As a Black nurse in America, I have watched in horror as members of my local and national Black community have been disparately infected by and have suffered adverse outcomes of the COVID-19 pandemic. According to the Centers for Disease Control and Prevention, Black people are more than twice as likely to die from COVID-19 as White, non-Hispanic persons. While the notion of Black communities suffering disparities from yet another preventable illness isn't surprising, the proverbial “light at the end of the tunnel” associated with the high efficacy of recently approved vaccines doesn't shine as bright in my community. Let me explain why and what we can do about it.
America's long history of mistreatment of Black people, as painfully detailed by Harriet A. Washington in Medical Apartheid (Doubleday, 2006) includes but is not limited to the Tuskegee syphilis experiment conducted by the government from 1932 to 1972 to study the progression of untreated syphilis. Black men were invited to participate in the study under the premise that they would be treated for “bad blood,” a term locally used at the time for syphilis, fatigue, and anemia. Proper informed consent was not obtained, and the men were misled and denied treatment, even when one became available.
This study and innumerable other traumas perpetrated by the U.S. government and medical professionals have been seared into the minds of generations of Black people. As a result, the widespread distrust and fear of health care institutions and the government has had the unfortunate effect of potentiating health disparities. In the case of COVID-19, exceptional circumstances forced the development of vaccines at an accelerated pace. Rushed vaccines, developed under a presidential administration that was less than transparent in addition to actively spreading misinformation, are a recipe for suspicion, regardless of ethnic background. Thus, many Black people are at a minimum skeptical of the new vaccines' safety if not outright resistant to the idea of taking a vaccine for COVID-19.
A plan for mass distribution of the COVID-19 vaccines to the Black community amid historic civil unrest and distrust of the government will require the full engagement of its leaders. It is imperative that Black leaders in public health, medicine, nursing, and the faith community take immediate action to address the well-justified concerns of the Black community.
In September, in advance of the vaccines' approvals, Walter Kimbrough and Reynold Verret, the presidents of Dillard University and Xavier University of Louisiana, two historically Black colleges in New Orleans, attempted to do just that. The two university presidents participated in COVID-19 vaccine trials and shared an open letter to students, staff, and faculty encouraging participation in the trials. The announcements were not met without controversy; however, this is exactly the sort of leadership by example that will be essential to moving more resistant Black people toward vaccination.
Black leaders in health care should be given local and national platforms to share their experiences and knowledge of the disparities in COVID-19 infections and outcomes for Black people. Collaborative efforts between local Black leaders in health care and the community should focus on providing information and education that is sensitive to the concerns and fears of Black people and accessible to those who are most vulnerable. Additionally, the value of the presence of Black care providers at vaccination clinics in communities heavily affected by COVID-19 cannot be underestimated. For many, the comfort in seeing a caregiver who looks like them when there is fear and lingering doubt will make the difference between receiving the vaccine or not. Ultimately, having a Black care provider at every clinic may not be possible in every community, but a concerted effort should be made.
Regardless of who advocates for the vaccination of Black communities, a sincere acknowledgment and acceptance of the legitimacy of the concerns and fears associated with health care must be addressed in any messaging and campaigns.