With vaccine distribution continuing to roll out and summer holidays finally here, our country is slowly approaching the end of this pandemic. One obstacle, however, that has largely deterred our nation’s progress is vaccine hesitancy.

To be clear, COVID-19 vaccine hesitancy does not refer to the baseless rumors spread by anti-vaxxers concerning the dangers of the vaccine. According to a new survey conducted by the Kaiser Family Foundation poll, 55% of the anti-vaxxer population believe that vaccines are not as safe as they are promoted to be, with 31% going so far as to claim that they fear getting COVID-19 from the vaccine itself (Web MD). This type of vaccine hesitancy is not only illogical, but it is ignorant to the surplus of evidence proving the efficacy of the Pfizer, Moderna, and Johnson & Johnson vaccines.

What requires careful attention, on the other hand, is the vaccine hesitancy heavily prevalent amongst people of color, particularly Black individuals. According to another KFF Poll, Black Americans are the least vaccinated of all racial and ethnic groups, with a mere 21 percent of the population having received at least one dose of the vaccine. Research has continuously proven the disproportionate impact that the pandemic has had on Black Americans, so why are vaccination rates among these populations so low?

The answer lies in the prevalence of medical mistrust in the United States, something heavily intertwined with COVID-19 vaccine skepticism. Medical mistrust is rooted in the long history of discrimination and exploitation that Black Americans have experienced in the healthcare field, and it continues to exacerbate the fear associated with the unknowns of the COVID-19 vaccine. Over 41 percent of Black adults report knowing “little or nothing” about the vaccine, which only further disincentives them from seeking it for their own families.

In order to continue battling the pandemic and overcoming vaccine hesitancy, the issue of medical mistrust amongst Black minority populations needs to be holistically acknowledged and ameliorated.

A Long History of Medical Mistrust
“There has never been any period in American history where the health of Blacks was equal to that of whites," noted Evelynn Hammonds, a Harvard historian, in the New York Times. “Disparity is built into the system.”

This long history of Black systematic racism in healthcare contributes greatly to the vaccine hesitancy resurfacing today. Take the experiences of Black men at Tuskegee Institute, for example. In 1932, researchers at Tuskegee conducted the infamously horrifying “Tuskegee Study of Untreated Syphilis in the Negro.” In this study, 600 poor and largely illiterate Black men, two-thirds of whom had syphilis, were studied over decades to examine the course of the untreated disease. The Black men, who were completely unaware of the actual name of the study, its purpose, or the crippling effects of the treatment they would undergo, were lied to about their disease and prohibited from seeking outside medical assistance over the duration of the study. In exchange for free meals, transportation, and burial stipends, participants were subject to 40 years of perpetual agony and intrusive testing.

The study ultimately ended in 1972 after its eruption across news media. However, its effects still reach American society into the present day. Researchers subsequently found that following the outbreak of the study in the late 20th century, the life expectancy for middle-aged black men fell by up to 1.4 years (NBER). Moreover, the study heightened the wave of medical mistrust that Black Americans carry in our healthcare system, exacerbating the inequality gap in this country for years to come.

How are Black Americans supposed to trust a system that has discriminated against them for centuries?

The Tuskegee study was only one example of the legacy of medical mistrust in the United States, a legacy that still exists today. Laura Bogart, social psychologist and senior behavioral scientist at the RAND Corporation, has conducted extensive research on the impact of medical mistrust on HIV prevention treatments, and she notes that medical mistrust primarily takes form in the contemporary experiences of discrimination that Black Americans face. For instance, one 2016 study conducted on a group of white medical students found that over 73 percent of participants held at least one false belief about supposed biological differences between white and Black patients. Many of these beliefs, such as Black patients having “thicker skin, less sensitive nerve endings, or stronger immune systems,” are rooted in centuries-old justifications for slavery, and they foster the alarming rates of pain undertreatment seen across Black communities (MNT).

This phenomenon comes full circle to our history of medical mistrust. Whether it be lack of access to emergency care, high rates of misdiagnosis, or perpetuated biological stereotypes, the legacy of Black discrimination is systematically ingrained in American healthcare.

Understanding The Cause For Vaccine Hesitancy
With this information in mind, the source of vaccine hesitancy amongst Black populations must not be subject to admonishment. Many Americans are quick to blame these groups for their reluctance to take the vaccine; however, the conversation needs to be shifted from blame to adequate acknowledgment of their concerns.

“If we recognize that mistrust isn’t necessarily harmful, it changes how we frame our response,” says Laura Bogart, cited above. “It’s very natural that people would want to put their guard up and ready themselves for the possibility of discrimination after experiencing so much systemic racism. If channeled effectively, mistrust can empower people to protect themselves and pursue changes at the institutional and societal levels.”

In many cases, mistrust allows Black Americans to effectively navigate their current healthcare challenges. Black patients overwhelmingly prefer to be treated by Black physicians, as shared patient-physician backgrounds are believed to translate to higher quality care. Research supports this notion: in fact, one such study found that the mortality rate of Black newborn babies is halved when they are cared for by Black physicians in comparison to white physicians.

Evidently, medical mistrust must not be criticized by white Americans, but instead attempted to be understood. It is a phenomenon rooted in our country’s long-drawn history of discrimination, and it serves as a source of empowerment and protection for Black Americans seeking out the best quality healthcare for their own families.

The Road To Overcoming Vaccine Hesitancy
The most important thing for Black communities to establish right now is trust: trust in the American healthcare system, trust in our public leaders, and trust in the COVID-19 vaccine. Trust can be achieved with education, and the only way for Black Americans to shift their perspectives on the vaccine is if they are equipped with accurate scientific information, access to insurance coverage, and reliable professionals that are willing to walk them through their unresolved questions. The key, says Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, “is for them to feel a sense of empowerment and control over their own health and their own decisions” (NPR).

Without valid reasoning, we cannot expect these populations to put blind faith in a system that has discriminated against them for years.

What’s more, Black Americans need to see professionals of their own skin color at the forefront of vaccine development. Public figures like Kizzmekia Corbet, an African American immunologist central to the development of the Moderna mRNA vaccine, have been extremely influential in building trust with the Black community, and we need more messaging coming directly from Black physicians themselves (NEJM). If Black Americans continue to see their own representation in healthcare, alongside reliable access to vaccine information, the presence of medical mistrust can slowly begin to be deconstructed.