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COVID-19 COVID-19
VACCINES VACCINES

get killed, when you send them home and they don’t know how to physicians were more likely to engage with them, and even consent
fight for themselves.” Despite being a physician herself and saving to preventive services like cardiovascular screenings and immuniza-
Mistrust of the COVID-19 Vaccine in countless lives during her medical career, her outcry for adequate and tions. They found that the effects were most pronounced for men
who have little experience obtaining medical care and among those
fair treatment could not save her own. This highlights the fact that
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African American Communities: even being an educated physician in our country does not exclude one who mistrust the medical system. To those points, we must work
directly with our community leaders and amplify the voices of people
from the systemic and structural racism.
of color to ease fears, build trust and disseminate factual evidence-
A recent pew research report highlighted the fact that black Amer-
icans are less inclined to receive the COVID-19 vaccination than based information about the vaccines. Only then will we be able to
A Problem that Stems Far Back from this Pandemic other racial and ethnic groups: 42% would do so compared to 63% of start healing and recovering from the mistrust, physical, and psycho-
hispanics and 61% of white adults. Another recent report from
logical damage imparted on the black race and culture for hundreds
UnidosUS, the NAACP, and COVID collaborative revealed that just of centuries in the past.
By Antonio Webb, MD
14% of Black Americans and 34% of Latino Americans say they have
trust in the safety of a new COVID-19 vaccine. The study also found Dr. Antonio Webb is an Orthopedic Spine Surgeon located
that 18% of Black and 40% of Latino respondents trust the COVID- in San Antonio, Texas with the South Texas Spinal Clinic.
With thousands of front-line workers and other members of our society already receiving 19’s vaccine effectiveness. The unfortunate reality is that Black people To contact Dr. Webb, please email toniowebb@gmail.com or
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the first round of COVID-19 vaccinations around the world, there is a subset of our in this country have been trained, over many centuries, to distrust both more information about Dr. Webb can be found at www.an-
the government and medical community on the issue of healthcare toniowebbmd.com or www.youtube.com/antoniowebbmd. Dr. Webb is a
population that still have doubts and hesitancy surrounding it: African Americans. and hence the hesitation and lack of trust of the COVID-19 vaccine. member of the Bexar County Medical Society.

Our Roles as Clinicians REFERENCES
The Issue at Hand atic and structural discriminations that have and currently exist in the As clinicians, our job is to first assimilate knowledge about various 1. Stern AM. Sterilized in the name of public health: race, immigra-
This hesitancy and lack of trust is multifactorial, stemming way back United States. It is well known that black and minority patients are conditions, treatments, medications and then impart this information tion, and reproductive control in modern California. Am J Public
to the 1800s. During this time, James Marion Sims, a national and more likely to die of preventable diseases such as heart disease and to our patients in a shared decision-making manner. To date (as of Health. 2005;95(7):1128-1138. doi:10.2105/AJPH.2004.041608
renowned doctor who later became known as the “Father of Gynecol- stroke. They also have higher rates of cancer, asthma, influenza, pneu- this writing), 300,000+ people have lost their lives to this deadly 2. https://www.cdc.gov/tuskegee/timeline.htm
ogy,” performed medical experiments on enslaved women. These monia, diabetes, and HIV/AIDs. For many of them, structural racism virus. Black Americans have been disproportionately affected by pan- 3. Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Dis-
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women, who by his definition of their position in society, could not and unequal treatment remain a contributing factor to disease and demic morbidity and mortality, and this experience is reflected in ease 2019 Case Surveillance — United States, January 22–May 30,
provide informed consent. During this time he performed experimen- death. There is an abundance of literature also showing that racial and hesitancy attitudes and behavior towards the COVID-19 vaccine. As 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765.
tal operations, many times without anesthesia. This was in part because ethnic minority groups are being disproportionately affected by leaders in our communities, we must first build trust. Having health- 4. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics As-
he didn't believe black women experienced pain in the same way that COVID-19. It is said that black Americans are infected with care providers from diverse backgrounds that are of the same race and sociated with Hospitalization Among Patients with COVID-19 —
3-5
white women did. Between 1930 and 1970, 65% of the 7,600 plus COVID-19 at nearly three times the rate of white Americans and are gender is critical. Studies show that black patients have better out- Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb
sterilizations ordered by the state of North Carolina were carried out twice as likely to die from the virus. This is due to many of the in- comes when treated by black doctors. For example, a Stanford Uni- Mortal Wkly Rep. ePub: 17 June 2020.
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on black women. For nearly half of the 20th century, black women equities in social determinants of health. These include discrimination, versity study looked at black men in Oakland, California and paired 5. Gold JA, Wong KK, Szablewski CM, et al. Characteristics and
were forcibly sterilized often without their knowledge. Some of these lower rates of health insurance coverage, barriers to accessing health- them with either Black or non-Black doctors. The men seen by Black Clinical Outcomes of Adult Patients Hospitalized with COVID-
women were sterilized during cesarean sections and were never told; care, educational inequalities, income and wealth gaps, and limited ac- 19 — Georgia, March 2020. MMWR Morb Mortal
others were threatened with termination of welfare benefits or denial cess to quality housing to name a few. These factors and others are Wkly Rep 2020;69:545–550.
of medical care if they didn’t “consent” to the procedure; others re- associated with more COVID-19 cases, hospitalizations, and deaths 6. https://www.cdc.gov/coronavirus/2019-
ceived unnecessary hysterectomies at teaching hospitals as practice for in areas where racial and ethnic minority groups live, learn, play, and ncov/community/health-equity/race-ethnicity.
medical residents. In the south, it was such a widespread practice that worship. Beyond these factors, research shows that historic and wide- html#fn2
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it had a euphemism: a “Mississippi appendectomy.” spread abuse and mistreatment of communities of color by the medical 7. Institute of Medicine. 2003. Unequal Treatment:
The US Public Health Service began the Tuskegee study in 1932. system and ongoing racism and discrimination drive disparities in Confronting Racial and Ethnic Disparities in
Black males in Macon County, Alabama, who had already contracted healthcare. This contributes to lower quality of care, distrust of the Health Care. Washington, DC: The National
syphilis, were recruited to participate in the study. These men were healthcare system along with stress and trauma. Academies Press. https://doi.org/10.17226/12875.
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told that the purpose of the trial was to study and understand whether Dr. Susan Moore, an African American physician, is just one exam- 8. https://static1.squarespace.com/static/5f85f5a15
syphilis progressed differently in black people as compared to white ple. She died in Dec 2020 following multiple hospitalizations for com- 6091e113f96e4d3/t/5fb72481b1eb2e6cf84
people. Although a novel treatment at the time, penicillin became plications from COVID-19. Acutely aware of her deteriorating 5457f/1605837977495/VaccineHesitancy_Black-
widely available a few years later in 1943, but these black males were condition, she repeatedly asked for medications to treat her pain; im- Latinx_Final_11.19.pdf
intentionally not treated. Unfortunately, many of these black males aging studies to assess her dyspnea and routine checks while admitted 9. https://coronavirus.jhu.edu/
died from untreated syphilis by the time the study was halted in 1972. to the hospital, all while under the care of a white physician. She noted 10.https://siepr.stanford.edu/research/publica-
Many others went on to infect their wives, some of whom then trans- on widely shared social media posts that her pain was dismissed during tions/does-diversity-matter-health-experimental-
mitted the disease to their children. her stay and that she didn't trust the hospital system. She expressed evidence-oakland
Fast forward to 2021, there are a lot of similarities between Dr. being treated like a drug addict and was reportedly told to be dis-
James Sims’ experimental operations in the mid 1800s, the uncon- charged home from the hospital despite her reported symptoms. She
sented sterilizations of black women and Tuskegee experiments in the publicly cried for help by stating, "I put forth and maintain, if I was
1930s, and disparities in COVID-19 - all which highlight the system- white, I wouldn’t have to go through that. This is how black people

16 SAN ANTONIO MEDICINE • February 2021 Visit us at www.bcms.org 17