Addressing the racist roots of vaccine development to overcome vaccination hesitancy
Key Takeaways
The early development of smallpox vaccines (the first vaccine that the US would see) involved testing on enslaved people.
Vaccine hesitancy within Black communities may be a result of racially discriminatory medical events in years past, including instances like the Tuskegee Study.
To address vaccine hesitancy among Black patients, doctors can acknowledge the gravity of the issue, use trusted messengers to communicate the vaccine’s importance, and communicate the diversity of recent trials.
Vaccine hesitancy is a hot topic in COVID-19 discourse. The term refers to a “delay in acceptance or refusal of vaccines despite availability,” and may apply to some US populations of color regarding COVID-19 vaccines, according to an article published by JAMA Network Open.[]
Black Americans, for example, may exhibit vaccine hesitancy as a result of unethical medical practices that have harmed members of their community.
Physicians can address vaccine hesitancy among Black patients by calling attention to the issue at hand, using trusted messengers, and reminding patients that COVID-19 vaccine trials feature diverse participants.
Slavery and vaccine development
The use of vaccines to prevent the spread of disease is a fairly new concept in the US and Europe. The birth of this practice, however, is inextricably linked to slavery in the US.
As noted by Jim Downs, historian and professor of Civil War studies at Gettysburg College, the first vaccine to make an appearance in the US was intended to protect individuals from contracting smallpox.
In 1721, an enslaved man named Onesimus instructed a doctor known as Zabdiel Boylston to take the fluid from a smallpox vesicle and inject it into others to serve as a means of protection against severe illness.
Boylston tested the early vaccines on his son and enslaved individuals, using the results of the experiment to prove the efficacy of variolation—also known as the process of infecting “a susceptible person with the smallpox virus in hopes of their developing a milder version and surviving,” according to an article published by StatNews.com.[]
The development of vaccines in the US could be considered a result of slavery.
On top of that, Black patients have faced other forms of medical harm that could contribute to current vaccine hesitancy.
Vaccine hesitancy among Black patients
Vaccine hesitancy among Black individuals may be a result of medical mistrust based on historical accounts of racially discriminatory practices in the medical field.
According to a 2021 article published by PLOS ONE, events such as the Tuskegee Study between 1932–1972—during which Black men with a syphilis diagnosis were barred from receiving treatment—may play a role in some populations’ distrust in the healthcare system.[]
Other legislative barriers, including eugenics laws that have disproportionately harmed patients of color in the past, may also contribute to vaccine hesitancy today.
Concerning COVID-19 vaccines, the PLOS ONE research suggests that Black and Hispanic populations are more likely than their White counterparts to wait 1 year before getting the vaccine. Black and Hispanic individuals are also less likely to encourage their families to get it.
Black participants also reportedly struggle to trust the safety and efficacy of the COVID-19 vaccines—which could lead to persistent COVID-19 infections within Black communities, who are already disproportionately affected by the disease.
Tips for addressing vaccine hesitancy
Vaccine hesitancy among Black patients may be rooted in past failures of the medical system to adequately care for Black patients.
And when it comes to COVID, this hesitancy could lead to higher infection rates among communities of color.
According to an article published by the AMA, doctors can address vaccine hesitancy in Black patients with the following tips:[]
Acknowledge the issue at hand. Vaccine hesitancy exists in several populations of color. Instead of grouping it in with conspiracy theories related to COVID-19, address the truth of early vaccine development with patients head-on.
Implement trusted messengers. Pointing to expert opinions on vaccine safety (like those of the top scientists at Moderna and Pfizer, or the FDA) can help to drive home the point that being unvaccinated will inevitably lead a patient to contract COVID-19 and risk the health of their community.
Remind patients of trial diversity. Discuss with patients how the healthcare system has come a long way since the Tuskegee Study, and the vaccines currently on the market have included African Americans in associated clinical trials.
To address further questions from patients regarding COVID-19 vaccine safety, you may also be interested in the AMA’s COVID-19 vaccine guide for physicians.
What this means for you
According to research, a doctor in colonial Boston took the advice of an enslaved African man named Onesimus in 1721 to create the first vaccine in the US. The early vaccines, intended to protect against the spread of smallpox, were tested on local enslaved populations. Additional discriminatory medical events—including the Tuskegee Study—may contribute to vaccine hesitancy among Black populations in the US. To combat such hesitancy, directly address and validate the importance of the issue, utilize trusted messengers, and make known the involvement of African Americans in COVID-19 vaccine trials.