Many Black Americans don't trust a COVID-19 vaccine. It's important to understand why‌

Maura Hohman

The name Operation Warp Speed — what the federal government has dubbed the initiative to condense the normally yearslong process of creating and distributing a vaccine into a matter of months — doesn't exactly instill confidence. In fact, many of Dr. Leon McDougle's patients, predominantly Black Americans, have pointed to just that when expressing their hesitation to receive a COVID-19 vaccine.

"People have concerns about something that was developed in warp speed," McDougle, a family medicine physician at The Ohio State University Wexner Medical Center in Columbus, told TODAY. "It may have been a viable political title. It is not such a title for the general public and uptake of the vaccine."

COVID-19 vaccine hesitancy affects all races

Recent research validates McDougle's view. In September, only 50% of Americans said they'd be willing to get a COVID-19 vaccine, according to a Gallup poll. By October, this number had risen to 58%. These rates are also notably lower among racial minorities. The same survey found 48% of non-white adults said they'd get the vaccine compared to 61% of whites.

Looking at Black Americans specifically, one of the most rigorous surveys on this topic found that only 14% "mostly or completely trust" a COVID-19 vaccine will be safe, according to COVID Collaborative, a national, bipartisan organization focused on ending the pandemic. It also found that less than one-fifth, 18%, of Black Americans "mostly or completely trust" a COVID-19 vaccine will be effective.

Asked about the reason for vaccine hesitancy in the Black community, McDougle was quick to call out that many white people are hesitant, too. But for Black people, he said, the impact of the Tuskegee Study, Henrietta Lacks and Dr. J. Marion Sims are still felt.

Medical experimentation's racist history

The Tuskegee Syphilis Study, which ran from 1932-1972 at the Tuskegee Institute in Alabama, notoriously withheld treatment from its Black, male participants, who were sick with syphilis (a bacterial infection usually spread by sexual contact) and not given all the information necessary to provide informed consent, according to the Centers for Disease Control and Prevention. The experiment, run by a division of the U.S. federal government, lasted 40 years, despite originally being scheduled for six months. It's estimated that 100 subjects died of tertiary syphilis, a late stage of the disease where a person's brain, nerves, eyes and more may be damaged.

During the same time frame, in 1951 Henrietta Lacks' cancer cells were taken without her knowledge when she sought treatment at Johns Hopkins Hospital in Baltimore. Her cells are a crucial research tool to this day. But the contribution is colored by issues of consent and undertones of experimentation on and profiting off Black bodies. Neither Lacks nor her family were ever paid, though the medical community's made countless dollars from her cells.

J. Marion Sims, called the founding father of gynecology, earned his title by experimenting on enslaved women without their consent — or anesthesia. It's a dark legacy that many argue still persists. One example: In 2018, Black women were 2.5 times more likely to die in childbirth than white women.

Present-day challenges go beyond health care

You don't need to look to the past for reasons for medical mistrust in the Black community, Dr. Allison Agwu, an infectious disease physician at Johns Hopkins in Baltimore, stressed.

"It's engrained from long-standing things that have happened that have communities really (concerned about) something being ... purposely given to them to deleteriously impact them," she told TODAY, later adding, "The past is the present and, if we're not careful, continues to be the future."

During the ongoing coronavirus epidemic, Black Americans with COVID-19 have been 3.7 times more likely to require hospitalization and 2.8 times more likely to die than whites, according to CDC data. In part, that's because Black Americans are also more likely to have underlying conditions and less likely to have health insurance or access to care, NBC News has reported.

But these statistics don't highlight "the everyday realities of how people feel ... and how institutional systems, structures and race impact ... when they interface with the medical system," Agwu said.

When having conversations with her patients about vaccines and treatments, she believes the keys are never to assume why someone's hesitant and to be truthful, both about the data and the reasons they may point to for any medical distrust.

"It's important that we talk through those because if you try to act as if those did not exist and they're delusional, et cetera, then you're not starting from a place of honesty," she said. "You've got to be honest ... to then gain trust to then debunk myths, acknowledge where things are awry in order to move forward."

Right now, many Black Americans, Agwu explained, are grappling with the question: "If you don't care about me when I'm getting shot down in the street ... why do you all of a sudden care so much about me with this vaccine?"

Vaccine rollout: What's next?

Dr. Lisa Cooper, a professor at Johns Hopkins' school of public health, told TODAY that she sees parallels between the COVID-19 epidemic in the U.S. and the 2014 Ebola outbreak in West Africa. Cooper, originally from Liberia, recalled that "there was a lot of mistrust from community of governments and all these outside people coming from other countries."

What ultimately made a difference, according to Cooper, was working with local leadership, such as chiefs from villages, who could speak in words everyone could understand and vouch for the clinical trials and treatments — once their trust was earned.

"I think it's really important who is delivering the message and who introduces the person who's delivering the message ... to vouch for them, for their credibility and trustworthiness," Cooper said. She added that she believes people like pastors', teachers', family doctors' and nurses' advocacy will have an impact "more so than somebody that (you) just maybe saw on television."

Martha Dawson, president of the National Black Nurses Association, told TODAY she believes Black medical professionals should share that they're planning to get the vaccine and actively following the recommended preventive measures throughout the epidemic.

"It's not like I'm saying, 'Do this,' and I haven't done it," Dawson explained. "I can say, 'I've done it,' ... so they're hearing from someone who's just not working there, but they also participate."

Another strategy that Cooper and Agwu agree is critical: A group of Black medical professionals has already sat down with Pfizer, Moderna and AstraZeneca to review their data, McDougle said. These ongoing meetings are being spearheaded by the Black Coalition Against COVID-19 and the National Medical Association, the country's largest group representing Black doctors and their patients.

"In our roles as trusted messengers, we want to be confident in any decision made by the Food and Drug Administration concerning the vaccines and therapeutics," McDougle said. "Thus far, the information appears promising."