The coronavirus pandemic has laid bare health inequities around the country, with African Americans disproportionately affected by COVID-19. And studies show African Americans and people of color are leery of getting vaccinated against the disease as the result of past mistreatment, citing the notorious Tuskegee experiment that turned Black men with syphilis into medical guinea pigs.
“We know that a lack of trust has been a major cause of reluctance, especially in communities of color, and that lack of trust is not without reason as the Tuskegee study occurred within many of our own lifetimes,” Surgeon General Jerome Adams said last week.
Some health care experts, however, say Adams’ message and those like it come too late, as the vaccine rollout is already underway.
“I think, potentially, it might have been a valuable conversation to have a few months ago, when Operation Warp Speed (OWS) was first conceived and rolled out,” said Dr. Michael Williams, director of the University of Virginia Center for Health Policy.
“So, talking about Tuskegee [and] many other similar events in … U.S. history … is double-edged. It’s critically important that Americans understand … many of those who experienced it, directly or indirectly, are still alive,” Williams said.
The importance of addressing ‘past wrongs’
Adams, who was speaking at a vaccination kickoff at which health workers at George Washington University’s medical center received Pfizer (PFE) and BioNTech’s (BNTX) newly authorized vaccine, said it’s important for the nation to address past wrongs including Tuskegee.
“To truly combat vaccine hesitancy and encourage diverse enrollment in clinical trials, we must first acknowledge this real history of mistreatment and exploitation of minorities by the medical communities and the government. Then we need to explain and demonstrate all that has been done to address these wrongs,” Adams said.
In 1932, the Public Health Service, working with what was then the Tuskegee Institute, began what would become a decades-long medical experiment called the “Tuskegee Study of Untreated Syphilis in the Negro Male” to study the “full progression of the disease.” At the time there was no known treatment for the highly contagious and deadly venereal disease.
Some 600 Black men (399 with syphilis, and 201 without) in Macon County, Alabama, participated in the study, lured by the promise of free medical care, free meals, and burial insurance. Researchers didn’t tell the sick men their diagnosis or the true purpose of the study. The men were given placebos and ineffective treatments — even long after penicillin became an effective treatment for the disease in the late 1940s.
By 1972, when a journalist exposed the unethical “study,” 28 men in the study had died from syphilis, 100 had perished from related complications, and at least 40 spouses had contracted the disease, with some 19 children born with syphilis.
Reaching Native American communities
Black Americans are not the only patients with reasons to distrust vaccines. U.S. officials are also trying to boost vaccine awareness campaigns in Native American communities, which also have a long-standing history of systemic abuse and unethical treatment by the U.S. federal government. At a Dec. 9 event, U.S. Health Secretary Alex Azar pointed to the hurdles of getting vaccines to tribal nations.
“OWS has worked with CDC and with these jurisdictions so that we have everything needed to administer the vaccine … and plans for how to get the vaccine to harder-to-reach areas and populations, like members of tribal nations and residents in long-term-care facilities,” Azar said.
Daniel Dawes, director of the Satcher Health Institute at Morehouse School of Medicine, said social determinants of health (factors such as where people live and access to healthy food) have been exacerbated by the pandemic and must be addressed.
“While we work in the near term to create equitable access to the vaccine, we cannot lose sight that health outcomes are declining and health inequities are widening in the United States because we have failed to address the root causes of these problems. The path out of this pandemic runs in parallel with the path towards health equity, and the path to health equity will only be paved when the U.S. seriously addresses the upstream factors and invests the resources needed to help every community thrive,” Dawes told Yahoo Finance.
Public awareness or pandering?
That the first person to receive a COVID-19 vaccine in the U.S. was an African-American critical care nurse at Northwell Health was no accident. Numerous health systems have highlighted at least one person of color at their vaccine kickoff events.
“Because of the long history of mistrust and, frankly, poor treatment of people of color by the U.S. health system … we are trying to send a message,” UVA’s Williams said.
With those at highest risk of contracting COVID-19 belonging to African-American, Latinx or indigenous populations, it’s necessary for health workers to step up, he said.
LatinX and Hispanics face discrimination within the health system, according to several studies, and are also in need of better communication.
“The goal … is to send a very strong and clear message that not only is the vaccine safe, but it’s critically important that those who are at highest risk are receiving it early in the pandemic response,” Williams said.
Dr. Uché Blackstock, Yahoo News Medical Contributor, however, suggested such media cam send a mixed message.
“Some have expressed that the #COVID19 vaccine photo-ops and videos with Black health-care workers come off as heavy-handed and like pandering to Black people. I can’t be mad at this take. We need to figure out a middle road for vaccine messaging,” Blackstock said.
Finding that middle road will be an ongoing challenge for future administrations, even as President-elect Joe Biden has appointed an overwhelming number of minorities in key roles.
Former U.S. Surgeon General Dr. Richard Carmona told Yahoo Finance that’s key. He told Yahoo Finance more minorities need to be in key health care positions to “speak with integrity to the science of an issue.”
“The politics, in some cases, is as deadly as the virus now, because we remain a nation divided,” Carmona said.