Earlier this year, bioethics philosopher Justin Bernstein sat down with Back in America podcast editor Josh Wagner to discuss the ethics of selecting a particular group to receive the vaccine first. Focusing on equity injustices, he highlighted non-healthcare essential workers as being the least compensated for their jobs and therefore the most deserving of being prioritized for getting the vaccine. The question then centered on prioritizing reparations of other inequities for racial and ethnic minorities in terms of the healthcare gap. Bernstein even went as far as to raise the question: “Should race and ethnicity be a factor in deciding who should get the vaccine first?” Ultimately deciding against it, Bernstein cited that vaccine hesitancy among Black American communities because they “know the long and sordid history of medical abuse and government deceptions” that continues today. So, what does this mean for the racial inequity in healthcare, and how can we begin to close it through vaccine eligibility?
This interview raised two important points: (i) The current system seems to prioritize people based on their employment, and (ii) that it does very little to support minority groups. I work in a New York City homeless shelter, and if you’ve never been to one, it is made up of families, social workers, security guards and administrative workers. I am one of two white people on staff, there are a total of six men on staff out of the forty people who work here. So with a majority-minority population of non-healthcare essential work, it is not surprising that the compensation, benefits, and working conditions are subpar. I am receiving the same low coverage, high premium health insurance, in-person exposure, and low salary as my coworkers. Most hold multiple higher-education degrees, and have over 10 years of experience in the field. Despite our paltry benefits, when our executive director informed us that we could get the vaccine before the general public, it led to distrust and disinterest. A coworker even suggested that we were the guinea pigs for the general public, implying we were unknowingly the subjects of their last phase of testing.
A COWORKER EVEN SUGGESTED THAT WE WERE THE GUINEA PIGS FOR THE GENERAL PUBLIC.
While this comment may have been in good humor, it made me think: When are essential workers deemed no longer essential? Then, I researched the demographics of non-healthcare essential workers, and discovered that “nearly two-thirds (64.4 percent) of frontline workers are women'' and “41.2 % frontline workers are Black, Hispanic, Asian-American/Pacific Islander, or some category other than white.” More specifically, “Blacks are most overrepresented in Child Care and Social Services (19.3 percent of workers).” What I found is that there is a connection not only between minority racial groups and essential work but also inaccessible to healthcare. In 2020, 23% of frontline workers lived in low-income families and one in ten of those workers did not have health insurance.
While these jobs are essential during times of crisis, the risk of spreading the virus to the people sanitizing our spaces are not being taken into account by employers, putting those that are working in person at higher risk of infection. If our own employers undervalue our safety, why should we expect the governing bodies to care? When offered the vaccine, I was one of two people that had been vaccinated or planned to do so.
JUST OVER 41% OF FRONTLINE WORKERS ARE BLACK, HISPANIC, ASIAN-AMERICAN/PACIFIC ISLANDER, OR SOME CATEGORY OTHER THAN WHITE.
One colleague came to me to ask, “Did you really get the vaccine? How do you feel now? I have been hearing these terrible stories of people feeling so sick they couldn’t get out of bed!” This began a trend; other coworkers began confiding in me that their favorite rappers have died because of the COVID-19 vaccine, or they were afraid it would interact badly with their medication. The CDC has recommended consulting a doctor before discontinuing medication in order to get the vaccine, they have also suggested avoiding over the counter medication before vaccination, but “for most people, it is not recommended to avoid, discontinue, or delay medications for underlying medical conditions around the time of COVID-19 vaccination.” While I had the contrary experience, they still questioned whether the vaccine would affect them differently based on “family history.” Black Americans’ underlying fear of experiencing medical care differently than their white counterparts is not new; it comes from a tradition in the United States of exploiting black bodies for labor, medical research, and involuntary sterilization. For the CDC to ask low-income essential workers to trust that programs designed for minorities and the poor are safe is, quite frankly, tone-deaf.
“BLACK AMERICANS ARE MORE LIKELY TO BE EXPOSED TO THE CORONAVIRUS THROUGHOUT THEIR DAILY LIVES. THEY ARE MORE LIKELY TO WORK IN LOW-WAGE JOBS AND TO LIVE IN SEGREGATED, CROWDED NEIGHBORHOODS WITH HIGH RATES OF POVERTY, INCREASED POLLUTION, AND LIMITED TRANSPORTATION. THE BLACK COMMUNITY ALSO EXPERIENCES HIGHER RATES OF INCARCERATION AND HOMELESSNESS.” - JAMA Health Forum
Laws to protect patients in the medical field have existed since 1900 and in 1931, the Nuremberg Code outlined what we refer to as informed consent into law. However, these laws were not considered in the cases of Black American bodies, as they were constantly exploited and neglected throughout history. The most infamous of these exploitations that coined the term informed consent was the Tuskegee syphilis study, but it is not a singular example (see Harriet Washington’s 2007 book Medical Apartheid for specifics). During the same time period, experiments included exposure to chemicals such as dioxin, a carcinogen, and component of Agent Orange, which its architect, Dr. Kligman argued was “too minimal an amount to cause harm.” The result of these experiments included infections, biopsies, and death; however, Dr. Kligman’s legacy as a forefather in dermatology remains unscathed. Today, the list of medical tests being conducted outside the federal regulations in prison institutions is long. This is because the law protecting inmates only applies to programs receiving federal funding, and as more prisons become privately owned, fewer human rights protections are granted. With mass incarcerations of Black Americans, a study found that“people of color are further overrepresented in private prisons contracted by departments of correction in Arizona, California, and Texas.” People of color incarcerated in those states are also going to be overrepresented in medical testing conducted in private prisons.
With few protections afforded to Black Americans in private prisons, is it fair to assume these attitudes of exploitation have leaked into other sectors of our society?
In times of the Spanish Flu and COVID-19, Black Americans were living under the laws of Jim Crow and now surrounded by the police brutality and killings that sparked the Black Lives Matter movement in 2013. While many assume that the passage of civil rights legislation and increases in life span may indicate the progress of our nation, there are far too many injustices for it to be that simply put. Sociologist and civil rights activist William Edward Burghardt (W.E.B) Du Bois found in the 1900 census that, “death rates for African Americans were two to three times higher than those for whites,” due to the blatant racist segregation laws that prohibited Black Americans from seeking medical care in white hospitals, as well as from seeking medical degrees from white medical schools. In today’s pandemic, “a collaboration between the COVID Tracking Project and the Boston University Center for Antiracist Research, the Racial Data Tracker found that Black Americans are dying from COVID-19 at 2.4 times the rate of white people.”
Political Scientist, Adolf Reed urges us to further examine these data points and recognize that "COVID transmission could readily shore up long-discredited but nonetheless lingering assumptions that blacks and Hispanics either bear distinct racial biologies or have developed group-specific cultural practices that account for their seemingly elevated vulnerability. Other scholarship has affirmed the reality of that danger. What’s more, recent Covid research has shown what should have been apparent from the outset—those early disparities in infection and death among blacks and Hispanics result most crucially from working and housing conditions that increase exposure and vulnerability." A study conducted in January 2021 showed that Black Americans continue to have low rates of occupying ICU beds and disproportionate rates of infection. This could mean that while Black Americans have had a higher risk of infection, they are still not receiving the life-saving care they need due to a lack of employer-based insurance. It could also mean that the racial wage gap has been the prohibitor from affording hospitalization.
The law has permitted racial integration in hospitals and medical schools, however, the data shows that systemic racism continues to be a barrier to health.
Black Americans are not the only community that is vaccine-hesitant, the Anti-Vax Movement has also gained traction after President Donald Trump supported the debunked claims that Measles, Mumps, and Rubella cause Autism Spectrum Disorder. According to the Kaiser Family Foundation, Republicans are the most resistant: 35% of whom do not want to get a vaccine. This trend is largely supported in rural areas where Trump succeeded in winning the most votes; however, Trump himself has now been vaccinated and, because he did not publicize this, his voters are still hesitant. Many Democratic politicians have publicized their vaccinations, and some are even creating incentives for more people to get vaccinated, like free Krispy Kreme. The New York Times just released a survey that hesitant Democrats are willing to consider a cash incentive, while Republicans are motivated by the relaxed guidelines promised by vaccinated herd immunity. In order to reach herd immunity (without vaccinating children), The Mayo Clinic has indicated that with a highly infectious disease such as COVID-19, it is difficult to determine an exact percentage that would be needed for herd immunity. For measles, we need 94% of the population to be immune, so if that’s any indicator we have a long way to go. Among smaller groups, the number might be 100%, many private sports leagues, clubs, and organizations have begun requiring vaccine cards from members in order to participate again. This is now being referred to as a Vaccine Passport, some may know that in order to travel on a commercial flight or train, negative test results have been required, going forward, proof of vaccination is the only alternative to the COVID-19 test.
So far, Texas, Florida, Arizona, and Idaho have started to create policies surrounding the COVID-19 vaccination - and proof of vaccination - as unconstitutional. Insisting the vaccine is voluntary in the same way these states did not enforce wearing masks and social distancing in public spaces. It appears that wearing masks was the precursor to the next political symbol, the vaccine passport. While masks alone cannot grant us herd immunity, the popularity of the vaccine has plateaued, and hopes for herd immunity are dwindling among the American public. As time has gone on, my coworkers have gotten vaccinated, but only once 25% of NYC had agreed to do it first.
If you or anyone you know are planning to, or have already received your vaccine, share your stories with us: the nerves, the lines, the discomfort, the relief, we want to hear it all. Send us your stories here.
Emma Myers is an editorial intern at Back in America. She currently works as an employment specialist with AmeriCorps in a Brooklyn family shelter, and she is learning French and loves her dog, Bobo.