Contextualizing COVID-19 Vaccine Hesitancy Among Black Americans.

• Author: Sarwar, Maliha
• Position: Article 4

"I do not want to be killed by a white doctor in America. I think I will be killed by a white doctor in America'" - Kiese Laymon

Kiese Laymon, a Black author from Mississippi, describes his experience growing up in America, and the belief system that came with it. (1) "A white doctor has the power to kill you or save your life, and your best shot is avoiding health care at all costs." (2) Laymon advises other Black Americans: Should you have to visit a physician, dress as proper as you can, over-enunciate your English and hope and pray that it will be enough for them to look past your skin color. (3) The anxiety and mistrust reported by Laymon, and many other Black Americans, describes a phenomenon white Americans have been largely able to ignore until the rude awakening that is the COVID-19 pandemic. Health care is not an apolitical experience, and care systems do not cater to all in a universal way. The standard of care and the experience of receiving it are deeply contextualized.

Health care systems have been shaped and created by white medical providers and administrators for white patients. Historically, the standard of medical care designed for and offered to Black people has been substandard, grudgingly provided, and often resulted in extreme discomfort and mistreatment for many Black patients.

Not only have Black Americans been actively excluded from healthcare, but they have been historically viewed by this system as bodies for experimentation rather than patients or considered mere "anatomical material." (4) Educational institutions Virginia Medical College and the Georgia College of Medicine hired individuals until as late as 1919 to perform the role of "resurrectionist," entering graveyards to retrieve the bodies of newly buried Black people to be studied and dissected. (5) The 1920s marks the beginning of many compulsory sterilization laws for a variety of different minorities in the United States, which even after being repealed, continued to be reported until the 1980s by many women without their consent. (6) As late as 2017, a Tennessee judge finally reversed a practice that allowed for inmates to shorten their sentence by thirty days should they subject themselves to sterilization, which would disproportionately affect Black inmates. (7) These infamous examples contribute to the structural violence that occurs in healthcare today, which is often overlooked by medical professionals.

The very foundation of Western biomedicine is built upon the exploitation of marginalized bodies, through unconsented experimentation. Advancements in the fields of oncology, immunology, and the polio vaccine are largely attributed to cells from a patient named Henrietta Lacks, who entered the Johns Hopkins Hospital in 1951 with cervical cancer. Without her knowledge or any kind of compensation, her cells were collected and used in many studies in practices which would be completely illegal today. (8) Commentary from the scientific journal The Lancet on Lacks' story also notes that she was born in the same cabin her enslaved ancestors lived in, showing that the freedom she supposedly had was not without loads of intergenerational trauma. (9) Although she herself may have been free, her identity as a Black woman placed her in the same patterns of structural violence and would eventually lead to the exploitation of her body as she lay on her deathbed.

The effects of this trauma are now more present than ever, when being a Black American increases the likelihood of being hospitalized after contracting the coronavirus 2.9 times and doubles the likelihood of death. (10)

The disproportionate distribution of illness associated with COVID infection in Black communities is compounded by a low vaccination rate which continues to trend all over the country. Both the disproportionate access to healthcare and the failure to understand the societal factors that create mistrust are linked to systems of institutional racism. It is only when these historical trends are examined that the low vaccination rates in Black communities can be understood. It is a combination of a history of poor experiences with the medical system, and a lack of access as a result of health care systems that were never set up to serve them in the first place. It appears that many Black Americans are remaining unvaccinated because they feel it is the safer choice. Analyzing the discourse and ethnography of Black community leaders, and the social determinants of health that affect them, highlights how this is not a new phenomenon, and they have spent much of their lives fending for themselves. This paper will examine how the American healthcare system has continued to let down Black Americans for generations, culminating in the shocking disparity of health outcomes by race in the current COVID-19 pandemic.

When it is a matter of life or death, there is no time to wait for the government to come and support you. Across the southern United States, Black community leaders have been mobilizing whatever resources are at their disposal to combat the structural violence they are faced with. They are doing all they can to get their communities vaccinated. (11) In Louisiana, where 32 percent of the population is Black American and only 23 percent have been vaccinated, Cala Brown, a nurse in Baton Rouge, is working hard to get the word out that vaccination is essential in fighting COVID. "At your age, it's the vaccine or the grave," she states soberly as she reaches out to anyone she knows is feeling skeptical. (12) Although a passionate believer in vaccination, she must come to terms with the fact that many of her peers can recount histories of abuse at the hands of the American medical system. (13) She does her best to acknowledge this intergenerational trauma, as, for many, this mistrust in the system is the root of hesitancy in accessing vaccines. She believes that it is only by acknowledging the...