Vaccine hesitancy or systemic racism

When the United States began to roll out Covid-19 vaccines earlier this year, uptake by black people lagged behind their white counterparts. Many assumed this was by choice: the history of medical abuses had supposedly left African Americans mistrustful of the public health intervention. A similar vaccine hesitancy has also purportedly hampered vaccination efforts.

But this narrative amounts to little more than obfuscation.

Minority groups and developing-country populations may approach health services cautiously — with good reason. From the gynecological experiments J Marion Sims performed on enslaved black women in the 1800s to the four-decade Tuskegee syphilis study, in which infected black men were observed but not treated, there is no shortage of instances of medical abuse against African-Americans.

By blaming low Covid-19 vaccination rates on vaccine hesitancy, analysts and healthcare providers are effectively using this history to again victimise the same people. Decisionmakers should not be permitted to evade responsibility for their failure to serve marginalised groups adequately by recalling the medical profession’s past inhumanity. Instead, these episodes should highlight the systemic racism that pervades healthcare today and spur action to address it.

Racism in healthcare is not a thing of the past. In the US and elsewhere, ethnic and racial minorities have faced substantially higher risks of becoming infected with the new coronavirus or dying from Covid-19. Non-Hispanic black people comprise 12% of the US population, but 34% of coronavirus deaths in cities and states that reported deaths by race and ethnicity.

This reflects the barriers ethnic and racial minority groups face in getting medical care and treatment, as well as inequities in other areas that affect health such as education, wealth, workplace conditions and housing.

The same barriers and inequities are undermining vaccine uptake. Chicago’s vaccine plan is a case in point. The city wanted to deliver doses through neighborhood pharmacies. But this would exclude the mostly black people who live in “pharmacy deserts”. Those same people are also less likely to have reliable internet access, making it difficult for them to register for a dose.

Similarly, claims that Africans are simply refusing to get vaccinated ignore the affronts by rich countries.Most Africans have not had the luxury of choosing whether they want the vaccine, because rich countries have been hoarding doses.

Moreover, the vaccines Africans do have access to — largely those developed in China, Russia and India — are often not approved in rich countries, and might be far less effective than, say, the mRNA vaccines produced by Pfizer and Moderna, which North Americans and Europeans have largely claimed. How can rich countries blame Africans for hesitating to accept vaccines they themselves have refused?

A handful of rich countries, led by the US, spent months blocking negotiations of an emergency waiver of World Trade Organisation intellectual property rules on Covid-19 treatments and vaccines, which would enable the rapid scaling up of production, to protect corporate interests. US President Joe Biden’s administration recently reversed the country’s position, and is now backing the waiver. During the HIV crisis of the 1990s and early 2000s, politics and profits similarly won out over the ethical imperative of ensuring affordable access to treatment, leading to hundreds of thousands of unnecessary deaths in the Global South, especially Africa.

Black people want the Covid-19 vaccine. In March, a Morning Consult poll found that racial gaps in vaccine willingness in the US were narrowing. As Georges Benjamin, executive director of the American Public Health Association, said in April: “We overstated the hesitancy issue,” and “understated the structural access issues”.

The same goes for African populations. In December, a survey conducted by the Africa Centres for Disease Control and Prevention (Africa CDC), in partnership with the London School of Hygiene & Tropical Medicine, indicated that 79% of Africans would take a Covid-19 vaccine if it were deemed safe and effective.

Ensuring that these groups get the vaccine is a job for their leaders. That means dismantling barriers to access and working to earn the public’s trust. The Africa CDC is setting an example by meeting people where they live, listening to and acknowledging their expectations and anxieties, and nurturing greater involvement with the public health system.

Privileged countries and people will be tempted to put their own needs first. They might even be tempted to disregard the lives of vulnerable populations. But that temptation points to a pandemic without end. — © Project Syndicate

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Stephaun E Wallace
Stephaun E Wallace, a staff scientist at Fred Hutch, is the director of external relations at the HIV vaccine trials network and Covid-19 prevention network and a clinical assistant professor of Global Health at the University of Washington.
Maaza Seyoum
Maaza Seyoum is African coordinator of the People’s Vaccine Alliance and partnerships lead of the African Alliance.

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