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Race and the vaccine; not a race for the vaccine.
I don’t understand how people could be against receiving this vaccine…well, actually I can; but not for the same reasons as some people might have.
I don’t understand how people could be against receiving this vaccine…well, actually I can; but not for the same reasons as some people might have.
Unfortunately, people of color, minorities, and other disenfranchised groups have a longstanding mistrust of public health initiatives designed for the “better good”, which were actually concentrated on making white people better.
This is not going to be an easy thing for me to write about, it’s not going to be an easy thing to read about, and I am going to ask for a bit of grace as I stumble through some of this.
My motivation is, in some small way, to take away some of that hesitancy and encourage all of us to vaccinate our way out of this disaster.
To start any discussion such as this, I think it is best to stay grounded by examining both history and data: of this pandemic, of health initiatives, of vaccines in general, and of these vaccines in particular.
History first.
History first.
We too often look at the horrors of Nazi experiments on humans as distant lessons to be learned. ( https://encyclopedia.ushmm.org/.../en/article/josef-mengele ) They are beyond compare in the scope of their atrocities. That is not open for debate.
However, we in our American bubble, need to struggle with our own evil and understand how this impacts today’s world. The Tuskegee Experiment was no less evil while being smaller in scope.
The US Public Health Service knowingly and purposefully withheld antibiotic treatment for syphilis from black men in Alabama. Furthermore, they lied to the participants and didn’t allow them to have information to be able to provide consent to act as subjects.
(this has directly led to the consent forms we all sign if we participate in a research study) Finally, as was referenced in the link below, it wasn’t until a whistleblower resulted in a New York Times article in 1972, that the Tuskegee study finally ended.
128 patients had died of syphilis or its complications, 40 of their wives had been infected, and 19 of their children had acquired congenital syphilis. ( https://www.mcgill.ca/.../40-years-human-experimentation...)
How many are learning about this horror for the first time today?
How many are learning about this horror for the first time today?
How many barely remember reading something about this in school? However, how many people of color, especially in Southern States, had these stories told to them in detail buy family members? How much of the education about this atrocity passes through the lens of color?
How much does this account for mistrust of research? ( https://pubmed.ncbi.nlm.nih.gov/9366634/ ) ( https://pubmed.ncbi.nlm.nih.gov/8918067/ )
Now for the history of this pandemic.
Now for the history of this pandemic.
As I wrote several months ago, SARS-CoV-2 is a tiny virus that has pulled the curtain back on the healthcare system throughout the US to expose the flaws in the system.
Just as Dorothy was instructed to “pay no attention to that man behind the curtain”, we can also position ourselves on an individual side of the prism of COVID to either see rainbows and hope brought on by incredible workers, researchers, and advances, or the cold steel rail of…
…a harsh and piercing “redline” of light. The cold steel rail reference is specifically to the Dark Side of the Moon as it has led (and been fostered by people) to the creation of an “Us and Them” mentality that uses our fear against us all.
The redline refers to the systematic discriminatory processes that effectively put a line around certain racial neighborhoods. Soon, we will begin to move past the greatest danger posed by the virus.
However, the picture that is left shows how some communities have suffered far more than others and were effectively the modern version of healthcare redlining.
( https://www.cdc.gov/mmwr/volumes/69/wr/mm6949a3.htm) Pre-pandemic healthcare in the hard-hit communities has been exposed for what it really is: a loosely fitting Band-Aid on a gaping wound. Does it do something? Sure. Does it do a great job? Absolutely not.
Remember, the system was not engineered to deliver anything other than the result it got. Most healthcare in our country provides basic health sustenance, the equivalent to an old-fashioned soup kitchen.
It keeps people from complete starvation, but it certainly does not nourish them. It’s neither universal in its availability nor quality. This has turned healthcare into neither a right nor a privilege for many people.
( https://www.nytimes.com/.../coronavirus-black-hispanic.html)
It now becomes understandable that people in certain communities no longer trust healthcare, nor do they trust that anyone is trying to help them receive it.
It now becomes understandable that people in certain communities no longer trust healthcare, nor do they trust that anyone is trying to help them receive it.
This is terrifying and distressing in the face of vaccine development because the people who could most benefit from protection are the least likely to reach out for it. It sets up a dangerous, continuous downward spiral.
Historically, this is no different from other vaccines.
Historically, this is no different from other vaccines.
Flu vaccine adoption amongst people of color has always been low. ( https://www.kff.org/.../addressing-racial-equity-vaccine.../) However, the scientific and health communities have been at fault for not really attempting to change the core issues. Case in point, the current COVID vaccine trials.
The Pfizer vaccine has been approved. This is wonderful news! However, it is unfortunately understandable why there are already some voices of concern amongst underrepresented and disenfranchised communities.
When the study population is examined, 81.9% of participants were white. [see page 19] ( https://www.fda.gov/media/144245/download) Unfortunately, the AZ/Oxford trial was no better in this regard. The Moderna trial has made some adjustments to be more inclusive.
( https://www.cnbc.com/.../moderna-slows-coronavirus...)
Here is where I ask for some grace. I am not interested in white knight syndrome. I’m also not examining allyship with this line of writing. Rather, as a physician it is important to concentrate on data and dispel myth wherever possible.
Here is where I ask for some grace. I am not interested in white knight syndrome. I’m also not examining allyship with this line of writing. Rather, as a physician it is important to concentrate on data and dispel myth wherever possible.
Through my own investigation and interpretation of data and history I can completely understand the mistrust inherent in the complex relationship between medicine, public health, and race.
Therefore, I have to beg for some likely underserved latitude in interpretation of the results.
Statistically it is safe across all groups. There is absolutely no evidence to suggest that anything about this vaccine is influenced by race.
Statistically it is safe across all groups. There is absolutely no evidence to suggest that anything about this vaccine is influenced by race.
What is unfortunately crystal clear is that outcomes from infection with COVID are absolutely influenced by race. Some of these impacts can be solely attributed to a long standing resource disparity in healthcare.
These facts must motivate the most at-risk communities to adopt survival strategies to come out of this horrible situation. One such strategy is widespread vaccination and taking advantage of minimizing continued unequal application of protection.
The most important thing to remember about COVID is that the danger of the actual infection is known; it is terrible, and it can be prevented by this vaccine.
One of the smartest physician-scientists at Texas Children's/Baylor, Peter Hotez, is leading the charge in vaccine development.
He is also leading the charge in making sure that such a vaccine accounts for the worldwide disparity that will continue to be unveiled by this virus. We also understand that these dipartites are in our own country. We have known this was a developing problem of trust.
( https://www.nejm.org/doi/full/10.1056/NEJMp2030033)
We have to respond as one. The failure of accounting for all of us is a failure to account for any of us. These examinations of differences are not just academic or theoretical.
We have to respond as one. The failure of accounting for all of us is a failure to account for any of us. These examinations of differences are not just academic or theoretical.
They are not simply the right thing to do morally and ethically.(though that should be enough) They are also the smartest thing to do scientifically and medically.
By examining our differences, by leveraging diversity in response and treatment, we might be able to unlock the real secret to our outcomes.
We need to use the opportunity presenting itself to fix the problems that now have been uncovered; and fix them in a meaningful and collaborative manner.
Interesting, aren’t these foundational lessons for all of human existence?
Interesting, aren’t these foundational lessons for all of human existence?
The lessons that we are all in this together, that we should do onto others what we want done onto us, and that our differences make us stronger. #COVID #race #vaccine #disparity
