As a critical care nurse on the front lines at a New York City hospital, Sandra Lindsay was a worthy choice this week to be the first American recipient of a new coronavirus vaccine.
But there is another reason Ms Lindsay may have been a model candidate to have her injection broadcast on live television: as a black woman who was born in Jamaica she is part of a racial group that has a longstanding reluctance to accept vaccinations and other interventions pushed by public health authorities.
“Unfortunately, due to history, my population — minorities, people that look like me — are hesitant to take vaccines,” Ms Lindsay acknowledged on Monday after her injection.
Having solved a scientific riddle in record time to produce a Covid-19 vaccine, public health authorities now face a more human conundrum: persuading minority groups that have been hardest hit by the pandemic to trust new vaccines. As Ms Lindsay noted, it would not work “if only some people” took it.
Only 42 per cent of black Americans said they would take a Covid-19 vaccine, compared with 61 per cent of white Americans, according to a Pew Research Center opinion poll published earlier this month. That finding was consistent with black people’s lower uptake of the vaccine developed for the last pandemic, the H1N1 flu virus in 2009 — not to mention the annual flu shot.
There are deep-rooted reasons for black Americans’ scepticism toward the public health system. One of the most harrowing was the so-called Tuskegee Study, in which black men in rural Alabama suffering from syphilis were denied treatment and lied to for decades by doctors so they could study the disease’s progression. The abuse ended only after a whistleblower came forward in 1972.
A study by Marcella Alsan, at Stanford Medical School, and Marianne Wanamaker, at the University of Tennessee, found that the distrust in the medical system bred by Tuskegee had spread throughout the black community. By 1980, it was responsible for a reduction in life expectancy for black men aged over 45 of more than a year, as well as a widening health gap between black and white Americans.
“Most are like, ‘straight-up no’,” Dr Brittani James, a physician in Chicago’s South Side area said of her patients’ response to the vaccine. “They are thinking ‘is this the government trying to hurt me?’ ‘Is the medical establishment trying to hurt me?’ They are truly terrified that they are being targeted, which is animated by racism.”
With Covid-19, historical distrust is mingling with other factors unique to this pandemic, according to Dr Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University. The record-breaking speed with which the vaccine was developed has contributed to suspicions that corners may have been cut and safety sacrificed.
Meanwhile, the fact that black, Hispanic and indigenous Americans are suffering higher death rates than white Americans appears to be deepening a belief that authorities view them as expendable.
“Some of this is grounded in historical trauma, some of this is grounded in everyday social bias when they interface with the health system, and some of this is very specific to the pandemic,” Dr Schoch-Spana said.
Among Hispanic people, there is an added distrust because of the crackdown on immigration, according to Francisco Moya, the city councillor for the Elmhurst section of Queens, New York. The heavily immigrant neighbourhood was among the worst-affected in the city by Covid-19 earlier this year. The virus is again on the march there, with a 9.4 per cent positivity rate recorded this week.
“When that anti-immigrant sentiment has been at the forefront of this administration for the last four years, there’s definitely going to be a mistrust for the federal government — especially when the vaccines are coming so quickly and there’s so little data,” Mr Moya said.
Through Spanish-language town hall meetings, including one on Tuesday, he has been trying to counter rumours that federal agents will be deployed at hospitals to arrest illegal immigrants who go for vaccinations — or will implant microchips in them. “If you go on the internet, you can see all the completely crazy rumours that are being spread about this,” Mr Moya said.
Public health experts say that minority communities must be involved in efforts to build trust.
“We have some great national spokespersons that are talking about the safety of vaccines — Tony Fauci and others. But this is really going to come down to tapping into trusted voices in local communities,” said David Harvey, who — as executive director of the National Coalition of STD Directors — has for years been struggling against the legacy of Tuskegee in launching sexual health campaigns within minority communities.
Speaking at Riverside Church in Manhattan last month, New York state governor Andrew Cuomo echoed that message. “We need to make special efforts with the vaccine to reach the underserved black, brown and poor communities,” he told congregants. “The private market alone will not do it. We need to enlist community groups to distribute the vaccine in their community.”
Churches serving black communities should play a role, Dr James suggested. Others are looking to the barbershop.
A programme developed in 2011 by Dr Stephen Thomas, at the University of Maryland, enlisted barber shops and hair salons used by black people to perform public health outreach. While giving a trim, a barber might talk to his customer about the importance of a colon cancer screening.
Another idea is to hire people from the affected communities — many of whom have been made unemployed by the pandemic — to serve as public health workers. A bill sponsored by Democratic senators Kirsten Gillibrand and Michael Bennet would provide federal money to create a “health force” that reflected the diverse communities it would serve.
“We can’t think about the Covid-19 vaccination campaign as a one-off whose only purpose is to get a shot in the arms of people,” Dr Schoch-Spana said. “It’s also about the larger recovery from the pandemic, and that means dealing with the economic, the psychological and the physical health impacts. It’s about recovery.”