In November 2020, news broke about the successful development of the first vaccines against COVID-19 and people began to debate whether or not they would be inoculated. As Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and the leaders of the Centers for Disease Control (CDC) sought to distribute information to diminish fears about the vaccine’s safety and efficacy, and most importantly, its crucial necessity in halting the pandemic; virulent misinformation about the virus and the safety of the injection was spreading rapidly across social media. In the United States alone, COVID-19 has killed nearly 600,000 and sickened more than 33,340,000.

One group that was understandably hesitant about receiving the vaccine was Black Americans. According to the Kaiser Family Foundation, in December 2020, 52% of Black Americans said they would take a wait-and-see approach to the vaccine with only 20% saying that they wanted to be vaccinated as soon as possible. In comparison, skepticism about the COVID-19 vaccine was lower in white (36%) and Latino populations (43%). This was particularly concerning since according to the CDC, Black Americans were 2.9 times more likely to require hospitalization for COVID-19 and 1.9 times more likely to die from the disease than white Americans .

Much of the hesitancy from Black Americans around trusting medical guidance about a new vaccine for an emergent disease is justifiably rooted in the long history of unconscionable racism embedded in the American medical establishment. This is evidenced by Dr. James Marion Sims, who is considered to be the “father” of modern gynecology, conducting experimental surgical procedures on enslaved people without anesthetics or their consent. As well as the infamous Tuskegee Syphilis study, where Black men were denied treatment for Syphilis  in order to study the disease’s long-term impacts. Meanwhile, white Americans reaped the benefits of these medical breakthroughs which came at the expense of Black Americans’ health and wellbeing.

However, hesitancy amongst Black Americans is not just rooted in the history of medicine, but is also tied to rampant present-day inequities in American health care. Black Americans contend with myriad health disparities and adverse outcomes. Black mothers are three times more likely to die in childbirth compared to white mothers while Black adults and children are less likely to receive adequate pain medication during an emergency room visit . These inequities are also evident in the uneven rollout of the COVID-19 vaccines. Thus, Black Americans face the compounded risks of underlying health conditions and comorbidities linked in part to health inequities, which make them more vulnerable to COVID-19 while having less access to lifesaving vaccines.

As mentioned, another group that has been exhibiting vaccine hesitancy is white, rural conservatives. Polls conducted by NPR, PBS NewsHour, and Marist, revealed that rural, white Republicans, and in particular male Trump supporters, were amongst the least likely groups to get the vaccine. Similarly, of the 41 million white evangelicals, 45% stated they wouldn’t get a COVID-19 vaccination according to a recent Pew Research Study in February 2021. 

In comparison to Black Americans, white conservatives offer very different reasons for not wanting to get the vaccine, which bely a fundamental mistrust in science and government. They also fundamentally believe that their freedom is paramount and surpasses public safety. This makes them especially susceptible to disinformation campaigns seeking to sow suspicion about the government, vaccines, and science, itself. 

Months after the initial announcement about the vaccine’s arrival, there was a noted increase in interest to receive the shot, which seemed to be in response to multi-pronged outreach efforts targeting Black communities. According to a recent Pew survey in February 2021, 81% of Black Americans saw the pandemic as a major public health threat and 49% saw it as a threat to their own health. And according to the Kaiser Family Foundation, 55% of Black Americans said they would be or have been vaccinated, which shows shifts in perspectives amongst Black Americans on getting the COVID-19 vaccine. 

While Federal agencies and public health leaders belatedly began instituting public information campaigns targeting marginalized populations, including Black Americans, what has been particularly notable is the concerted outreach on the ground in Black communities by trusted community organizations. 

The African American COVID-19 Educational Outreach initiative, a breakthrough collaboration by Kaiser Permanente, East Bay Community Foundation (EBCF), and twelve community partners across the country was created to “prevent disproportionate death and infection rates in high risk communities of color, to dispel misinformation about COVID-19, provide support to community-based organizations on the ground who have the knowledge, expertise, and relationships with the community, and capture learnings to inform future legislation,” explains Sachi Yoshii, EBCF’s Vice President of Strategy & External Affairs. Yoshii goes on to note how this initiative “highlights how vaccine access is a racial justice issue.” The range of activities includes educational outreach, “come to you” vaccination clinics which are mobile and in trusted spaces including churches and barbershops, messaging campaigns and PSAs featuring local Black health care workers, and social media campaigns featuring local cultural personalities. 

Preston DuFauchard, CEO of West Oakland Health Council (WOHC), one of the local partners of EBCF, acknowledges that when the clinic started offering COVID-19 testing and the vaccine, some patients expressed concerns about getting the virus from testing based on misinformation, while others were worried about how rapidly the vaccine was developed and its possible side effects. But given the history of racism and inequity in the health system and the politicization of the vaccine, he says these fears are “completely understandable” and he doesn’t think the phrase “vaccine hesitancy” applies to the Black community. “Black people want to take control of their own bodies … that control involves being informed consumers about medical services,” said DuFauchard. 

DuFauchard notes that WOHC has seen shifts in attitudes for both testing and vaccination. “We have found good responsiveness in our patient population for acceptance of the vaccine,” DuFauchard explained. And this is likely due to the fact that WOHC has built its outreach and vaccination efforts around the needs of the community, from having walk-in hours, to proactively reaching out to their patients to scheduling testing and vaccinations, to having their health care providers, who are part of the community, offer their own testimonies about their vaccine experience. It’s worth noting that WOHC has not lost a single patient to COVID-19 throughout this pandemic.  

Meanwhile, despite the fact that vaccines are now more accessible, rural counties whose populations are overwhelmingly white and conservative are having trouble convincing this population to get vaccinated. Given the size of this community, their reticence may threaten the country’s return to safety and normalcy. A targeted information campaign addressing white conservatives and Evangelicals might offer a possible remedy but faces an uphill battle since their mistrust in science and government is deeply rooted in their conservative beliefs.

The stark contrast we see in the reasons for hesitancy in these two communities as well as their respective reactions to vaccination outreach efforts reflects the historical and present-day story of racism in America. When it comes to Black Americans, despite this group’s justified fears and mistrust of the health care system due to historical and ongoing systemic racism, they are taking the advice of experts in their communities by getting vaccinated, protecting themselves and others. Meanwhile, white conservatives, who have not had to endure struggles against a racist health care system, behave as if their beliefs are more important than the nation’s public health and collective safety. In truth, their vaccine hesitancy is willful vaccine resistance, risking lives and prolonging the pandemic. Theirs is a virulent privilege, rooted in delusions of white supremacy masquerading as faith and ideals.

In a recent Rolling Stone article bioethicist and professor of public health, Dr. Faith E. Fletcher noted the impact of unfair scrutiny on Black Americans around vaccine hesitancy. “To advance health equity, we must actively resist and challenge existing narratives that portray communities of color as risky, irresponsible, and incapable of behavior change, and shift the responsibility to structures that disadvantage some members of society.” Notably, what’s missing is a corresponding scrutiny for rural white conservatives and the risk they pose as they continue to resist the vaccine not out of circumstance but choice. 

As people herald the end of this global crisis and the return to pre-pandemic life, there is an opportunity to recognize and acknowledge that while COVID-19 disrupted lives, it didn’t disrupt the systemic racism built into American healthcare. Instead, it painfully underscored it.

Kavita Das writes about culture, race, gender, and their intersections. Her first book, Poignant Song: The Life and Music of Lakshmi Shankar (Harper Collins India), was published in June 2019 and her next book Craft and Conscience: How to Write About Social Issues is forthcoming (Beacon Press, Summer 2022). @kavitamix