Examining Vaccine Hesitancy Requires an Equity Lens

Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) continues to spread throughout the US, and the world. Though the number of people vaccinated is increasing, the virus continues to spread due to a significant segment of the population who are unvaccinated. Should these unvaccinated individuals come in contact with the virus, they may likely develop moderate to severe symptoms, that could land them in the hospital or worse. Though it is hard to go 24 hours without talking or thinking about COVID-19 these days, there still remains an important consideration regarding the pandemic that is being neglected by much of the discourse around who is and isn’t getting vaccinated.

“Vaccine hesitancy” is often used by institutions and people to point blame (directly or indirectly) at Black, Indigenous, and other people of color (BIPOC) for not “complying” with advances in the COVID-19 response via vaccines. However, when vaccine hesitancy is used in this way, it denigrates BIPOC communities and minimizes the very real experiences they share that have created distrust of systems and the institutions that have failed to consider and protect them throughout this nation’s history. This lack of acceptance of COVID-19 vaccines by some BIPOC communities can also be seen in other areas of medicine and science, including annual flu vaccine uptake, and other interventions that have proven to be effective.

Racism and bias (implicit and/or explicit) are still very real threats to the bodies of BIPOC, a reality proven through numerous historical examples of racism, bias, and unethical treatment by scientists. Examples such as the US Public Health Service study of untreated syphilis in Black men (commonly referred to as the Tuskegee Syphilis Experiment), the use of Henrietta Lacks’ cells without consent or restitution, the Eugenics projects in North Carolina and other parts of the South, and too many other medical atrocities to name here. We can also turn to current day examples of BIPOC communities being mistreated, discriminated against, and receiving less than standard care in medical facilities across the country which continue to leave scars of trauma. This trauma comes in addition to the unabated experiences of racism via social and structural systems like law enforcement, jails/prisons, academic institutions, housing, employment, etc. Thus, what many perceive as “vaccine hesitancy” in BIPOC communities, is actually the community’s reflex response to protect themselves and their loved ones. The skepticism demonstrated by BIPOC communities is therefore natural and requires the understanding that this response is not indicative of vaccine rejection, but instead reveals the need for a community-centered COVID-19 response.

To support BIPOC communities gaining important health information and making informed decisions, we all must be better at meeting people where they are, introducing scientific concepts using plain language, engaging trusted BIPOC community voices to serve as educators and messengers, and ensuring consistent funding is prioritized for BIPOC community-led solutions to maximize the health and wellness of these communities.

Contributed by Stephaun Wallace, PhD and Louis Shackelford
COVID-19 Prevention Network (CoVPN), Fred Hutchinson Cancer Research Center