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Lack of Access, Not Hesitancy, Drives Racial Vaccination Gap

People wait in chairs
People sit in chairs at Richmond's Celebration Church on Tuesday, the first day of operations for the city's new Southside vaccination site. (Photo courtesy of the Richmond and Henrico Health Districts)

With vaccination underway, early concerns that Black Virginians would be ‘hesitant’ to take the COVID-19 vaccine have not borne out. Instead of an ‘interest gap,’ new data shows access barriers may be the real cause of racial disparities in vaccination rates.

Dr. Danny Avula, the state’s COVID-19 vaccine coordinator, said there’s been a ‘change’ at a press conference earlier this month. 

“It’s been really interesting to watch the national data around hesitancy,” he said. “Two months ago, I probably said here that we have a lot of concern about the African American community and their willingness to take [vaccines]. That’s changed dramatically. From December to January to February, we’ve really seen vaccine hesitancy drop in that population. And where we see the most hesitancy is actually in white Republicans living in rural areas.”

Shawn Utsey, a psychology professor and chair of the African American studies department at Virginia Commonwealth University, isn’t convinced things have actually changed. Instead, he says the concerns over Black hesitancy were never based in reality.

“[The media] foresaw the lack of compliance from Black populations as being an obstacle to eliminating COVID-19,” he said. But for months, “I was making the case that the Trump followers, which is nearly half the country, would be even more problematic.”

That claim is borne out in polling. In December, when public health officials were warning of Black hesitancy, 35% of Black respondents to a Kaiser Family Foundation poll said they would probably or definitely not get the COVID-19 vaccine. While that was the highest of any racial group, 42% of Republicans said they were unlikely to get inoculated.

As time has progressed, that gap has widened. In a February Poll, KFF found that 23% of Black respondents said they would not get a vaccine or only get one if mandated. That number was 38% among Republicans. 

Utsey says the media created the narrative of Black hesitancy, based on a stereotype of Black people as noncompliant.

“This follows a pattern of problematizing or infantilizing Black folks in terms of being responsible citizens,” Utsey said.  “The reality was Black people tend to be very compliant despite a history of suspicion based on exploitation by the medical establishment.”

The American medical community has long abused Black people. From 1932 until 1972, the Public Health Service left 399 Black men to suffer from syphilis to study what happened when the disease went untreated. In the late ‘90s, 34 Black and Latino children at the New York State Psychiatric Institute were given fenfluramine, a weight-loss medication that was banned in the United States after reports of heart valve disease, to see if it would reduce ‘violent or criminal behavior.’

Richmond has its own sordid history of medical abuses. In the 19th century, as medical colleges started to pop up around the nation, students needed cadavers to dissect. While European cities set up exchanges where medical schools would get unclaimed corpses, no such system existed in the U.S. Instead, American schools took a far more sinister route, robbing graves in city cemeteries. In Richmond, the Medical College of Virginia, which would later become part of VCU, profited by exhuming bodies from the city's historically Black cemeteries, something Utsey discovered while researching one such graveyard. 

Utsey says that while events such as these have left their mark on Black Americans ability to trust the medical community, they continue to do what is asked of them.

“Contrary to popular belief, Black people are actually good citizens. We understand what it means to be good citizens and when it’s not really about me but about my fellow citizens,” he said. “They don’t put themselves first. They put the group first. This is kind of a remnant of African culture where the focus is not on the individual but on the group.”

Though hesitancy was overstated by the media, Black Virginians are still less likely to have been vaccinated than their white counterparts. It’s hard to know exactly what demographics have been vaccinated because the state did not collect demographic data for roughly one-third of vaccine recipients. But based on the data the Virginia Department of Health has collected, white Virginians are over 50% more likely to have been vaccinated.

Avula recognizes that as a shortcoming the state is hoping to overcome. 

“We know, just looking at our data, that we’re not reaching Black and Latino residents to the degree that we want to and need to,” he said. “The more that we do community facing events, the more that we get out into neighborhoods where many undocumented residents live and do those types of open vaccination events, the more that we’re going to be able to educate and support and ultimately provide opportunities for vaccination.”

Ustey, however, says the lack of vaccine availability for Black Americans is a result of intentional decisions, pointing to Florida, where Gov. Ron DeSantis has been accused of favoring wealthy, white communities during the vaccine rollout.

“Although that was a pretty obvious attempt to direct the resources to the more resourced people, or the more privileged people… in not so obvious ways, that’s probably taking place in other places as well,” he said.

According to the Richmond Times-Dispatch, all four zip codes furthest from the city’s established vaccination sites have a majority of residents who are Black or Latino. Those zip codes also house a majority of Richmonders who’ve contracted the coronavirus, which has disproportionately affected Black and Latino Americans.

Utsey cites the inclusion of university professors as part of Phase 1c of the state’s distribution, while most students won’t be eligible until Phase 2, as an example of the subtle ways the vaccine rollout has disadvantaged Black Virginians.

“As a consequence of me having a Ph.D. and being a tenured professor at a university, I’m experiencing privilege again,” he said. “The argument would be, of course, that because faculty are older and the students are younger and less vulnerable to COVID, that it makes sense to vaccinate faculty first. But the case at VCU is we have a lot of nontraditional students. Many of our students are not 18, 19 years old. So that one size fits all is having a negative effect.”

Richmond opened its first vaccine center in Southside on Tuesday at Celebration Church, and the state recently opened a mass vaccination site at the historically Black Virginia State University in Petersburg. While these moves may help reduce the vaccination gap, Utsey says there’s a lesson to be learned from the troubled rollout.

“Like [Dr. Anthony Fauci] says, follow the science. If you follow the science, then you have an opportunity to better understand the Black response to pandemics and other national emergencies,” he said. “If we follow the science, that would also reduce the tendency to characterize Black people as a group in which the historical narrative continues to haunt us despite a change in behavior.”