avanzo, Ben, et al. “Answers to Common Questions about Immigrants' Access to the COVID-19 Vaccines.” National Immigration Law Center, 12 Apr. 2021, www.nilc.org/2021/04/12/immigrant-access-to-the-covid-19-vaccines/.
“COVID-19 FAQs for the Community.” Vanderbilt Institute for Clinical and Translational Research, 26 Aug. 2020, victr.vumc.org/community-faq/.
“Understanding MRNA COVID-19 Vaccines.” Centers for Disease Control and Prevention, 4 Mar. 2021, www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html.
Pace, Nicholas M., et al. “The Compensation System for Potential Side Effects Is an Important Part of a COVID-19 Vaccine Campaign.” RAND Corporation, 18 Dec. 2020, www.rand.org/blog/2020/12/the-compensation-system-for-potential-side-effects.html.
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