COVID-19 Vaccine: Great Equalizer, or Instrument of Inequity?
By Maya Green
“When can I get my COVID-19 vaccine?” has been the question on many Americans’ lips since the Pfizer vaccine first became available in the United States back in December. Now, almost three months later, 21% of Americans have gotten their first shot, with the majority still wondering when it will be their turn. However, for many Americans, it is not as simple as waiting for a call, hopping in a car, and driving to a vaccine site. As with several healthcare-related issues in the U.S., the COVID-19 vaccine does not exist in a vacuum; it goes hand in hand with an immense lack of information, misinformation, and outright discrimination.
The social determinants of health, or SDOH, are largely responsible for America’s systemic healthcare inequities. These social and personal factors such as race, gender, sexuality, income, living situation, and employment status, among others, have an appreciable impact on an individual’s access - or lack of access - to healthcare. So, the question is, are the SDOH affecting access to the COVID-19 vaccine? Experts answer this query with a resounding “Yes.”
Healthcare and Race: A History of Misinformation
When discussing racial discrimination in the United States healthcare system, the Tuskegee study of 1932 to 1972 is often cited. In the study, researchers told 600 Black male participants- two-thirds with syphilis and one-third without- that they were being treated for an ambiguous ailment referred to as “bad blood.” In fact, the real purpose of the study was to observe the course of syphilis in the body; the men were never “treated”, even when an effective cure for syphilis was discovered, and they were never informed of the study’s true intent. Because of this lack of information, the participants never gave their full consent to be observed-but were nonetheless-continually for 40 years.
Today, the COVID-19 vaccine is available but regarded as far from trustworthy by many Black and Brown Americans; according to a report by the COVID Collective, less than 20% of Black Americans and slightly over a third of Latinx Americans believe the vaccine is safe and effective. With the healthcare system’s history of egregious treatment of BIPOC compounded by regular traumatic and exhausting experiences of medical racism, there is no question as to why this mistrust pervades.
The COVID Collective’s numbers are paralleled in local vaccine data. In Snohomish county, the Health District reports that three times more White county residents have received the vaccine than Latinx residents. While age demographic differences may partially account for this disparity, local health experts agree that mistrust of the vaccine likely plays a significant role as well.
Does the LGBTQ+ Community Trust the Vaccine?
A research study published in the journal Vaccines found that a diverse population of LGBTQ+ people feel uncertain about receiving the COVID-19 vaccine. Notably, BIPOC participants in the study expressed vaccine hesitancy at a significantly higher level than that of White LGBTQ+ participants. This statistic indicates that the SDOH play a role in shaping perceptions of the vaccine, especially when individuals face discrimination on the basis of overlapping social determinants of health.
HIV positive patients (BIPOC members of the LGBTQ+ community make up a disproportionately high portion of this group) are more likely to be hospitalized due to COVID-19, but were nonetheless excluded from Pfizer and Moderna’s early vaccine trials. In late summer, both companies announced that their late stage trials would include subjects with HIV, largely due to protest by AIDS activist groups.
For many, the fact that a demographic so affected by COVID-19 had to protest for their own protection against the virus calls representation in vaccine trials into question. Similar to the concerns of the BIPOC community, much of this apprehension is caused by a simple lack of information and/or direct communication with marginalized groups.
For instance, for those who take hormones, such as people in gender transition, the idea of a novel injection can be anxiety-inducing without any evidence to prove the vaccine does not react negatively with hormones. Medical experts say there is no reason to worry about a negative vaccine-hormone interaction, but this reassurance is not necessarily reaching the ears of those who need to hear it most.
Taking Action Against Healthcare Inequity
The social determinants of health can create insurmountable obstacles to good health and healthcare for BIPOC, LGBTQ+ people, HIV patients, and other marginalized groups through systemic inequities in the US healthcare system, medical research, and sources of factual, unbiased information.
How can we counter the discrimination, trauma, and misinformation a significant group of Americans associates with these systems?
One way to start is with more and better representation:
Increasing the number of physicians of color, as well as medical researchers of color, is an essential step towards building BIPOC confidence in the healthcare system. For instance, a study by the NAACP indicates that Black patients are two times as likely to trust Black physicians as they are physicians of other races.
Another counter to medical mistrust is direct communication with marginalized communities by experts that look like them or who come from a similar background.
This study suggests that presentations about COVID-19 given to Black and Latinx people by Black and Latinx people encourage the former to look for more information about the virus, increasing their COVID literacy and likely building their trust in the vaccine. Check out the resources below for toolkits created especially to educate Black, Latinx, and faith communities about COVID.
Read, Listen, and Learn More
Educate your community about the COVID-19 Vaccine:
Read:
- The Immortal Life of Henrietta Lacks, Rebecca Skloot
Listen:
- A Shot in the Dark, NPR’s Code Switch podcast
Learn:
- “Beyond Tuskegee- Vaccine Distrust and Everyday Racism”, The New England Journal of Medicine
- “L.G.B.T.Q. People Face Increased Risks From Covid, but Many Don’t Want the Vaccine”, The New York Times
- KFF COVID-19 Vaccine Monitor: Who is Getting the Vaccine?
