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Black Distrust In Medical Institutions Existed Before Covid-19. The Pandemic Hasn’t Changed It

As vaccine trials begin, researchers have struggled to recruit Black participants. This has been difficult given the distrust of the country's current government and heightened awareness of racial injustice . 

By Kaylan Ware, The Undivided for The Howard University News Service

The World Health Organization (WHO) declared the coronavirus outbreak a global pandemic on March 11. This pandemic has disproportionately affected Black and low-income communities that are frequently more severely impacted by disease. 

The hospitalization of Black or African American, Non-Hispanic people as a result of the coronavirus is 4.7 times higher than that of white, non-Hispanic persons, according to the Center for Disease Control and Prevention (CDC).

This data supports the conclusion that Black people have been disproportionately affected and are more likely to experience a fatal battle with the coronavirus. According to Business Insider, those with underlying health conditions were 12 times more likely to die from COVID-19. Underlying health conditions such as diabetes, hypertension and heart disease affect Black Americans at higher rates than white Americans. 

As vaccine trials begin, researchers have struggled to recruit Black participants. This has been difficult given the distrust of the country’s current government and heightened awareness of racial injustice . 

“[Black Americans] stand out from other racial and ethnic groups in their attitudes toward key health care questions associated with the outbreak,” reported Pew Research Center. “In particular, Black adults are more hesitant to trust medical scientists, embrace the use of experimental medical treatments and sign up for a potential vaccine to combat the illness.” 

The author of this study, Cary Funk, covers “the breadth of science as it intersects with broader civic issues” in her role as Pew Research Director of Science and Society Research. Previously surveying public trust in science and since the emergence of COVID-19, Funk continues to examine the public’s trust in science and specifically medical scientists. 

“Overall, we see that Black Americans have a lower level of confidence, lower trust in medical scientists to act in the best interest of the public, especially compared to white Americans,” she said. “And that’s not new. It’s not caused by the Coronavirus. It’s actually a long-standing pattern, but given the impact of the disease on the Black community, these kinds of differences perhaps are more important.”

According to Funk and Pew Research findings, there were wide differences between Black and white Americans over whether they would opt for a COVID-19 vaccine if it were available. Approximately 54 percent of Black Americans said they would definitely or probably get the vaccine, compared to about 74 percent of white Americans. 

Funk noted differences in immunization rates between Black and white Americans for vaccinations including the flu and measles, mumps and rubella vaccines. 

This hesitation and decreased participation in medical trials can be attributed to Black medical distrust. 

Director of Maryland Center for Health Equity Stephen Thomas developed the Health Advocates In-Reach and Research Campaign (HAIR) “to engage barbershops and beauty salons in Prince George’s County as culturally relevant portals for health education and delivery of public and medical health services in the community.”

“My focus is on taking what we know – taking the science, medicine and public health – and translating it into culturally tailored community based interventions,” Thomas said. 

This campaign grew out of Thomas’s observation that a barber had more credibility than a physician with the community they serve. 

“We’ve become pillar citizens in the community,” barber Mike Brown said. “We’ve become fashion consultants, marriage counselors, health advocates.” 

Thomas began considering how barbers could partner with the medical community to bring knowledge and medical resources to Black community gathering places like barbershops and salons. These shops and salons have become COVID-19 mitigation sites, offering testing, educational resources, flu shots and of course, hair cuts.

“One of the things that we know now is to reach the very population whose lives we are committed to saving, we have to change the way that we were doing,” he said. “Waiting for people to get sick and show up in a hospital. And so what we’ve done in the HAIR network is bring the health and medical professionals to the people in a setting that the community trusts.”

Thomas recounted an incident where the health department issued a citation to a barber because someone was not wearing a mask, therefore not adhering to COVID-19 reopening laws. The barber was not provided with support or information to ensure that laws would be followed after the thousand dollar a day citation was written. 

“Why would you leave that shop without ensuring that they could act on the regulation you were citing them for?” Thomas said. 

This incident is where health equity comes in according to Thomas. Citizen and government relations are also impacted by such interactions. 

Jana Johnson-Davis, member of the Georgia Coalition 2 Save Lives and organizer of Loved Ones, Not Numbers initiative, considers the ways current trust in medical communities is impacted by the government. 

“We know the history of medicine and experimental treatments here in the United States between the government and Black people,” she said. “But then to complicate things, we have President Trump who we know is untrustworthy. He has his own agenda for pushing these treatments that are moving so much faster than they normally would, so that makes you nervous already.” 

Johnson-Davis recognizes the validity of this distrust given Black Americans’ history with medicine and medical trials in addition to being poorly represented by the country’s leadership. This lack of representation and acknowledgement led her to organize Loved Ones, Not Numbers.

The initiative serves to humanize and memorialize the people who lost their lives to the coronavirus. Photos, quotes and reflections are shared by the family when registering their lost member for the initiative. 

“For many people, particularly law makers, it seems as though they had just become numb,” Johnson-Davis said. “So, we put names and faces to these numbers and started an online photo memorial.” 

Additionally, members of Georgia Coalition 2 Save Lives sent an open letter to Georgia’s Governor Brian Kemp following his announcement to reopen the state beginning April 24. 

“The coalition members wanted to sit down and talk to the governor about what he’s doing to help save and protect Black lives,” Johnson-Davis said. 

Kemp has not responded to the open letter and meeting request shared with his office in May. This lack of attention continues to influence Black relationships with medicine and government entities. 

Senior Associate Director of the Maryland Center for Health Equity Sandra Quinn has engaged in community research and service for years with particular interest in African American communities, vaccine disparities and the legacy of the Tuskegee Syphilis study. She has also served as the principal investigator on studies funded by a grant from the National Institute of Minority Health and Health Disparities on building trust between minorities and researchers. 

“The disparities in Black, Latinx and Native communities right now is just horrific, in terms of the impact of the virus, and illness and death,” Quinn said. “It is incredibly worrisome, and in many ways, it was all totally predictable. It was predictable because far too many people are in positions where they can only do their jobs in the workplace, and so therefore, they don’t have the option to work at home and reduce their risk.” 

Quinn currently serves on the COVID Prevention Network through the University of Washington and is working with COVID-19 vaccine trials. 

Concerns in terms of participation in vaccine trials “range from the ongoing legacy of Tuskegee, Henrietta Lacks, but it’s also not just the legacy of those studies, it’s that people have seen and experienced discrimination today in healthcare,” she said. 

Thomas admits to growing up with some weariness towards medicine despite his mother being a nurse and his interest in health. 

“There have been some really high profile [to increase Black medical participation] efforts like all the presidents of the Black medical schools signing up for our study,” he said. “In the barbershop, that doesn’t move the needle or these guys.”

Not only does Quinn study the sources of medical distrust and low participation, she also researches and implements ways medical scientists and researchers can involve themselves in minority communities, making an active effort to rebuild trust and learn the communities they are serving.

“Many researchers just do not have either the experience or the skills to reach out and form the kinds of partnerships they need to form with community organizations, with institutions in the community, with local media that may serve Black communities,” Quinn said. “So, they tend to rely on a sort of standard approach. They do a posting of a research study through their clinical networks, and they don’t necessarily do what it takes to reach out and ask people to participate in a respectful way.”

“[To eliminate distrust,] I think it would take a rededication of our commitment to the common good and to begin with empathy,” Thomas said. “There’s no lack of solutions. What’s lacking is the will to implement those solutions. I think we have to have more voices of the people lifted up. And for those of us who are holding these solutions or access to them, for us to translate that access into forms that the community can actually use to save their own lives.”

Researchers should review the implications and disparities when considering Black people for medical trials. The “devastating” and persistent nature of this virus provokes medical scrutiny, fear and general uncertainty, especially for those disproportionately affected due to background and pre-existing conditions.