Hearing the Countless Concerns about COVID-19 Vaccination
News Analysis by (Former CT Health Commissioner) Renée Coleman Mitchell and Kent Ashworth
Hartford, CT – On TV, “Vaccine Hesitancy” has become the go-to label for suspicion held by individuals who see the COVID-19 shot as a crapshoot … even though scientists and available research advise that the shot will protect most everyone from serious illness and death.
Despite the bottom-line, life-saving benefits, the umbrella term “hesitancy” misses the point. Black people are not subject to broad-brush branding. There are multitudes of reasons for people’s caution about the vaccine.
Conventional wisdom relates reluctance to poor people’s historic lack of access to a doctor, the racist history of guinea pig experiments, and the unnecessary confusion prompted last year when presidential politics took precedence over preventing death. Making wearing a mask a political statement instead of infection control turned out to be a fatal error of major proportions.
At the 2020 outbreak of the virus, the political insecurity of leaders in China, India, Russia, Turkey, the United Kingdom – and the U.S. – caused them to downplay the crisis, ignore the science, and reject international cooperation. According to a new analysis in the journal Foreign Affairs, “Politicians made mask wearing a matter of political identity. The result of all the chaos, delay, and stupidity was a largely uncontrolled spread and a heightened death toll.”
Beneath all the noise, research also shows Black people have been systematically undertreated for pain based on race-based biases built up over time.
In its Winter 2021 issue devoted to “Confronting Racism in Medicine,” the Harvard Medicine Magazine describes how structural racism (long cataloged in education, environmental protection, health care, housing, mass incarceration, poverty, and family wealth) has always existed in medical training. Medical students have always wondered why there are difference in medical standards and treatment of Black patients, but now have the courage to speak out. They question grandfathered – and faulty – treatment recommendations based on race.
Just as it is important to understand the science if we are to better prepare for the next pandemic, it is crucial that we hear the full range of reasons why Black people don’t want the vaccine. One reason: Some want to ask their questions and/or hear an honest discussion of the pros and cons.
Over the past year, we have personally listened to many reasons people give for declining the vaccine. In anecdotal conversations struck up with women and men ages 21 to 83, including among health care workers, young high school and college graduates, highly educated engineers, and educators with PhDs, and political leaders, as well as with those essential workers who don’t have the option to work remotely at home, a long list of categories comes up when people are asked why they will not get the vaccine.
Albeit anecdotal, our information tells us no single label can possibly take into account the multitudes of reasons for reluctance. Yes, most are aware of the horrific research on Black people such as the Tuskegee Experiment. Moreover, Black people continue to experience race-based medical treatment. It is important to consider how many different, individual reasons are given to balk at taking the shot. Here is an overview:
- • Phobia about needles.
- • Invincibility among youth.
- • Being resigned to fate.
- • Peer group fear and rejection of the vaccine (by friends, family, or co-workers).
- • No experience (and hence no working relationship) with a family doctor.
- • Based on experience, little reason to trust in the effectiveness of health care.
- • The vaccine’s unknown, potentially negative impact on pre-existing conditions.
- • Leading scientists’ acknowledgement of certain individuals’ vulnerabilities.
- • Media accounts of bad reactions to the shot.
- • The current federal okay of only “emergency use” – but not full approval.
- • The apparent speed of the vaccine’s development.
- • The impression by some that they already had, and had gotten over – COVID-19.
Facing these considerations and more – plus rampant rumors and misleading information – people just want to ask their questions and get answers.
Those with health coverage and relationships are equipped to raise their COVID-19 questions at the doctor’s office, but underserved folk play out those conversations elsewhere … or not at all.
Dialogue is important, especially given the disproportionately higher rates of COVID-19 illness and death in Black communities. Accordingly, here are some often heard questions – and candid answers:
Q: As with many of the “social determinants of health,” life expectancy for people of color already was registering lower before the pandemic – and the decline in life expectancy in 2020 was 3.25 years for Black Americans and 3.88 years for Hispanic Americans, compared to 1.36 years for white Americans (according to a new study released in The BMJ, from Virginia Commonwealth University, the University of Colorado-Boulder, and the Urban Institute). Given the systemic gap in public health outcomes chronicled since the 1980s, did we just see the pandemic accelerate the already growing public health crises of racism and poverty? A: Yes.
Q: Can you recommend helpful sources of reliable information that should be taken into account by parents, community leaders, and others in touch with individuals opposed to the vaccine? A: The Centers for Disease Control and the Johns Hopkins Medicine websites are goldmines for those who have specific questions or general curiosity.
Q: What approaches, if any, would help cut through reluctance among the people already most vulnerable to COVID-19 and its predicted variants? A: The opportunity to ask questions and receive a full airing of factors is important. For example, those concerned about the rapid development of the vaccines should know that researchers had been advancing the technologies leading to the shots for many years. Enormous advance work was well under way.
Q: Albeit from anecdotal conversations, what stands out most among vaccine skeptics, in terms of their core reluctance? A: Historically, our nation has a long history of hypocrisy in government pronouncements. The Trump administration’s political shell game over COVID-19 infection control in 2020 was just the latest example. It’s important to keep an open mind; the updated information on the CDC and Johns Hopkins Medicine websites reflects the fact that the research is tracking trends in the illness in real time.
Q: Given the many reasons for reluctance (including the deep problems of access and the history of horrors), how can skeptics go about weighing the benefits and risks before exercising the option to be vaccinated or not? A: It’s too soon for research to be conclusive, especially with the new variants of the virus. Even though small numbers of individuals have experienced problems, however, the vaccines are overwhelmingly (around 90 percent) effective in preventing serious injury and death. So, while not perfect, the odds of staying healthy after getting the shot are very good.
Q: What would be the key points to emphasize in an honest appraisal of the pros and cons as to the known benefits and unknown risks of the vaccines (rather than the extremes of overly optimistic PR on the one hand, versus confusing politicization on the other)? A: The technologies that enabled fast development of the vaccines have been in the works for years, so that past preparation was crucial. Now it will be equally crucial to understand how to control infection in the future.
Q: Who are the best messengers? A: Those family members, friends, and medical specialists who have earned your trust by showing good judgment about the facts – and care about your well being. The worst messengers operate without the facts.
Q: Looking to the future, what are the most promising ways to address both the pitfalls and the disinformation that surround pandemics? A: Don’t get sucked in by those who play politics with infection control.
Black and Hispanic Americans’ access to and treatment by the health care system has been stained by the slew of inequities in education, income, stable jobs and housing, livable wages, etc. (the components of structural racism that form the social determinants of health). But social determinants are just one of the countless reasons why people do not want to get the vaccine.
Even if the answer for now is, “no one knows yet,” people of color deserve the opportunity to ask their questions and receive balanced responses.
