Vaccine effectiveness is the ability of a vaccine to prevent outcomes (i.e. disease and infection) in a real-world setting, outside of experimental and clinical trial settings.
Research teams at Moderna and Pfizer- BioNTech have produced promising COVID-19 vaccines with high efficacy values (94.1% and 95%, respectively). Yet how these vaccines will aid in diminishing the COVID-19 pandemic remains threatened by vaccine hesitancy and anti-vaccination movements.
Although vaccines have been shown — time and time again — to prevent disease on an individual level and prevent, control, and eliminate large epidemics and pandemics, vaccine hesitancy and anti-vaccination movements are still prevalent around the world, especially in North America.
An unfortunate outcome of the COVID-19 pandemic is how it has revealed existing and newly established widespread distrust in medical science, which we as a public health community need to come together as a unified force to better understand and address. Moreover, it has further exposed racism in our health systems, which existed long before the COVID-19 pandemic emerged.
Moving forward, healthcare decision makers need to better understand the history of medical racism and how it still persists in our health systems today so that we can acknowledge and work towards dismantling it, particularly during this critical time where COVID-19 vaccinations are being administered.
Widespread anti-vaccination movements in North America remain largely composed of White citizens; however, the COVID-19 pandemic and vaccination strategies have resurfaced vaccine hesitancy among Black individuals and Black communities. There is a key difference between largely White-led anti-vaccination movements around the world, and hesitations from the Black global community about taking the COVID-19 vaccine.
Hesitancy among Black individuals and the wider Black global community is a result of the dark history of non-consensual and systematic experiments conducted on Black people by White European and North Americans.
With colonization and the trans-Atlantic slave trade came brutal acts of medical violence perpetrated by European colonizers against Black people. Much of the modern sciences that have led to medical discoveries such as antibiotics and vaccinations have dark and violent histories rooted in medical experiments and practices, which today, would be considered abhorrent crimes against humanity.
Instances of such medical racism and violence have been documented around the world. King Leopold II of Belgium, colonized what is now the Democratic Republic of Congo, where he enslaved hundreds of Congolese people, subjecting them to amputations if his production and agricultural quotas were not met. Black enslaved people in North America, especially Black women, were subjected to violent treatments in the name of medicine and were experimented on without consent and against their will.
Additionally, in the 19th and 20th centuries, medical schools in the United States had a widespread practice of violently exploiting enslaved Black people as “anatomical material” for studies and experiments in the name of education. The Tuskegee Study, a study led and commissioned by the U.S. Public Health Service (a branch of the United States Government, whose mandate is to “protect, promote, and advance the health and safety of [the] Nation”), violated its fundamental purpose and the most basic human rights of their study participants by intentionally withholding antibiotic treatment for syphilis from over 400 Black men in Tuskegee, Alabama. This led to Black study participants unjustly and unnecessarily developing and dying from advanced syphilis.
Medical racism still persists today. Studies have found that Black children disproportionately die during delivery, Black people are more likely to develop a chronic illness, and Black children are differentially prioritized in emergency care departments. These examples are all symptoms of individual-level, institutional-level and systemic racism in the health and medical field. Sustained, systematic, and prolonged acts of medical violence against Black people around the world contribute to COVID-19 vaccine hesitancy among Black people and communities today, and rightfully so.
In order for a vaccine to be effective in protecting public health and controlling an outbreak, a certain threshold of uptake is required. The COVID-19 vaccinations are critical tools in protecting against the spread of the virus in communities.
Safe and effective vaccination is especially critical in communities of colour, who have been disproportionately affected by the pandemic for reasons rooted in systemic racism. Concerns of government distrust when it comes to the COVID-19 vaccines and the Black community are warranted given the history of medical racism and violence. For this reason, it is important the public health, scientific and political community reckon with history.
Vaccine hesitators shouldn’t be grouped into a monolith, especially Black people and communities who are hesitant about vaccines. The global history of medical racism was intentional, and not incidental, and it is important for healthcare decision makers to recognize this history and accept current truths.
While racism education is important and provides a level of understanding and awareness, healthcare decision makers also need to actively work towards dismantling medical racism that remains persistent and contributes to racial disparities in health. Vaccine hesitancy is a threat to global health, and should be taken seriously.
Governments and healthcare decision makers should therefore prioritize repairing the root causes of distrust and hesitancy experienced by Black people and in Black communities around the world. Reckoning with history, working with Black communities and leaders, and taking tangible steps towards addressing medical racism and violence is a good place to start.
Stephanie Wiafe (she/her/hers) is a Ghanaian-Canadian woman, currently located on the unsurrendered territory of the Musqueam, Squamish, and Tsleil-Waututh people. She is a highly skilled global public health professional and researcher, with a graduate degree in Public Health from Queen’s University and a Honour’s Bachelor of Interdisciplinary Health Sciences from the University of Ottawa. Steph has cultivated a career dedicated to global public health equity, working alongside communities that experience severe social exclusion, isolation and health disparities.