Winning Trust for a Vaccine Means Confronting Medical Racism

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Moving too fast and not paying attention to a minority group’s history with the government is causing problems for reaching Latino groups as well, says René F. Najera, an epidemiologist who teaches at Johns Hopkins University and George Mason University. So is not understanding that, within an ethnic group, not everyone has the same concerns. “For the Mexican and Central American cohort, the concern is: Am I going to be asked to produce papers? Am I going to have to register on some database?” says Najera, whose family is originally from Mexico. “Permanent residents are worried about the Trump administration and the change to the public charge rule; they are fearful that using the health department or getting your vaccines could keep them from becoming citizens. And then within the Puerto Rican community, there’s a memory of unethical medical practices.”

Savoy, who is African American, sees patients at a clinic in North Philadelphia, in a historically poor zip code. Every year, she says, she has heard concerns about flu shots from some of her patients: worries about what the shot contains, fears that people are being used as test subjects. News coverage of the White House’s push to get the Covid-19 vaccine out quickly—even the name of the effort, “Warp Speed”—has made all that much worse.

“People say, ‘I always was suspicious that the government was trying to do stuff to me. And now I’m seeing on TV, the government is clearly doing things that don’t seem aboveboard,’” she says. Among her Black patients are grandparents who are old enough to have been included in the Tuskegee study, which was launched in 1932 and didn’t end until 1972, four years after a whistleblower made it public. “They will tell me that there are certain things that they will trust me on, and certain things that they love me for, but they just know that I’m just not old enough to know any better yet,” Savoy says.

Among her white patients, Savoy adds, there is similar distrust—not from any significant scandal such as Tuskegee, but from the experience of being a poor person in America. “They have been in situations where they feel like the government or society didn’t protect them,” she says. “And they see this as another situation where they can be harmed.”

So to get to vaccine acceptance, public health planners have a lot of work to do. That includes taking the time to refine messages about vaccine safety that acknowledge the harms done to minority communities in the name of health. It also includes identifying the channels where people are now likely to encounter misinformation—from Facebook or WhatsApp or local radio—and finding people who can deliver credible messages on them. That probably doesn’t mean members of the government public health establishment, but it could mean local physicians or community health workers or influencers. Or people who occupy more than one of those categories, such as the doctors and nurses taking to TikTok, the volunteers knocking down disinfo on social media, and the vaccine research coordinator posting Covid-19 Instagram memes.

At the same time, it’s important not to be reductive. The history of the Black community is not only Tuskegee, and it would be unthoughtful to assume that all people from that community react to a politicized, fast-tracked vaccine through that frame. In considering what would cause minority groups to be hesitant about the Covid-19 vaccine, researchers who come from within those communities say that it’s equally important to consider what might cause them to accept it.

“How many people of every race and ethnicity are worried about cost, worried about access, worried about whether or not they have health insurance?” asks Jewel Mullen, a physician and the associate dean for health equity at the University of Texas at Austin’s Dell Medical School, who is African American. “There are a lot of other considerations that can be in the way of somebody wanting to receive a vaccine.”

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