Daron Lee Calhoun II does not go quietly to the doctor. When a vaccine for COVID-19 becomes available, he will likely not be among the first to get it.
“I’m scared they’re going to roll it out on Black people first, use us as guinea pigs again,” he said.
Calhoun, 32, is an administrator at the Avery Research Center who coordinates programming and the Race and Social Justice Initiative. He knows the Avery cannot safely reopen until a vaccine is widely available.
“We serve a very vulnerable community,” he said.
So he’s torn between two impulses: desire for protection from the coronavirus and skepticism due to the troubling history of medical exploitation.
“Is the vaccine actually going to work for us?” he said.
Blacks and Latinos in the U.S. are bearing the brunt of the virus, comprising a disproportionate number of cases and deaths, according to the CDC COVID Data Tracker.
About 20 percent of cases and 22 percent of deaths involve African Americans, though Black people are about 13 percent of the U.S. population. That death rate is nearly 2½ times greater than the death rate for Whites, and it’s likely an undercount since some unhospitalized deaths go unreported and others recorded by health officials do not always include information about race.
In South Carolina, Blacks comprise 27 percent of the total population of 5 million. But they account for 34 percent of reported COVID-19 cases and 39 percent of reported deaths, according to the S.C. Department of Health and Environmental Control.
The reasons for the disparities include widespread discrimination in health care, housing, education, criminal justice and finance, as well as limited access to medical care, occupational hazards, wealth and education gaps, and housing issues, the CDC reports.
Entrenched distrust of the health care system among African Americans stems from a long history of abuse, said Anton Gunn, MUSC Health’s chief diversity officer.
“There is every ounce of evidence that many of the advancements in modern medicine came at the expense of experimentation on Black people in America,” he said, referring especially to J. Marion Sims, a doctor from Lancaster County who developed the modern field of gynecology by performing surgeries without anesthetic on enslaved Black women without their consent.
“That acknowledgement has not been universal in the medical field, however it is universal (in the Black community),” he said.
Racial discrimination also was manifest in South Carolina’s eugenics program, which sterilized approximately 277 people from 1935 to 1963. African Americans were among those singled out, representing 102 out of the 277 surgeries performed, according to research from the University of Vermont.
In the late-1980s, the Medical University of South Carolina, in cooperation with law enforcement, initiated a policy of involuntary drug testing of pregnant women. Ten women tested positive for cocaine use, nine of whom, all African American, were arrested on charges of possession, distribution of cocaine to a minor, or child abuse.
A lawsuit arguing that the drug testing constituted an unlawful search eventually reached the U.S. Supreme Court, which decided in favor of the women.
Anton Gunn, chief diversity officer for MUSC Health, says Black people would trust medical institutions more if they saw themselves reflected in the medical staff. File/Brad Nettles/Staff
Black people know well these examples of exploitation and abuse, Gunn said. They also remember the non-consensual Tuskegee syphilis experiments, begun in 1932, in which Black men infected with the deadly bacteria received no drug treatment.
“Researchers told the men they were being treated for ‘bad blood,’ a local term used to describe several ailments, including syphilis, anemia, and fatigue,” according to information form the CDC. “In truth, they did not receive the proper treatment needed to cure their illness. … Although originally projected to last six months, the study actually went on for 40 years.”
Another factor: implicit bias among doctors and nurses who too often treat Black patients differently from White patients, Gunn said.
Black patients sometimes wait longer than Whites to receive medical assessments or treatment, noted a 2015 study published by the National Institutes of Health. The study also showed that doctors sometimes spend less time with Black patients compared with White patients; they don’t tend to collaborate as extensively; medical providers sometimes are more domineering or condescending with Black patients and arrive at diagnoses differently, prescribe therapies differently.
A recent study published by the National Academy of Sciences presents an example of how implicit biases impact health outcomes: Black newborns are more likely to survive when cared for by Black doctors. “The mortality penalty they suffer, as compared with White infants, is halved,” the study said.
“Given all of that, there is extreme distrust, extreme difficulty getting people to participate (in COVID-19 vaccine studies), but the need is greater,” Gunn said.
Trust would increase if Black people could be treated by Black doctors and receive health information from Black sources, and if researchers of color participated more in medical studies, he said.
“We need the right message from the right people,” Gunn said. “I know people in my immediate family who won’t get a flu shot. This stuff is real. It makes it very hard for any institution, including MUSC, to make progress.”
Thaddeus Bell, who runs a private practice in North Charleston, said the medical community denied its racist history for too long. Medical schools failed to teach it and to take measures to counteract its negative impacts.
He recently gave a talk to a group of local Black employees, and only about 20 percent of them said they had gotten a flu shot. Distrust is a big problem, but so is a failure on the part of primary care providers to properly inform their patients, Bell said.
Dr. Thaddeus Bell in 2018 speaking at Fetter Health Care’s Thaddeus J. Bell Family Health Center in Summerville. Bell has a private practice in North Charleston and is devoted to educating people about racial health disparities.
“My practice is 99 percent African American,” he said. “I don’t have a problem convincing people to take the flu shot anymore in my practice, but that’s because I’ve spent a tremendous amount of time educating people.” Doctors must engender trust and provide encouragement. “I expect (my patients) to follow through. But it was a journey, not something that happened overnight.”
The flu vaccine plays an important role in the COVID-19 response, Bell pointed out.
“This winter, a lot of African Americans are going to die from coronavirus and the flu,” he said. But if you’ve gotten a flu shot and later show symptoms, your doctor can rule out the flu and get a jump on COVID-19 treatment, he said.
Marvella Ford, a cancer researcher at MUSC and professor in the department of public health sciences, said racial health disparities can be traced back to slavery itself and the racist assertion that Black people were somehow less human than Whites (or not human at all, but merely chattel).
“People say, ‘Well, that’s all in the past,’ but it’s not so far in the past,” she said.
Nevertheless, the coronavirus pandemic is a “game-changing moment,” an opportunity to alter perceptions and attitudes on a grand scale, Ford said. “This is a population-based disease. The only way we’re going to snuff it out is if everyone gets vaccinated. We should be having conversations with community members now.”
Ford said that means forging partnerships among organizations to devise and implement information campaigns, explaining how vaccines are made and how they work, describing impacts on children and the elderly, spelling out safety protocols and being honest about what we know and what we don’t know.
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