COVID-19 Vaccine Disparities and Hesitancy: A Bleak Picture of Public Health for Black Americans
Public health inequity has always been prevalent in the United States, but perhaps nothing has shed a brighter light on that inequity than coronavirus. First declared a global pandemic by the World Health Organization approximately one year ago, the virus has ravaged nearly every continent, with the global death toll sitting at approximately 3.1 million according to the Johns Hopkins Coronavirus Resource Center.
The United States is one of the hardest-hit countries. According to the same data compiled by Johns Hopkins, coronavirus deaths in the U.S. make up nearly 20% of all coronavirus deaths. This percentage is stark when one considers the fact that the U.S. population is less than 5% of the world population, according to the U.S. Census. For Black Americans, however, the numbers are even grimmer.
The APM Research Lab has been tracking COVID-19 deaths by race and ethnicity from April 2020 through early March of this year and have found that Indigenous, Pacific Islander, and Black Americans have experienced the highest death tolls, with 1 in 555 Black Americans dying from coronavirus.
The Centers for Disease Control and Prevention (CDC) has acknowledged this inequity and outlined a number of contributing factors: discrimination, healthcare access and utilization, occupation, educational, income, and wealth gaps, and housing.
Nambi Ndugga serves as a Policy Analyst for the Kaiser Family Foundation’s Racial Equity and Health Policy Program and says the inequities are not surprising.
"I think any time there is a shock to the system such as a pandemic, we expect that shock to the system to exacerbate any inequities that we're already seeing prior to the pandemic. We know that communities of color have less access to health care, are more likely to be uninsured, and just face a lot more structural barriers to getting adequate health care compared to their white and wealthier counterparts,” said Ndugga.
The battle against coronavirus has been racked with loss and tragedy for all American communities, but there are several lights at the end of the tunnel: the vaccines. So far, the Food and Drug Administration has authorized three different COVID-19 vaccines for emergency use for people over the age of 16.
For a short period of time, only two of those vaccines were being administered countrywide. On April 13, the CDC and the FDA recommended temporarily pausing injections of the Johnson & Johnson/Janssen (J&J) coronavirus vaccine after reports of people experiencing a rare and severe type of blood clot. “Although the J&J/Janssen vaccine is still authorized for use, CDC and FDA recommend this vaccine not be given to anyone at this time while this safety signal and its possible implications are investigated,” said the CDC.
Ten days later the CDC recommended lifting the pause and resuming administration of the vaccine. J&J was the third vaccine manufacturer to receive authorization.
The first vaccine to receive approval was the Pfizer-BioNTech vaccine, which is now boasting 100% efficacy in trials for children between the ages of 12 and 15 according to a press release from Pfizer. At their current pace, the pharmaceutical company could be the first manufacturer to receive emergency use authorization for children under the age of 16.
These unprecedented medical advancements have been coupled with an aggressive vaccination plan proposed by the Biden Administration. As of April 25, NPR reported 28% of the U.S. population is fully vaccinated. Additionally, all fifty states have recently expanded vaccine eligibility to those over the age of 16.
“I indicated that I hoped to get 100 million shots in people’s arms in my first 100 days. We met that goal last week by day 58. I’m setting a second goal, and that is: We will, by my 100th day in office, have administered 200 million shots in people’s arms. That’s right, 200 million shots in 100 days,” said President Biden during his first press conference on March 25.
On April 21, the President announced during a White House press conference that his new goal has been achieved.
Despite the positive news on the vaccine front, racial disparity has managed to seep its way into vaccine distribution in the United States. The Kaiser Family Foundation (KFF) has been rigorously collecting data to paint a picture of which groups have been disproportionately getting vaccinated and which groups haven’t.
“So far, in our analysis of state data, we are seeing that across the board, white people are getting vaccinated at higher rates compared to other communities of color: Black, Hispanic and Asian communities,” said Ndugga.
Additionally, Ndugga says vaccine disparity for minority communities can have widespread consequences.
“In this particular setting where we have an airborne pandemic, an airborne virus, one community not being as protected does have a large impact on the larger community. It may impact reaching herd immunity. It may impact slowing the spread of the virus.”
The federal government and a number of states are attempting to address and mitigate these disparities. President Biden said he plans to invest $10 billion to expand vaccine access to communities of color and add 12 more federally-run mass vaccination sites which will target those communities, “We have to reach out. They’re the ones most affected by both the vaccine, but also by the pandemic.”
Colorado announced several strategies including establishing community partnerships to aid in vaccinating communities of color. Tennessee added 100 new vaccination sites across the state focusing on rural and underserved areas. Montana and Utah ensured people of color were given priority access in the initial stages of vaccine distribution.
Aside from disparities in vaccine distribution, there is another hurdle facing Black Americans when it comes to getting those life-saving shots: vaccine hesitancy.
As soon as coronavirus was declared a global threat, it was announced that vaccines would be produced and administered as quickly as possible. In the U.S., that announcement was met with doubt and mistrust, especially by Black Americans.
“Fear for sure plays a part. And I also think there's an underlying sense of understandable mistrust in terms of the government and the medical field as a whole. COVID is a rapidly developing situation. So, I think there's just a lot of unknowns which can cause some uncertainty,” said Moss.
Initially, hesitancy had been decreasing for all Americans according to a recent KFF poll. However, since the pausing of the J&J vaccine, hesitancy is on the rise again as the pace of vaccinations in America slows. One poll conducted by NPR, PBS NewsHour, and Marist found that Black and White Americans are almost equally hesitant to get the vaccine.
However, the factors driving the uncertainty for Black Americans are partly rooted in a long history of medical racism and malpractice, most notably the 1932 Tuskegee Syphilis Experiment.
The atrocity, which has been well-documented, began when 600 Black men received improper treatment for syphilis as part of a study to observe what would happen if the disease went untreated. None of the men consented to or were aware of the 40-year study, and a number of the men perished from the disease.
The U.S. government eventually acknowledged the wrongdoing with a formal apology from President Bill Clinton in 1997, but the damning legacy from that trial and others like it persist in the minds of Black Americans, even those who work in the medical field.
“At the end of the day, you are still a Black person. And sometimes when you're a Black person and in those settings, you get to see firsthand how Black Americans are treated. You might even have your own experiences of racism and discrimination, which can make you hesitant to trust these systems,” said Moss.
Edward Dudley works as a pharmacist for a large chain pharmacy and even admits that he had doubts when the Pfizer vaccine was first announced, “I was probably a little apprehensive at first about it. I have finally come to the conclusion that the pharmaceutical companies are doing everything that they need to do in order to assure that the vaccines are safe and effective.”
Dudley says he understands the skepticism from his community, but he argues that the reward greatly outweighs the risk.
“Science has evolved quite substantially in the last five to ten years. Even if there are side effects, most of the time the side effects are minimal. Most of the time people get through it. Anything is going to be better than you coming down with COVID itself,” said Dudley.
Ashanti McCormick, 25, has heeded Dudley’s call and got her first shot of the Moderna vaccine. Like, Dudley, she was also not completely trusting of the vaccines due to fears of medical racism. “I live in Alabama, so of course Tuskegee was on my mind. I was also hesitant because I felt like they were rushing to make it, but then I realized a lot of countries were pooling their resources to get it done. So, I just had to rationalize that it was safe,” said McCormick.
For McCormick, she says part of that rationalization process was looking up what exactly was in the drugs, “There are some very user-friendly articles that break down what the vaccine is made of, and then I just made the decision to go get it.”
McCormick registered to get her dose on March 28 at the Morgan County Health Department in Decatur and says she does not regret the decision.
Blake Ralling, 28, a former network news producer who has extensively covered COVID-19 was also against the vaccine at first, “Originally I thought the vaccine was produced and distributed too quickly and that led to me not having enough confidence.”
However, Ralling said that the history of medical racism in America was not a factor in his decision, “I changed my mind when I realized that getting the vaccine was an inevitable process.”
While general vaccine hesitancy is not new nor unique to Black Americans, the coronavirus pandemic has exposed the systemic vulnerabilities the community has always faced when it comes to public health in the United States.
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