We Can't Build Trust in Vaccines Without Addressing Racism in Health Care

Two years ago, I wrote an article called "When Racism Anchors Your Health." It was about the long-tail erosion of individual wellness that results from racism in health care availability and quality (in addition to the more immediate harm that comes from poor care). There's a word for suffering racist care in the long term: "weathering," which the race disparities scholar Arline Geronimus describes as “the deterioration of health as a result of the chronic stress of being exposed to systemic racism for your whole life—the product of an accumulation of lifelong physiological stress-mediated wear and tear.”

My grandmother knew all about weathering. She was the vessel for that first story I wrote about it. At the time, she was in the early stages of battling cancer for a sixth time—this time in her brain, and terminal. She passed nearly a year ago, just three months before COVID-19 “officially” hit America. 

I can’t imagine what it would have been like for her to have survived just for the poor state of Black health care—this time, as it failed to meet the demands of a pandemic—to once again endanger her aging Black body, which lived through Jim Crow, the Civil Rights Movement, and simply being a Black woman raising a Black family in an anti-Black country. Now, my family continues to face health inequities like the ones she faced as we watch COVID-19 cases take Black lives.

The saying goes that when white people catch a cold, Black people catch pneumonia. Centuries of medical inequities in Black communities have proven this to be part of the American health care system's design. The long history of anti-Blackness in health care continues to oppress and harm Black communities: It has been painfully exacerbated by the COVID-19 pandemic, and it causes fear and wariness among Black Americans who may be skeptical medical treatment based on racist historical precedent.

As vaccines begin reaching people in the U.S., the history of medical distrust among Black Americans is feeling as close to the surface as ever. Many remember the federally run Tuskegee syphilis study, in which Black men were not treated for syphilis for nearly a decade while being lied to by the white medical community studying them and their families while they tested treatments. Although the Tuskegee trials didn’t involve a vaccine, the medical violence Black people faced in being used as experiments impacted—and still impacts—every facet of how we interact with health care.

The COVID-19 numbers themselves follow the historical pattern of how health care inequity increases risk for Black people. According to the Centers for Disease Control, Black people are 1.4 times more likely to contract COVID-19 when compared to white counterparts. They are 3.4 times more likely than their white counterparts to be hospitalized, and 2.8 times more likely to die from the virus. These inequities are not coincidental. 

In the first week of December, a news report about an NBA player star named Karl-Anthony Towns surfaced about how he has lost seven family members to COVID-19, including his mother, and how it was affecting his mental health. Even with the added stress of grief (let alone the way he feels about avoiding COVID risks himself), he was still expected to suit up for the first game of the season on December 23. Examples like this one are not rare among Black people. We are expected to continue to perform under the anti-Black capitalistic model in spite of the many oppressions we face. Each attack our bodies in ways seen and unseen, with no recourse to protect our own health. 

To gain more clarity on the urgency of vaccine distribution amid this understandable distrust from Black communities, I reached out to Uché Blackstock, an emergency medicine physician and the founder and CEO of Advancing Health Equity, a company that partners with health care organizations to address the critical factors that contribute to health inequity. 

“Multiple factors have influenced the racial health inequities that we've seen in this pandemic and each of them is directly related to systemic racism," Blackstock said. "[These include the] lack of testing availability in Black communities, Black Americans carrying the highest burden of chronic disease due to lack of access to quality health care, and Black Americans being more likely to work in public-facing jobs as essential or service workers. Systemic racism has essentially placed Black Americans at [greater] risk for being infected and dying from coronavirus.” Beyond that, Black people are more likely to be uninsured or underinsured in comparison to their white counterparts. 

As the Supreme Court continues to weigh the fate of the Affordable Care Act, Black health care is trembling on the line. “The ACA's health insurance expansions have contributed to increasing rates of access to health care for Black Americans," Blackstock said. "High rates of uninsurance is one of the most significant factors leading to poorer health outcomes among Black Americans. In this pandemic, Black Americans have suffered the most significant job losses, [which] also leads to the loss of employer-sponsored health insurance—and likely worse health outcomes.” 

According to Blackstock, “We should be pushing for more than the ACA and Medicaid expansions in order to improve the health of Black communities. We should be pushing for a single-payer, universal health care system where Black Americans can access free, quality, and culturally responsive health care.”

Even that is not enough to address the consequences of medical racism. In conversations about vaccination, I’ve heard the same stories from family and friends who are split on their trust in the safety of the vaccine. They know how health care in our communities, even at its best, has been grossly administered to us. “The history of medical abuse and exploitation, ongoing discrimination and the political interference in the public health response to the pandemic has made some Black Americans wary of the vaccine, and we will get left behind,” Blackstock said. “Public health messaging surrounding vaccine education and outreach over the next few months will be key to making a difference in our communities.” 

Blackstock encourages physicians treating people who are nervous about the vaccine to find an empathetic approach. “I acknowledge and affirm the wariness, to make sure that I'm answering all of their questions thoroughly [and] with respect, and then acknowledge that this won't be a one-time conversation, but instead a series of conversations," she said. "My goal is for them to take all of the information that I have given them to make an educated decision for themselves.”

In the coming year, Black people in the U.S. will once again be “weathering” more than just our poorer health outcomes. We’ll be trying to survive in a country on the verge of economic and social collapse, while feeling distrustful of science and those whose job it is to administer it. A country where health is a right reserved for those who are white, and Black “health” is a myth that continues to erode with every report and damning statistic confirming our plight. A country where one could only dream of a day where Black health is a reality, rather than a clock ticking towards our mortality. 

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