What is it that makes some black people reluctant to get the coronavirus vaccine?
Polling in both Britain and the US shows that they are among the least likely to say they will get vaccinated. This is despite being at up to four times greater risk of dying from Covid-19 than white people.
Mainstream commentators dwell on the supposed hold of religious ideas, unfounded fears and exposure to conspiracy theories among ethnic minorities. Underlying their talk is the assumption that rejecting the vaccine is an act of stupidity.
But there are many rational reasons why black people in particular have little faith in the medical establishment—including patterns of poor care that reflect racist practice.
A little-discussed reason for vaccine reticence is the way that scientific racism has in the past been used to justify the most hideous experiments on black people.
The most infamous of these was carried out in the US Deep South and became known as the Tuskegee Study.
Starting in 1932, 600 black men from Alabama were used as guinea pigs in an experimental study into syphilis, a potentially deadly sexually transmitted disease. The United States Public Health Service’s stated goal was to “observe the natural history of untreated syphilis” in black populations.
But the researchers who came to town never told their subjects this—instead it was said they would be treated for “bad blood”.
Over the course of forty years, the medical wing of the state contrived to keep secret the true nature of its ongoing operation.
Unlike a later US study in Guatemala, the men in Tuskegee were not deliberately infected with syphilis.
Instead, subjects were split into two groups.
In one were people who had tested positive for syphilis but were unaware, and never subsequently told by the researchers. The other group was negative and equally uninformed.
Both were given deliberately ineffective remedies to further their belief that they were being treated for fatigue or anaemia.
The study only wanted to see what happened to those with the disease but without medical care. As such, the authorities went to great lengths to ensure their subjects never found out about their infection—and that meant making sure that no one else treated them either.
In 1934, the study leaders told local doctors about the experiment and instructed them not to diagnose syphilis in any of their subjects. In 1941 many men were drafted into the army, and were found on examination to have the disease.
Doctors arranged for them to be discharged from service and sent home without explanation.
Across the US in the 1940s treatment for syphilis rapidly improved when antibiotics became widely available and rapid treatment centres opened.
Many of the participants, thinking they were already being treated for their illnesses by kindly doctors, never sought out the treatment centres, and instead carried on deteriorating.
By 1965 the study bosses were arguing in small medical circles that it was too late to give penicillin to people in their research as the disease had already progressed too far. But it was another lie.
The antibiotic remains recommended for all stages of its treatment even today.
It wasn’t until a whistleblower inside the programme leaked information about Tuskegee to the New York Times newspaper in 1972 that the experiment finally ended.
By then only 74 of the original 600 men were alive. Out of that 600, some 128 had died of the disease or complications, 40 had infected their partners, and 19 of their children had contracted it congenitally.
But the terrible effects of the study went far wider.
In 1980, Tuskegee revelations were still reverberating across the US. A university study shows that by then the fear of medicine and doctors had risen dramatically among black people.
That meant that all manner of illnesses went untreated, and, as a result, life expectancy among black men over 45 had fallen on average by over a year.
The closer you lived to Alabama, the more scared you were, and the more life you lost. But the investigation also revealed that the story of Tuskegee spread far and wide and affected black consciousness across the country.
Lillie Head’s father, Freddie Lee Tyson, was one of those studied. When the truth came out she describes a wave of distrust hitting her community. “There was a feeling of shame,” she said. “The feeling of being betrayed by people you thought were there to help and protect you.”
To understand what could drive the medical establishment into thinking that this horror show was a legitimate scientific enquiry we have to understand the twisted nature of American racism.
Even after the US Civil War formally ended slavery, the notion of black people as a separate and inferior species to whites was common, and widely supported in scientific circles.
Doctors routinely talked of a hierarchy of races with whites at the top, and black people at the bottom.
Former slaves, they said, were “riddled with imperfections from head to toe”, and that they didn’t know true pain because of their “primitive nervous systems”.
The scientific establishment had an obsession with race and sex, and in particular the idea that black people’s brains were underdeveloped but that their sexual organs were “over developed”.
This fed into another great racist fear—that black men might have relations with white women, and that the white race might then be “polluted”.
These delusions stood behind the syphilis study.
The authorities that commissioned it wanted to prove a form of black male promiscuity lay behind poor health outcomes and thereby confirm their own superiority.
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Many liberal commentators are today content to see Tuskegee as part of a banished past.
But, for example, much more recently Africans have repeatedly been used to test drugs in dubious circumstances—only then to be denied treatments they have helped develop.
In the 1990s Pfizer carried out tests in Nigeria of a new treatment for meningitis. Eleven children died in the trial.
Other participants suffered blindness, deafness and brain damage.
US physicians also conducted tests on HIV-positive Zimbabwean women in 1994.
The drug was supposed to stop mother to child transmission. But half the women were given a placebo, even though a proven treatment already existed.
As a result, an estimated 1,000 babies contracted HIV/AIDS.
In the 1960s and 70s establishment fears of “black delinquency” drove an attempt to limit the number of black babies. In the US, this led to a huge programme of sterilisation that focused on black and Native American women.
In Britain, the contraceptive drug Depo-Provera was tested on black and Asian women without them being warned of the side effects.
There are allegations of women given the drug without consent, or while unconscious.
Black women’s groups ran “Ban the Jab” campaigns and demanded both the right to safe contraception and the right to have as many children as they wanted.
For some, this history of medicalised racism melds with very contemporary examples of prejudice in the health service.
And the two taken together become a reason to suspect the coronavirus vaccine to be dangerous, or worse, part of a plot.
But the vaccine is neither of these. It would be a tragedy if fear of the jab drove many of those most at risk of coronavirus into turning down the vaccine.
To win back trust the NHS must be seen to be addressing racism in the medical establishment.
And black people must be at the forefront of the drive to allow local people more control over how the vaccine programme is run.