Historical Reasons for Vaccine Hesitancy Among African Americans and Why People of Color Play a Critical Role in Achieving Community-Wide Protection Against the COVID-19 Coronavirus

Written By Humayra Ali
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People of color, including Black, Hispanic, and Native Americans, are nearly 3 times more likely to die of COVID-19 than Caucasian, white people. However, there is an immense level of vaccine hesitancy among these people, particularly African Americans. Aside from the safety concerns, vaccine hesitancy among people of color is deeply rooted in mistrust in our government and healthcare disparity. If most of our African American and Latino communities refuse to take the COVID-19 vaccines, then we simply won’t get to herd immunity.

Herd immunity can be better understood as herd protection. When a big percentage of the population is vaccinated, the infection cannot spread as easily, mainly because there aren’t that many people left (unexposed or unvaccinated) who can succumb to the infection—therefore, the disease can potentially disappear. But, the key to making herd immunity work is by vaccinating most of the population. 

It’s all about the numbers

In the case of COVID-19, about 70% of the population must be vaccinated before we achieve herd immunity through vaccination. 70% of the population amounts to about 230 million Americans; of which, Caucasians make up about 60% of the U.S. population. In other words, if every Caucasian person were to get the COVID-19 vaccine, the Americans would still fall short of herd immunity. Accordingly to a recent survey, only 68% of the Caucasian population are willing to get the COVID-19 vaccine. With this projection, we would only get to 42%. 

African Americans make up a little over 13% of the U.S. population. A recent study suggests that about 60% of African Americans refuse to take the COVID-19 vaccine. If this survey outcome holds up, it will be very tough to reach that expected 70% threshold to reach herd immunity. 

Latinos are equally needed to reach herd immunity. They make up just over 18% of the U.S. population. Similarly, the same study revealed that 32% of Latinos could opt out of getting a COVID-19 vaccine. When you combine the % of African Americans and Latinos who could potentially refuse the vaccine, herd immunity becomes almost impossible. Without increased acceptance of vaccines, we will likely compromise community-wide protection against COVID-19.

Why the skepticism with COVID-19 vaccines among African Americans?

A significant level of mistrust among the Blacks comes from historical disparities such as the Tuskegee Study, the Henrietta Lacks’ case, and the inequities they still face by the medical community today. 

In the Tuskegee study, Black men with syphilis, a sexually transmitted disease that can cause serious long-term effects such as arthritis, brain damage, and blindness, were promised treatment but didn’t receive it. Many of the men died, became blind, or developed other serious health problems. 

The Tuskegee Study was an observational study of more than 400 sharecroppers with untreated syphilis to investigate how the disease differed clinically in Blacks versus non-Black people. This study was conducted by the U.S. Public Health Service. The study was highly unethical in the sense that the trial participants were not told they had syphilis, not provided any counseling on avoiding the spread of the disease, and, most strikingly, not given any treatment throughout the study--which lasted pretty long from 1932 to 1972. This infamous study was the longest experiment on humans that used no treatment in the history of medicine. Usually, when a medication is proved to be beneficial in patients after some time during a clinical study, patients from the control group (those who get a “dummy” drug for comparison purpose) are switched over to the treatment group—the thinking is that it would be unethical to continue the study knowing how the medicine under investigation could benefit the patients. 

More detrimentally, this Tuskegee study exemplified exploitation of blacks in medical history, making a lasting implication in their distrusting the government and healthcare system. Because of this historical exploitation, our clinical research communities are still struggling to improve the representation of minority participants in clinical trials, which is a shame because without having sufficient representation of different ethnic groups in the clinical studies, we may not know for sure how effectively a drug would perform in that racial cohort.

In another example, Henrietta Lacks’ “immortal” cancer cells (called the HeLa cell line) were used for medical research without her or her family’s knowledge, let alone their consent, and without any financial compensation. The HeLa cell line was established in 1951 from cervical cancer cells taken from an African American patient named Henrietta Lacks. This was the first successful attempt to immortalize human-derived cells in a laboratory setting. HeLa cells were widely adopted in research labs across the globe mainly because of these cells’ extraordinary capacity to survive and multiply—therefore immortal--and there were no restrictions when it came to sharing the cells from one lab to another. As researchers shared the HeLa cells widely with other scientists, they became a mainstay of biological research. 

The year 2020 marked 100 years, or the centennial year, since Henrietta Lacks’ birth. Ms. Lacks died in 1951 from aggressive cervical cancer at the age of 31. Today, work done with HeLa cells underpins much of key discoveries in modern medicine in various fields including cancer, immunology, and infectious disease. Not to my surprise, HeLa cells have even been used recently in research for COVID-19 (coronavirus) vaccines. The collective impact of the HeLa cell line on research is evident by its occurrence in more than 74,000 scientific journal abstracts. To speak more to its broad utility, I even used HeLa cell lines pretty routinely during my Ph.D. work to grow and characterize viruses. But little did I know how much this Black woman contributed to my research work. 

The story of Henrietta Lacks also illustrates the racial inequities that are entrenched in our systems. None of the biotechnology companies that profited from Ms. Lacks’ cells compensated any money to her family. Even decades after her death, doctors and scientists repeatedly failed to ask her family for consent for use of the cell line, revealing her name publicly, and sharing her medical records with the media.

Then there are some African Americans who are genuinely concerned about the safety of COVID-19 vaccines when developed under a rapid schedule, just like many other ethnic groups questioned this, including whites. To them, I say that even African American scientists and leaders were part of the COVID-19 vaccine development/approval initiative. Meharry Medical College President Dr. James Hildreth is an African American member of the FDA committee who authorized the first two COVID-19 (Pfizer’s and Moderna’s) vaccines. To date, there is no evidence that COVID vaccines may have serious long-term side effects. Clinical safety and efficacy testing of the vaccines has been ongoing since March 2020 and more than 10% of the U.S. population have been vaccinated. Out of millions of doses, only a handful of severe side effects have been reported that are manageable severe allergic reactions. 

Historically, it has taken years to develop an effective vaccine that also has a good safety profile. Today, the crisis surrounding the COVID-19 pandemic created an urgency to speed up the vaccine development initiatives. This record-speed achievement raised a lot of skepticism around how this was done, and whether these vaccines are safe to administer. Another article in this blog explains why indeed it was possible to make these vaccines in record time without compromising safety and efficacy.

VaxTherapy is NOT affiliated with any of the pharma/biotech companies working on COVID-19 vaccines. The purpose of this post is to provide education and awareness from a virologist’s independent perspective based on available facts and data

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