Understanding Vaccine Hesitancy Among Black Americans

Julie McDowell:

Surveys have shown hesitancy among African Americans to take the Covid vaccine, much to the concern of physicians and public health experts who emphasize the perils posed by immunization gaps in certain populations to overall public health.

But it's important to understand this hesitancy, explains Dr. Valerie Fitzhugh, who is associate professor and interim chair of pathology at both the Rutgers New Jersey Medical School and the Rutgers Robert Wood Johnson Medical School. Dr. Fitzhugh, thank you so much for discussing this topic. What are some of the factors that have caused distrust of medical procedures like vaccines within the Black community, and can you provide some examples?

Dr. Valerie Fitzhugh:

So the distrust of medical procedures is both historical and unfortunately current. We've heard a lot in the media because this one has come up a ton of times recently with the Tuskegee Syphilis Study. And in the Tuskegee Study, the so-called goal of the study was to observe the natural history of untreated syphilis in Black people. But the people in the study were completely unaware. So what they were told instead is that they were receiving treatment when they weren't. And because of this, they were essentially watching people, not even essentially, they were watching people with a treatable disease but not treating them. Because the assumption was that they wouldn't be convinced to get treatment anyway, which of course is ridiculous. I mean, how could you say that about a group of people?

And so the way that the United States Preventative Health Service justified that study was by calling it a study in nature rather than an experiment, which I thought was terrible because that's just not something that you should do to any group of people. But this is what was done. And of course, as a people, we in the Black community have heard about this study for years and years and years. And so this is the one that's been highlighted I think most prominently in examples recently.

But there are others. Henrietta Lacks was a incredible Black woman, she was from Maryland, and she developed a very aggressive cervical cancer. And while she was being treated at Johns Hopkins, samples of her cancer cells were taken without her consent, and they gave some of the tissue to a researcher. And that's how the HeLa cells that we hear so much about in the media were created.

And the reason these cells were so important to so many things in scientific discovery was because it was what we call an immortal cell line. So this cell line could keep replicating and replicating and replicating indefinitely, and it's been used for all kinds of things in biological research. But her family was never consented. She was never consented. And so how can you continue to do these things to people and not have them be fully on board what's being done to them?

Then there's the mistreatment factor. Mistreatment in medicine continues in the Black community. Our most recent example was that of Dr. Susan Moore, who in December, 2020, died from Covid. And in her struggle, she made videos while she was an inpatient in the hospital, telling the world about requests for appropriate care that she was not receiving and being accused of drug seeking behavior. And this is not uncommon to Susan Moore, and she was a physician, so you can only imagine how people without that level of education are being treated when they seek medical care.

And so throughout history, but into the modern day, there are many reasons and many examples of why people do not trust.

Julie McDowell:

What sorts of concerns are you hearing from patients or people in your community when it comes to Covid vaccines?

Dr. Valerie Fitzhugh:

So one of the biggest concerns, and I've heard this one almost universally, is that the vaccine was developed too fast. And interestingly enough, because every time I bring that up, people will often ask, "Well are those the anti-vaxxers?" And I said, "Well, actually, some of that also comes from people who were vaccinated as children, who have fully vaccinated their children, but this feels too fast to them." And there's a lot that needs to be unpacked there because this is where misinformation and disinformation becomes very important.

The mRNA technology that went into the Pfizer and Moderna vaccines has actually been studied for decades. It's just that this is the first time that we're really hearing about it in this application, the way it was done, and so people are thinking, "I don't want a vaccine that was developed in a matter of months." But the reality is the technology has been around for years. We were just looking for the right time to use it.

The other thing that I think is important for people to know and to understand is that a lot of money, billions of dollars were put into this effort. And if you put that kind of money into an effort, suddenly you have resources. And those resources can go a long way.

When Covid hit, the whole world's focus turned to Covid, and a lot of other science stopped while the effects of Covid were being researched, what it does to the body, what it does to the tissues, but also now these vaccines. And so something that I'd like people to understand is that yes, it was faster than any other vaccine that we've ever seen, but it was fast for the right reasons. And the science behind it is sound, because I think that's really important.

A lot of the other concerns come from just this mistrust of the medical establishment, and I think we have a long way to go to work to mending that in the Black community.

Julie McDowell:

So that leads me to my next question. Why is it important for medical institutions to win back the trust of the black community?

Dr. Valerie Fitzhugh:

Black doctors tend to be underrepresented in medicine. We just are. Just as we are underrepresented as a people in the community, as Black people are, we are underrepresented in medicine. And there has been, and always has been a significant movement once there were enough of them, of Black people wanting to see Black doctors, because we have a lot of shared experience. Many of us were raised a similar way. There are things that we understand about each other that other people don't necessarily understand. And so that's wonderful and important.

But the reality is there are not enough of us to treat our entire population, who are just as underrepresented in medicine as we're underrepresented in society. And so we need allies, we need our physicians of other ethnic groups to be the allies that these patients need. They need to hear these patients, they need to engender that trust, and that's going to take time. And that's not something that's going to happen next week or in a couple of days, and this may be years in the making, but it's worth it so that we can show my community, people who look like me, that medicine is safer than it's ever been before, and that medicine is advancing rapidly and that we are here to take care of folks.

The other thing that I think is really important is that people need to be aware of their biases, and we all have biases, but as physicians we need to be aware of those biases so that we can treat people the best way that we can and not let thoughts or perceptions of people affect how we're treating them. And I think those are really important steps to starting to gain that trust in the community.

Julie McDowell:

Are there other actions that can be taken to restore trust of medical institutions in the Black community?

Dr. Valerie Fitzhugh:

I think as physicians, we need to be out there, and we being all of us. We need to go into the communities and speak to people. We need to hear when people don't trust medicine. And that's a hard thing for doctors to do, because we've studied this. We've spent years studying medicine, learning our crafts. Speaking to it as a pathologist, I've spent five years learning how to be a pathologist, and I spent the decade plus since trying to perfect that craft. But the reality is, most people don't want to hear that.

When I talk to people about the vaccine and about my trial experience and all the different things that I've been through with Covid, when they tell me, "That's great, Doc, but I'm still not sure." My response to that is, "I hear you, I hear you, and I understand why you feel that way. I know the history, I know how people are behaving now, and I get it. I don't want to try to convince you to do something that you may not want to do, but at least hear me and maybe we can come to a mutual understanding."

Acknowledging that the mistrust is there and not just shooing it off as being in people's minds is the single most important thing that I think we can be doing right now to try to engender more trust in medicine, in communities of color.

Julie McDowell:

Finally, Dr. Fitzhugh, where can pathologists and listeners learn more about restoring trust of medical institutions in the Black community?

Dr. Valerie Fitzhugh:

I think from the physician angle, and for most patient facing physicians, I think listening to their patients will be the single most important thing that they can do to really beginning to restore that trust.

People need to feel heard, and I think that is critically and incredibly important. Looking at it from a pathologist angle, because I don't see as many patients as I used to, and most of my work is behind the microscope and in the clinical laboratories, for other pathologists out there, pay attention to your colleagues. When we start to have these conversations, and they are difficult conversations around bias and mistrust and microaggression, if you have colleagues of color in your practice, and I say if, because we know that minorities are underrepresented in medicine and they're underrepresented in pathology, but when you have colleagues of color in your practice and these topics arise, if they speak up about it, hear them, listen to them.

Because in the world outside of the medicine that we practice, all people see is a Black person. They don't see the degrees, they don't see the expertise, they just see what they see on the outside. And so a Black pathologist or a Black physician is just as likely to undergo the same mistreatment and have the same concerns that any other person in Black society has. We just have the advantage of having been to medical school and knowing that we can make that difference. But certainly hear your colleagues, hear your patients, hear your friends, because if you can do that, you'll be a part of the solution, and that's truly important.

Julie McDowell:

Well, thank you very much, Dr. Fitzhugh, for taking the time for this discussion.

Thank you for listening to this CAPcast. Be sure to listen to our other CAPcasts from the CAP on our SoundCloud channel by downloading the SoundCloud app on your mobile device. And we're also on Apple Podcast and the Stitcher app. To find this podcast, search for the word CAPcast on these apps. Once you find our podcast, be sure to click the subscribe button so you don't miss new CAPcast episodes.

Download Transcript