Black Americans’ Distrust of the COVID-19 Vaccine

2020 has been a year of hardship for all Americans. The COVID-19 pandemic struck our country in a way that we have never seen in living memory. It has infiltrated all corners of the country and killed more Americans than World War II. The virus has caused a cascade effect of disruption that not only challenged the physical and mental health of Americans, but also overran our health care system and the economy, causing widespread economic shutdowns and leaving millions without jobs.

Aside from its medical effects, the virus has exposed many of our society’s vulnerabilities, including the darker underbelly of our social fabric: the longstanding, deeply-rooted racism towards Black Americans. 2020 put a magnifying glass on racial disparities in this country, forcing us to confront realities affecting Black Americans that have always been there: economic disparities, health disparities, and police violence to name a few. The virus highlighted health disparities affecting Black Americans, who were 3 times more likely to be hospitalized from COVID-19, compared to their white counterparts, and twice as likely to die from the virus. Black Americans disproportionately lost their jobs due to pandemic-related economic losses. The virus also reminded us that Black Americans are more likely to be uninsured and less likely to have access to and utilize health care services.

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2020 appeared to end with an encouraging turn. Two COVID-19 vaccines were found to be over 90% effective in preventing illness from the virus, and they were approved emergently for use (and now a third vaccine is currently seeking emergency use authorization). This could be the turning point for our country and offer hope for all Americans, right? If only it were that simple.

A nationwide Kaiser Family Foundation survey¹ found that in December of 2020, 35% of Black Americans stated they definitely or probably would not get the vaccine. This was a significantly higher percentage of reluctance compared to all other ethnic counterparts surveyed. The revelation of this study, in a similar vein to the rest of 2020, reflects a much deeper problem within our society. Many Black Americans distrust the American medical system.

This is understandable. Our country’s medical establishment has a longstanding history of abusing Black Americans. One of the most heinous generational traumas was the Tuskegee experiment, in which a massive cohort of Black participants were recruited with the incentive of free medical care. In truth, they were diagnosed with syphilis without being informed or offered treatment, but instead deceitfully monitored to study the progression of the disease.

When doctors and research scientists today pursue basic research training, all must review the tenants of the Nuremberg Code, a globalized set of research principles drafted in 1947 that emphasize the ethics of patient consent for research participation. The Nuremberg Code was established after the 1941 Nuremberg trials, which sought justice for the heinous experiments by Nazi doctors involving torture, poisoning, and mass murder of Jewish individuals in concentration camps during World War II. What we as modern doctors and researchers tend to overlook is that the Tuskegee experiments here in the United States, that involved no informed participant consent, no knowledge of their infection with a deadly disease, and withholding of proper treatment for their illness, ran from 1932 all the way up until 1972.

It is no wonder, then, that when the COVID-19 vaccine trials began, social media posts among Black Americans erupted with references to Tuskegee. Even though the trials ended in 1972, the trauma remains etched in the Black community’s historical memory.

As psychiatrists, most of us were trained with a clinical framework that considers a patient’s feelings towards the doctor. But with our focus on mental health, we are prone to view other domains of our patients’ physical health and wellbeing as beyond our purview. Consequently, many of us are reluctant to confront the topic of COVID-19 with our patients; however, it is important for us to do so in order to establish trust with our patients. The reluctance of Black Americans to get the COVID-19 vaccine reflects a deeper distrust of the medical system as a whole, that not only failed them, but also took advantage of them and deliberately hurt them. So how can we as psychiatrists overlook such a critical underpinning of our Black patients’ transference towards us as their medical doctors?

I, like many others, only just began in 2020 to take a hard look in the mirror and confront my own implicit biases towards my Black counterparts and patients. I recently began to talk with my Black patients about their racial experience, and I have been astonished and humbled by the revelations of everyday racism that my patients would share with me. Explorative conversations about race have proven to be invaluable, and have brought me closer with my patients and helped me grow as an individual and a doctor. As we see these discrepancies in trust over the COVID-19 vaccine (one of our only hopes to resume social normalcy), I think we must take the conversation further.

We as psychiatrists can and should start talking with our patients about the COVID-19 vaccine. COVID-19 does not only affect our patient’s physical health, but also has devastating mental and emotional consequences. We need to engage in conversations with our patients about their mistrust of the health care system, as we are part of it. Educating our patients about the seriousness of the illness and the benefits of the vaccine can go a long way. Providing them with reliable resources, especially if it comes from trusted agencies, organizations, faith leaders, professionals, or a nationally-recognized African American figure, may make a difference.

Advocating for our patients’ wellbeing is a basic responsibility of being their psychiatrists. With our additional support, we can continue our efforts to help our patients live healthier and happier lives—and rebuild broken trust.

Dr Hoq is a clinical instructor of Child and Adolescent Psychiatry, and of Psychiatry at New York University’s Grossman School of Medicine. Dr Adam is Clinical Professor of Psychiatry, University of Missouri- Columbia, Columbia, MO.