Nursing & Healthcare News

Race, Mistrust and Pandemics

Survey finds Black Americans wary of potential COVID-19 vaccine

Black woman wearing a mask and looking to the right of the camera. The background is blurry and the whole photo is in black and white

One of the big questions about any COVID-19 vaccine is whether people will take it. A new survey from the Kaiser Family Foundation (KFF) and ESPN’s The Undefeated found that only 50 percent of Black adults would get a COVID-19 vaccine, even if it were available for free.

Haunted by the Past

The hesitancy Black respondents expressed isn’t the usual antivaxx rhetoric. While many white respondents who said they wouldn’t get a COVID-19 vaccine underestimate the risks of the disease, most Black respondents are painfully aware of the danger the pandemic presents. Black adults are twice as likely as their white peers to know someone who has died of COVID-19.

However, more than 60 percent of Black respondents are skeptical that a newly introduced vaccine would really be safe. “I don’t trust the medical community because of mistakes in the past,” said one older Black man.

Persistent Bias

Skepticism about a COVID-19 vaccine is only one facet of Black Americans’ mistrust of the healthcare system, which stems from persistent bias, discrimination and a lack of providers who understand Black patients’ perspective. Seventy percent of Black respondents say racial discrimination is common in healthcare settings, particularly for Black women with children.

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The KFF survey is far from the only evidence of such inequities. In a January post on the Health Affairs blog, Shantanu Agrawal, M.D., M.Phil, and Adaeze Enekwechi, Ph.D., cite some recent research findings, noting that “maltreatment can be routine, almost ubiquitous” for Black and Latino patients.

A Legacy of Mistrust

Some Black respondents to the KFF survey also expressed fears that their communities might be used as unwitting guinea pigs for an inadequately tested vaccine. One younger Black woman worries that “they would be putting the virus in me instead of protecting me from it,” and says she “would need more proof that it’s safe before I would allow myself or my child to take the vaccine.”

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Such fears have some grounding in ugly historical fact.

For example, from 1932 to 1972, U.S. Public Health Service researchers and physicians in Tuskegee, Ala., deliberately withheld treatment from hundreds of poor Black men with syphilis — while falsely telling patients they were being treated for “bad blood” — in order to study the long-term effects of the disease. The Tuskegee Study only ended after a reporter publicly exposed the truth in 1972.

“A Rational Response”

That revelation had a corrosive effective on Black Americans’ trust in the medical profession. Researchers Marcella Alsan, M.D., MPH, Ph.D., and Marianne Wanamaker, Ph.D., believe this distrust has measurably reduced the life expectancy of older Black men, and is still felt today.

“As long as biased beliefs, policies, and practices are still prevalent in the U.S. healthcare system,” Alsan and Wanamaker wrote in a 2018 study in the Quarterly Journal of Economics, “mistrust is a rational response that may continue to contribute to health disparities.”

What can be done about it?  Agrawal and Enekwechi say it’s time for the healthcare industry to “take ownership of our contributions to the problem.” They offer several recommendations, including bias training for clinicians and building a more diverse provider base.

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