Vaccine Hesitancy, Systemic Accountability, and the Black Lived Experience.

The United States is in the storm surge of the COVID-19 pandemic. CNN reported that more than 2,800 Covid-19 deaths were reported in the United States on Wednesday, December 2nd — the most the country has ever reported in a single day. This news comes as Operation Warp Speed has produced several vaccines that are presently in large-scale (Phase 3) clinical trials and the U.K. just became the first country in the world to authorize a COVID-19 vaccine. While many doctors, public health experts, and the general public see this as a good sign that the end of the pandemic is in sight, the devil is in the details of who will be prioritized in receiving the vaccine and how it will be delivered.

Public health experts have also warned that specific communities may not readily uptake the vaccine due to religious, political, and philosophical perspectives. There is particular attention on critical numbers of Black Americans who report that they are unlikely to take the vaccine given their harmful experiences with longstanding medical and scientific racism in the United States. This is concerning as Black people continue to die from COVID-19 at disproportionate rates relative to their population in the United States.

Data on Black Americans’ views on the COVID-19 vaccine support developing extensive public health interventions that will combat vaccine hesitancy, “the reluctance or refusal to vaccinate despite the availability of vaccines.” According to a joint survey by the Kaiser Family Foundation (KFF) and the Undefeated, “Black adults are less likely than other groups to say they would get a coronavirus vaccine if it was free and determined safe by scientists.” Ongoing distrust in the healthcare system as well as in the rapid process of developing the vaccine, represent the primary reasons why many Black people express reticence with the prospect of getting the vaccine.

These findings are not earth-shattering news. In general, Black Americans are less likely to get a yearly flu shot relative to their white counterparts. Nonetheless, even when this difference is considered, a critical number of Black people express reluctance to getting the COVID-19 vaccine. Again this data is unsurprising. It should not be underestimated how much historical and contemporary experiences of medical racism partly account for Black Americans' rightful hesitation in taking the COVID-19 vaccine. Put into conversation with the Trump administration’s politicization of the COVID-19 pandemic, Black people’s hesitancy says much more about systemic racism and the fragility of United States’ democratic institutions than anything about their collective intellect.

Perhaps a bigger story revealed in some of the data on vaccine hesitancy is that there is a gender/sex difference in Black Americans’ views on the COVID-19 vaccine. According to the COVID Collaborative survey, “56 percent of Black men would get the vaccine, vs. four in 10 Black women.” This statistic speaks to intersectional experiences that are steeped in race, class, and gender that Black women experience in the healthcare system. The KFF and Undefeated survey report that “Black women overall are also more likely than Black men to report feeling that a health care provider didn’t believe they were telling the truth, assumed something without asking, or suggested they were personally to blame for their health problems.”

Everyday interactions between Black women and the healthcare system are a feature of the structural domain of power in a matrix of domination where power relations are organized around and designed to maintain the status quo of white, cis-gender, male power. Thus relationships, policies, and laws that are forged in this sphere not only exclude Black women but disproportionately harm them and their communities, making it more likely for many Black women to distrust a vaccine that is developed within the structural domain.

The million-dollar question, then, is how can the healthcare system gain Black women’s trust?

Patricia Hill Collins argues that Black women’s epistemological framework includes an ethic of personal accountability that provides them with alternative measures and standards for verifying information and relationships in the structural domain. In general, Black women do not automatically recognize knowledge holders based on educational credentials, race, gender, or age. Instead, they deem one’s knowledge claims as valuable in as much as that person maintains a moral and ethical connection to the ideas and theories they espouse and are accountable to the communities that are impacted by them. For example, Collins writes about her Black female students’ request for personal information about a Black male scholar in order to evaluate the merit of his thoughts on Black feminism. She writes:

“By requesting data on dimensions of his personal life routinely excluded in positivist approaches to knowledge validation, they invoked lived experience as a criterion of meaning.”

In a similar vein, an ethic of systemic accountability might be applied to the healthcare system and its messaging about the COVID-19 vaccine where knowledge claims are authenticated by the Black lived experience and an ethical relationship that is grounded in recompense. This means that healthcare providers and public health authorities must work to develop a framework of systemic accountability that does the following:

  1. Understands the healthcare system as one of many racist systems that continues to oppress Black people. Engage Black patients as whole people who are also harmed by economic, educational, judicial, and government systems.
  2. Moves beyond simply acknowledging the history of medical and scientific racism. Assume that Black patients have directly experienced medical harm or mistreatment across different health systems in the recent past and address it.
  3. Centers the Black lived experienced as critical and valuable knowledge. Validate it by asking Black people what systemic measures and processes are essential to them in assessing the safety of medications and vaccines.
  4. Highlights the ways a given healthcare system has developed ethical relationships with Black communities outside of healthcare. Develop Black business and community connections that are invested in systemic change.
  5. Creates mechanisms to achieve equitable healthcare for Black communities. Establish coordinated programs and workshops that provide training and professional development in health equity that specifically focus on anti-Black systemic racism.

To be clear, many individual physicians and public health experts already practice many, if not all, all of the things listed above. Indeed, some data suggest that Black people generally value personal relationships with their healthcare providers. While these relationships can be improved, the problem remains at the systemic level in healthcare.

As different coalitions of science and health advisors gear up to spend millions of dollars on vaccine education campaigns, they would do well to consider that what many Black people need most at this moment to feel comfortable taking the COVID-19 vaccine, is an ethic of systemic accountability where wide-spread responsibility for providing quality, safe, and equitable care is accountable to the Black lived experience.


Kim Gallon is the Executive Director and Founder of COVID Black. Learn more about COVID Black by clicking here.




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