‘Why should we trust you?’ Black Americans, hardest hit by COVID-19, are the most skeptical of potential vaccines

Dr. Bisola Ojikutu, an infectious disease specialist at Mass. General and Brigham and Women’s hospitals, said structural inequality in medicine has laid the groundwork for Black Americans' skepticism about a potential COVID-19 vaccine.John Tlumacki/Globe Staff

Festus Adelabu, a 48-year-old electrical engineer from North Andover, normally isn’t skeptical of vaccines. But if an immunization for the novel coronavirus were to be developed and approved for the American public, he wouldn’t take it — at least not anytime soon.

“I’m not an anti-vaxxer. It’s just a matter of common sense, given everything we know,” he said. “How do you say, on the one hand for months, that ‘COVID-19 is hoax, it’s just the flu, don’t worry about it, it will go away,’ and all kinds of stuff, and then turn around and say, ‘Take these vaccines that we’re providing to you for free?’ What? Are you kidding me?”

Adelabu has countless reasons for distrusting a potential vaccine, and most of them lie with the federal government’s “fumbling” response to the pandemic, which has killed more than 170,000 Americans in less than six months. But for a Black man like him, the specter of racist medical experimentation also looms large, he said.

Black Americans are dying from COVID-19 at nearly 2 ½ times the rate of white people nationwide, according to the COVID Tracking Project, and despite representing roughly 13 percent of the population, they have accounted for 22 percent of coronavirus deaths in cases in which race and ethnicity are known. And yet, in a sign of deep-seated and well-earned distrust in the US medical establishment, surveys have shown consistently that Black Americans are less willing than other racial and ethnic groups to accept a coronavirus vaccine.

A nationwide poll released earlier this month from researchers at Harvard, Rutgers, Northeastern, and Northwestern universities found that 52 percent of Black respondents are likely to take a COVID-19 vaccine, compared with 67 percent of white people, 71 percent of Latinos, and 77 percent of Asian Americans.

The Pew Research Center, which reported similar findings in June, found Black Americans are generally more wary of medical researchers and doctors, in addition to being more skeptical of experimental treatments. Fifty-three percent of Black adults surveyed by Pew had a mostly positive view of medical research scientists, compared with 68 percent of white and 67 percent of Hispanic respondents. An even smaller proportion of Black adults, 35 percent, expressed a “great deal of confidence in medical scientists to act in the best interests of the public.”

Black distrust in health care and research stems from a long history of medical exploitation and misconduct. Nineteenth-century physician J. Marion Sims, the so-called father of modern gynecology, for example, developed his groundbreaking surgical tools and techniques by operating on enslaved Black women without anesthesia. In 1932, the US Public Health Service launched the notorious Tuskegee study, a secret four-decades-long experiment in which hundreds of Black men from rural Alabama, without their informed consent, were left untreated for syphilis, so researchers could study the disease’s deadly progression.

“The African American community has very, very significant and historic reasons, including racism, segregation, and experimentation, to be very mistrustful,” said Dr. Joseph Betancourt, vice president and chief equity and inclusion officer at Massachusetts General Hospital. “This is compounded by the fact that African Americans are significantly underrepresented among doctors and researchers, so these communities don’t have trusted messengers.”

This mistrust extends to the present-day treatment of Black patients, who continue to face bias and inequities in medical care and access. Numerous studies show Black Americans routinely receive worse care than their white counterparts, in addition to experiencing prejudice from their medical providers and insidious stereotypes, including the false belief that Black people feel less pain.

“This is really about looking around at the inequity within our system and seeing who has access and who doesn’t have access, and whose hospitals are the highest quality and how do certain people get care faster than other people?” said Dr. Bisola Ojikutu, an infectious disease specialist at Mass. General and Brigham and Women’s hospitals. “It’s about structural inequality in our system.”

“If you don’t feel as though all things are equal,” she added, “why would you necessarily believe that new therapies and interventions are going to either be necessarily equally effective or necessarily equally accessible to you?”

Among public health scholars, the survey data on Black patients’ skepticism regarding a potential COVID-19 vaccine is not surprising. Black adults consistently lag behind whites in immunization rates for other illnesses, such as the flu, said Sandra Quinn, a professor and chairwoman of the family science department at the University of Maryland, who studies racial disparities in vaccine acceptance. In her research, Quinn found that Black people who believe they have been treated fairly in health care settings were more likely to trust the flu vaccine.

“I think it’s important to recognize that people may well be willing, and one of the things we’re going to have to be really cognizant of is what health departments, government, and health care providers do to be trustworthy,” Quinn said.

But the federal government’s response to the pandemic has done little to boost confidence among communities of color that have been devastated by the virus, Quinn noted. Even the name of President Trump’s initiative to develop and distribute millions of doses of a COVID-19 vaccine by early 2021 — Operation Warp Speed — has contributed to the public’s perception that safety will be compromised in the rush to deliver a vaccine, she said.

So what can health care providers do to repair the relationship with Black Americans, soured by centuries of medical abuse and mistreatment?

Michael Curry, deputy chief executive and general counsel of the Massachusetts League of Community Health Centers, said it’s imperative that “trusted voices” in communities of color lead public information campaigns about the potential vaccine.

“We have to make sure that African Americans and others who are disparately impacted by COVID-19 know that folks have been their advocates to make sure there’s medical efficacy and safety assured in whatever labs are distributing these vaccines and whatever government-sanctioned vaccines are put forward,” he said.

Ojikutu, who has been working closely with researchers to enroll Black and Latino participants in clinical trials for the COVID-19 vaccine through the Harvard University Center for AIDS Research, emphasized the importance of acknowledging the medical community’s sordid history, Black Americans’ justifiable distrust, and the ongoing problem of structural racism in health care.

“We have to think about ways to become more transparent in our behaviors and activities so that patients and communities realize what’s happening,” she added, particularly when recruiting Black and brown patients for clinical trials, another longstanding struggle for medical researchers.

Last year, Black patients represented just 9 percent of participants in trials for new drugs, according to the Food and Drug Administration, while 72 percent of participants were white.

“Be very clear about the research that’s occurring, what the pros and cons are, why they should do it or why shouldn’t,” Ojikutu said. “And even in our conversations with patients, understanding what we know and what we don’t know.”

The Rev. Dr. Ray Hammond, pastor of Bethel AME Church in Jamaica Plain, said he has already begun “laying the groundwork” for discussions about the importance of taking the COVID-19 vaccine with his mostly Black congregation. A former emergency medicine doctor, Hammond said he has previously spoken with congregants about the need for diverse participation in clinical trials and has hosted mobile vaccination clinics at his church between services.

“What I’ve discovered is there’s both wariness, but there’s also confusion about what vaccines can and can’t do, and what the process looks like,” he said. “Some of it’s deep and long-lasting. Other elements I think are specific to this situation, but I think both of them can be addressed patiently.”

In a recent webinar with other physicians about COVID-19 vaccine research, Ojikutu recalled being asked by a community member, “Why should we trust you?” For the panelists, it was a sobering moment.

“I think everybody paused and said, ‘Hmm, that’s a tough question,’ ” she said. “I’m not saying anybody should immediately trust anybody. . . . It’s very clear that some level of mistrust is quite normal and quite expected. It’s a normal response to an adverse environment. But if someone is saying, ‘OK, let’s talk about this,‘ we have to at some point open the door to these discussions.”