Why Fewer Black Americans Are Getting The COVID-19 Vaccine (*No, It’s Not Hesitancy)March 9, 2021
The early data we have on vaccination rates is incomplete, but one fact is particularly alarming: Black Americans are getting vaccinated at a much slower rate than their white counterparts. This is troubling given how hard the pandemic has hit Black Americans.
But it’s also concerning because people often misunderstand why the rate is lower. Many are quick to point to a distrust of the medical community, as Black people do have a long history of being ignored or actively mistreated by health care professionals in the U.S. — most notably, in the infamous 40-year-long Tuskegee study, which denied Black men treatment for syphilis so researchers could track the natural progression of the disease. But a recent Pew survey challenges the idea that Black Americans are hesitant to get vaccinated: A majority of Black adults (61 percent) told Pew that they either planned to get a COVID-19 vaccine or have already gotten one, a sharp uptick from the 42 percent who said in November that they planned to get vaccinated.
And this reflects what health experts have told me about this issue. They don’t really think distrust of the vaccine explains the large gaps we’re seeing in vaccination rates. What’s more, blaming the gap wholly on distrust is dangerous because it puts the onus on Black Americans around vaccinations and distracts us from the real reasons why the inoculation rate is lower. “The experience of Black Americans within the U.S. health care system has been extremely troubled to say the least,” said Sean Dickson, the director of health policy at the West Health Policy Center. “But we don’t want to rely on the narrative that Black people aren’t willing to get the vaccine,” he said, adding that he thought the real issue was the lack of investment in vaccine distribution in Black communities.
In fact, a recent NPR analysis found that vaccine hubs, particularly ones in Louisiana, Texas and Alabama, were largely missing from predominantly Black and Hispanic communities, while few whiter neighborhoods were without one. And in a national study conducted in conjunction with the University of Pittsburgh School of Pharmacy, Dickson found that Black Americans in nearly two dozen urban counties in and around Atlanta, New Orleans and Dallas, among a host of other cities, faced longer driving distances to vaccine centers than white Americans.
Even when vaccine distribution centers are more evenly distributed, researchers find that communities of color are still missing out. Residents from wealthier, predominantly white neighborhoods often claim an outsize share of vaccine appointments in Black and Hispanic neighborhoods, using up the available supply. This has already happened in several states, including in California, where outsiders were misusing a program intended to make vaccine appointments available in communities of color.
The fact that vaccine registration systems are largely online is partly to blame, as there is often a racial divide in who has reliable internet access. Take Washington, D.C., where the ease of signing up virtually made it simpler for wealthier, white people to push out Black people who were trying to get an appointment. The city did move to quickly implement a new sign-up system that offered appointments first to people in ZIP codes with the highest COVID-19 infection and death rates, but some residents said the process still wasn’t helping the people who need the vaccine most.
George Jones, whose D.C.-area nonprofit agency runs a medical clinic, told The New York Times that hardly any of the people coming in for shots at his clinic were regular patients. “Somehow we’ve got to persuade them to use those spots,” he said. Health experts who study medicine and health disparities warn that internet access is emerging as a major determinant of health due to the growing role the internet plays in connecting patients to care, especially during the pandemic. “The question is ‘Who’s going to actually get vaccines?’ — older adults who are tech-savvy, with financial resources and family members to help them, or harder-to-reach populations?” asked Abraham Brody, a professor of nursing and medicine at New York University, in an interview with Kaiser Health News.
Black Americans are also disproportionately likely to work in front-line jobs categorized as essential, which means it’s likely harder for them to request time off to get a vaccine. Some states, like New York, have plans to open, or have already opened, several 24/7 sites. And Dickson told me that one thing more cities could be doing is developing mobile or pop-up vaccination centers that are open during hours convenient for people in the service industry. Some states, like Texas and New York, are already experimenting with mobile pop-up centers. And in Philadelphia, the Black Doctors COVID-19 Consortium is offering walk-in vaccine clinics that don’t require appointments.
President Biden’s administration is also taking more aggressive steps toward achieving equity in vaccination rates. On Monday, Vice President Kamala Harris announced that the White House would invest $250 million in federal grants to organizations working to address gaps in the COVID-19 response. And in January, Dr. Marcella Nunez-Smith was appointed to lead a new federal task force to tackle coronavirus inequities; that same month, the White House unveiled a plan whose goals include increasing data collection on high-risk groups and providing equitable vaccine access. The $1.9 trillion economic stimulus plan is also expected to help cities and states open up more vaccine hubs in communities of color. Others in Biden’s orbit, including former President Barack Obama, have pledged to get their injections publicly to show that it’s safe.
But perhaps most notably, Biden has now said that the country is “on track” to have enough coronavirus vaccines for every adult by the end of May. Experts, however, think that this is not going to be enough to overcome the access issues that many Black Americans face. For instance, the national county-level analysis conducted by Dickson and his team found that more than one-third of U.S. counties had two or fewer types of facilities that could conceivably serve as vaccine distribution centers. “The vaccine rates are low not because people don’t want the vaccine, but because those who want it can’t get it,” said Robert Fullilove, a professor of sociomedical sciences at the Columbia University Medical Center.
That said, it’s important to address vaccine hesitancy — when it’s there. But the experts I’ve talked to say issues like accessibility, a lack of investment in Black communities and overall health inequities are the biggest barriers for Black people to get the coronavirus vaccine. But those aren’t the only things making it harder than it should be. Nunez-Smith previously told the Financial Times she was worried about misinformation on COVID-19 specifically targeting Black communities. And already in the Black community, some influential people have shared anti-vaccine memes; there’s also widespread misinformation claiming the vaccines contain microchips or cause autism (they don’t). White House officials are working with Facebook, Twitter and Google to stop COVID-19 misinformation from going viral, but as we’ve learned from the past two presidential elections, combating misinformation — and disinformation — can be challenging.
There’s a real urgency in making sure the racial and ethnic disparities we see in the current vaccine rollout is addressed quickly, though, especially as the U.S. approaches the one-year anniversary of its first lockdowns. But as Dickson cautioned me, we should be clear-eyed about what the problems are, and careful to not rely on an incomplete “vaccine hesitancy narrative” to explain why Black Americans are getting vaccinated at lower rates. “The … narrative can become self-fulfilling if we presume Black Americans will be vaccinated at lower rates than white Americans,” Dickson said. “[I]f we presume that’s the case, then we don’t take it upon ourselves to see it as a problem.”