Vaccine hesitancy: A side effect of systemic racism

January 13, 2021

African and African American Studies Assistant Professor Terri Laws talks about the role of transparency, acknowledgement and actionable change in repairing the broken trust behind the COVID vaccine hesitation in communities of color.

Graphic of injections
Graphic of injections
Graphic by Violet Dashi

More than 70% of Black Americans say they know someone who has died or been hospitalized due to COVID — that’s nearly 20 points higher than Americans overall. In the same Pew Research Center survey, Black Americans stand out in another area too: The most reluctant to get the newly rolled out vaccine, with only 42% saying they would.

Looking at the numbers by themselves, it seems surprising that the percentages are not more closely aligned. But African and African American Studies Assistant Professor Terri Laws says it's predictable that there'd be a gap when thinking about what’s occurred since Europeans first landed on the country’s shores.

Portrait of Terri Laws
Portrait of Terri Laws
Assistant Professor Terri Laws

“It’s a matter of trust,” says Laws, who began conducting research about clinical trial participation among underrepresented communities more than a decade ago. “People say it’s irrational to not trust clinical science and scientists. But let’s look at 400-plus years of history where law, religion and science played a part in devising categories we call race then using those categories to justify mistreatment toward communities of color. It’s not like we got to this point yesterday — the distrust is rational. We can’t change the facts of history, but there are ways to boost trustworthiness.”

Through her research experience, Laws discovered a successful approach in trust building: Transparency.

As a bioethics fellow at the University of Texas MD Anderson Cancer Center between 2010 and 2012, Laws focused on research ethics interviewing African American men diagnosed with prostate cancer. She wanted to understand their decision making process when they had been offered participation in a clinical trial. She was part of an initiative to expose students and scholars to the ethics environment in a hospital and research facility.

Laws wanted to participate so she could share information about clinical trials with patients from underrepresented communities. To answer questions and be forthright, she learned each step of the developing science process, including the social and cultural aspects of knowledge discovery. “I wanted to be able to explain the clinical trial process to people hesitant to participate. It’s important for communities of color to have involvement in medical developments because those could improve or save their lives. Learning the process grew my trust in developing science too.”

Other ways to grow trust? Laws says investment of time and tax dollars, active listening, and a genuine interest to help.

Even though there’s been an all-hands-on-deck COVID vaccine investment, persons of color still wonder where they are on the priority list. A survey by the Kaiser Family Foundation found that nearly one-half (48%) of Black Americans and over one-third (38%) of Latinx were not confident their needs had been taken into account during vaccine development. What can change this? Remaining focused on their healthcare needs, Laws says.

“Trust is earned,” she says. “A real question is: If only Black people were impacted, would there be the same level of investment? It’s something to think about — these inequities literally make the difference between living and dying. It’s important to give credit to the science-positive things in our lives like vaccine development, but we also need to call out injustice.”

Laws says her interest in public health started in a science-positive place.

As a child, Laws recalls learning about how scientist George Washington Carver and the agricultural science program at Tuskegee University (then named Tuskegee Institute) made life better for African Americans in the early 20th century through peanut and sweet potato experiments. “It gave African Americans, often poor, a sustainable way to feed their families. It left an impression on me.”

Years later, Laws discovered Tuskegee’s involvement in a different experiment — the infamous United States Public Health Service’s Study of Untreated Syphilis in the Negro Male. “To be honest, I didn’t want to talk about Tuskegee because  there is no way past the history. I didn’t want it to take over my research. Therefore, you have to go through it."

Laws continued, "I found a conceptual model that allowed me to talk about the 'sacred' quality of Tuskegee among Black Americans. Not as a matter of worship but based on its deep emotional and intellectual qualities. Macon County locals continue to say that the site of largest recruitment was one of the Black Baptist churches near Tuskegee University.”

During her cancer center bioethics fellowship, Laws attended a conference at Tuskegee University’s National Bioethics Center to discuss the study and a way forward. She says her time there, which included surviving family members of the men violated in the egregious “experiment,” helped her move through the painful history, but there’s much more to do when it comes to acknowledging today’s health and social injustices like lack of doctors who share a social and cultural experience, or clinic access in impoverished areas, or not having affordable healthcare coverage. “We’ve been talking about a way forward for quite some time. We need more action.”

Laws hopes the healthcare cracks widened by the COVID-19 pandemic are moving the needle toward action. Community organizers, religious leaders, academics and medical professionals are going into neighborhoods and are launching online campaigns to share vaccine information and address the trust concerns among Black and Brown Americans with hopes of reducing hesitancy.

“Information is being shared. People are connecting those in need to health resources. It’s happening,” she says. “However, we still need to do better as a nation in continuing to address our health inequities.”

Laws notes the nation’s top infectious diseases doctor recently spoke about seeing evidence of disparate health experiences. So she’s cautiously optimistic other leaders will recognize the health crisis happening in vulnerable communities.

During a recent webinar Laws attended, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci spoke about spending the next 10 years focused on health equity. “That’s huge coming from him. When Tony Fauci says we need to dedicate attention to health inequities, that means something. Now we need decision makers to heed his guidance.”

Laws says we’ll pull through this pandemic — she just hopes lessons are learned and a foundation is laid for positive long-term change.

“We’re talking about how racial health inequity is a longstanding problem. That’s a good step, but can’t be the only step. It needs to stay on the front burner because change, especially cultural change, takes time — and so does trust.”

Professor Laws is a past member of the Ethics Committee at the Henry Ford Hospital in Detroit. She’s a recent member of the health disparities faculty for ReBUILDetroit, a National Institutes of Health collaboration among Detroit area universities seeking to attract undergraduate students from underrepresented communities to biomedical careers. Her health disparities and cultural competence publications have appeared in the Journalof Religion and Health, Pastoral Psychology, and Religion & Politics. Laws is currently writing a race, religion and bioethics manuscript on African American religion and health.

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