COVID-19 vaccine faces Black communities' centuries-long mistrust of health care

The Associated Press reported on October 14 that a survey it conducted with the NORC at the University of Chicago showed that just 22% of Black respondents said they plan to get the COVID-19 vaccine when it becomes available. Black Americans have been disproportionately hard-hit by the virus. Their hesitancy is a hurdle the pharmacy and medical professions must acknowledge and overcome by earning trust.

Behind the Black community's wariness of the COVID-19 vaccine is the lingering legacy of the Tuskegee Study of Untreated Syphilis, which was conducted by the U.S. Public Health Services (USPHS) starting in 1932. Six hundred Black men—399 with syphilis, 201 without—were intentionally misled about the study's purpose and were denied the facts required to provide true informed consent.

In exchange for their participation, the men received free medical exams, free meals, and burial insurance. Originally intended to be a 6-month study, it secretly lasted for 40 years and aimed to follow the men until their deaths.

Researchers told the men they were being treated for “bad blood,” a local catch-all term for a set of conditions including syphilis, anemia, rheumatism, digestive issues, and fatigue. The truth was that USPHS researchers withheld treatment for their syphilis—even after penicillin became widely used to cure the disease in 1947—and actively discouraged the men from seeking treatment elsewhere. Researchers simply watched the men suffer from the disease.

In 1972, USPHS investigator Bruce Buxton, troubled by the study's lack of ethics, leaked the story to the media.

Congressional hearings followed in 1973, and in 1997, President Bill Clinton officially apologized to the victims and their families. “What was done cannot be undone. But we can end the silence. We can look at you in the eye and finally say on behalf of the American people, what the United States government did was shameful, and I am sorry,” he said. A 1973 class-action lawsuit was settled for $10 million.

The Tuskegee experiment is not-too-distant history, and health disparities still affect African Americans; they have poorer outcomes even when controlling for socioeconomic status. Mistreatment remains common. And there are too few Black health care providers. According to Data USA, just 7% of pharmacists are Black.

The speed at which the COVID-19 vaccine development process—“Operation Warp Speed”—is taking place has triggered fear and suspicion that the ultimate product could be unsafe, especially among Black Americans.

The National Medical Association (NMA) is the largest and oldest national organization representing African American physicians and their patients in the United States. The organization has convened a panel of seven Black doctors to vet the federal review of companies' vaccines. They'll be joined by Lakesha Butler, PharmD, a clinical professor and director of diversity, equity, and inclusion at Southern Illinois University Edwardsville (SIUE).

The NMA COVID-19 Commission on Vaccines and Therapeutics will evaluate vaccines currently in clinical trials for safety and efficacy, Butler told SIUE News. The commission will also evaluate clinical trial processes, of which many Black health care providers are skeptical.

Its aim is to ease minority communities' misgivings. “Research proves that racial concordance between physician and patient results in greater health outcomes due to improved trust,” Butler told SIUE News. If providers are confident in the vaccine's safety, their patients are more likely to as well.

“This work is personal for me, because I have loved ones who have been mistreated and have mistrust for the health care system,” Butler said. “I am committed to addressing racial and health inequities through my national and community service, teaching and research.”

For the full article, please visit for the November 2020 issue of Pharmacy Today.