Behind Vaccine Hesitancy: A History of Medical Abuse and Systemic Racism

It has been over a year and half since the eruption of the COVID-19 pandemic. Since then, vaccines have been made widely available in the Global North, and we triumph over news of successful vaccine trials and rollouts for privileged populations in developed countries. But, the fact remains: not everyone is willing to put trust in these shots. 

Pro-vaccination slogans and sentiments continue to contrast with fervent accusations of “fear-mongering” from anti-vaccine protestors and high vaccine hesitancy rates. However, it is crucial to acknowledge that the issue of vaccine hesitancy cannot simply be attributed to misinformation campaigns or stubborn anti-vaxxers. From our positions of privilege, a lot of us might have overlooked the unrelenting grip that institutional racism has had on Black communities throughout history, and the culture of mistrust in and antipathy to the healthcare system that this has created.

A December 2020 US telephone poll found that 35% of Black adults said they would definitely not get vaccinated, and about half of those respondents cited mistrust of vaccines and worries about getting COVID-19 from the vaccine as the main reasons. 

The phenomenon of Black vaccine hesitancy is sadly corroborated by the hard data of demographic characteristics of the vaccinated US population. In a 2021 study conducted by America’s Centers for Disease Control and Prevention (CDC), the number of fully vaccinated Black people is significantly lower than expected, based on the number of people in the Black demographic group in the US population, compared to the White demographic.

Britain has also not eluded this problem. The Office for National Statistics revealed that Black or Black British adults have the highest rates of vaccine hesitancy (21%) compared with White adults (4%) across England, Scotland and Wales.

The Black community’s distrust of the healthcare system is not exclusive to the COVID-19 situation either. A 2017 US study found that high-risk Black adults are less likely than high-risk White adults to get vaccinated for seasonal influenza, which contributes to greater influenza-related morbidity and mortality. All African Americans, except those who always receive vaccinations, in the study have lower access to medical care, less knowledge of vaccine recommendations and less positive flu vaccine attitudes than their White counterparts. Most White adults demonstrate lower perceived risk of side effects, less hesitancy towards the flu vaccine and higher perceived descriptive norm of their own race than African Americans.

All this scepticism of the healthcare system and the authorities point to a protracted legacy of questionable drug development practices and medical abuse against Black communities, deeply steeped in systemic racism. In 1932, through the United States Public Health Service (USPHS), the US government famously sponsored a biomedical experiment coercing 600 Black men into a study on the effects of untreated syphilis in what is known as the ‘Tuskegee study’. The male subjects were not informed they were part of the research as participants, and were instead made to believe they were being examined for “bad blood”. By 1943, penicillin was the popular, widely available treatment of choice for syphilis. However, none of the participants was actually offered the drug, since the study is designed to withhold medical treatment. Many died. The survivors spread the disease to family members, partners and their children. It was only four decades later, in 1972, that an Associated Press story pressured authorities to investigate the study, which was then deemed “ethically unjustified” and consequently stopped. The first and only formal Presidential Apology came from President Bill Clinton, 65 years later, in 1997.

Omar Neal, the nephew of Freddie Lee Tyson, who was one of the unfortunate subjects of the study, expressed: “There was shame. And there was disbelief. Disbelief that the government would do that. How could you? How dare you use my humanity for such an egregious activity.” 

Neal has also more recently lambasted the US government for cutting public health funding and pared down infrastructure across the Black Belt, the region historically known for its slavery and planation system pre-existing the Civil War, and its predominantly Black population in the American South. Lowndes County in Georgia, USA is the prime example. 75% of its 10000 residents are Black, and one in every three Black residents live below the poverty line. But it only has one physician and no hospital. George Thomas, their one doctor, revealed that up to 40% of his patients receive no health insurance.

Scandalous historical cases and institutional racist neglect are only the tip of the iceberg. The abuse, maltreatment and implicit healthcare bias trickle down to the everyday lives of countless Black people. Take 36-year-old Kayla Williams, a Black mother of three young children, who died of suspected coronavirus last March in London. Her husband said the hospital would not treat her since she “was not a priority”. Black patients could receive less pain relief than White patients, simply because of the illogical false belief about Black people’s perception of pain being much different from people of other races. Only 35% of minority ethnic patients received the appropriate prescriptions compared with half of the White patients, a study of racial bias in pain assessment and treatment recommendations showed.

It cannot be denied that getting vaccinated and combating against the anti-vax conspiracy remain important items on our agenda. But calling on BIPOC and the Black community to get their jabs no matter what or blaming them for “irresponsibly causing harm to society” with no regard for their worries, comes from a place of ignorance and casual racism, rather than a vaccine-positive “woke-ism”. Black people are not ignorant or insolent for opting out of vaccinations; they understand the science behind the shots, but the fear of systemic, decades-long abuse and the instinctual response of self protection often overpower their government’s vaccine slogans. To reduce vaccine hesitancy into a simple black-and-white issue of educated vaccine positivity vs misinformed conspiracy madness is to brush over the legitimate, rational concerns of racist discrimination and maltreatment by the healthcare system and authorities.

African Americans are twice as likely to die from the virus compared to their White counterparts. It has been argued that the disproportionately high COVID-19 mortality rates of Black Americans could be attributed to pre-existing health conditions like diabetes, heart disease, kidney disease, obesity, asthma and cancer. To a certain extent, all of these things can be traced back to discriminatory neglect and/or abuse from medical staff, which is further intensified by housing, environmental and healthcare inequities and deprivation.

The stark contrast in Covid-19 mortality rates and attitudes towards vaccination between racial groups should be enough to convince the international community to address the racial disparity and bias in treatment of ethnic minorities, especially Black patients, through genuine action. That means speaking candidly about the decades of abuse BIPOC communities have been suffering from, ensuring adequate representation of BIPOC in clinical vaccine trials and senior medical research positions, and increasing funding into public healthcare and infrastructure in Black-populated regions.

Lest we forget that the responsibility of safeguarding public health and ensuring the wellbeing of the People should fall on the state governments and intergovernmental institutions, not the victims, who have been used, abused and failed by the system for generations. It is high time for the world to focus their energy on addressing misinformation campaigns and anti-scientific attitudes in anti-vax crowds, rather than to condemn marginalized communities for being doubtful of the authorities.

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