Vaccine hesitancy among racial minorities likely due to history of untrustworthy medical practices, experts say

The U.S. has an extensive history “shaking confidence in science and medicine” for racial minorities, according to Francisco Lucio, JD, associate dean at the Office of Equity, Diversity and Inclusion at the University of Arizona. He said this is an important backdrop for the considerable hesitation to receive the COVID-19 vaccine among minority communities.

 

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We are seeing this unwillingness largely as a result of the history of structural racism in U.S. health care. This “scope of medical abuse” includes the gynecologist James Marion Sims experimenting on black slave women in the 1800s, the sterilization of Native women without informed consent as a form of birth control in the 1970s and a history of eugenics practices that disproportionately impacted women of color. He also listed the Tuskegee Study and Henrietta Lacks as examples of malpractice targeting non-white individuals.

“We have a longstanding history of sterilization laws, that were really founded in eugenics laws, that we saw in places like California. [These laws] disproportionately and forcibly sterilized women of color in the early 1900s through the 1970s.”

Lucio explained that social factors resulting from structural racism such as unemployment, poverty and lack of home ownership frequently influence the health outcomes of these communities. He said a study from the American Heart Association revealed that African Americans have a higher rate of high blood pressure, stroke and diabetes than other populations. 

To show that untrustworthy medical practices are not just a relic of the past, Lucio offered contemporary examples of medical malpractices against racial minorities. The 1990s fenfluramine study in which researchers gave children — the majority of which were Black or Latinx — intravenous fenfluramine doses in an attempt to link violent behavior to certain brain chemicals, raised various ethical concerns, according to Lucio. The recruitment process selected children who had siblings in the criminal justice system and intimidated them to imply their incarcerated family members would be harmed if they refused to participate.

He also referenced a measles vaccine study conducted in the early nineties by the Center for Disease Control that gave high doses of experimental measles vaccines to Black and Latinx children in Los Angeles without their informed consent. The children’s parents were not told the vaccine was experimental, according to the Washington Post. In 2020, numerous women reported medical abuse in Immigration and Customs Enforcement detention centers.

According to a study in the Journal of Community Health, 34% of Black individuals and 29% of Latinx individuals are hesitant to receive the vaccine. By comparison, 22% of white individuals said they were hesitant. Among Black Americans, only 14% trust in the safety of the vaccine and 18% trust that it is effective, Lucio said. 

Valeria Madera-Garcia, MPH, a PhD student at the University of Arizona’s College of Public Health displayed the disparities in who receives the vaccine in a graphic:

 

Lucio provided one individual’s response to a survey that asked participants if they trusted the vaccine:

“I am not confident that this really is a prevention for COVID-19. I feel like it could have other sinister or ulterior motives for African Americans.”

Richard Correa, MD, a member of the University of Arizona’s Office of Equity, Diversity and Inclusion’s Diversity Committee, offered specific insight on COVID-19 in the Latinx community’s response to the vaccine.

According to him, the Latinx population has the highest rate of uninsured individuals out of any racial population in the country. They are underrepresented in medicine, public health and clinical trials. The Latinx community has numerous barriers to COVID-19 prevention and vaccination including the lack of disease knowledge, the lack of translation services, the lack of access to testing and the lack of resources to isolate (such as food shortages and family support).

He highlighted some examples of outreach efforts to Latinx communities that have proven successful. Sharing Lucio’s emphasis on trust, he said the most important thing to do is gain the trust of the community through confidentiality and providing the best services, saying. He said it is also important for health care professionals to inform their patients they have been vaccinated.

Correa called on health care workers to tell patients to get tested and to isolate. However, he cautioned them to be considerate in phrasing their advice to isolate and never tell them to isolate themselves in a room. Medical professionals must be weary of the differing living situations of many individuals in the community — according to Correa, Latinx households often have up to ten people living in one room, so isolating can be difficult.

He added that family oriented messages are often most effective with the Latinx community, so health professionals should try and frame COVID-19 recommendations as benefiting a patient’s entire family. He said health care professionals should dispel any myths and conceptions about COVID-19, ensuring Latinx patients have accurate information about the disease.