by Jodi L. Miller
Black people were 1.1 times more likely than their white counterparts to contract Covid-19, 2.8 times more likely to be hospitalized because of it, and two times more likely to die from the disease, according to Centers for Disease Control (CDC) data compiled from March 2020 through October 2021. Still, a Pew Research report released in December 2020 revealed that only 42% of Black Americans were inclined to get vaccinated, compared to 63% of the Hispanic population and 61% of whites.
The RAND Corporation, an American nonprofit think tank, conducted a survey of Black Americans in late 2020 to determine the cause of their reluctance to be vaccinated against Covid. One of the key findings of the survey was that “Black Americans attribute their mistrust of vaccines in general and Covid-19 vaccines in particular to systemic racism, including discrimination and mistreatment in health care as well as by the government.”
The Black community’s reluctance is understandable once you recognize the way that the government has historically treated the African American population in relation to health care dating back to emancipation and even before. In his 2011 book, Sick From Freedom, Jim Downs, a historian and history professor at Gettysburg College, writes that at least one quarter of the four million formerly enslaved became sick or died between 1862 and 1870. More than 60,000 formerly enslaved people died from an outbreak of smallpox that began in Washington, DC and spread throughout the South. The formerly enslaved were not welcome at white hospitals or treated by white doctors, and there weren’t many African American doctors at that time. In his book, Professor Downs writes that the newly freed slaves were “the first advocates of a federal health care system.”
Ignoring the pain
Dr. James Marion Sims is considered the “Father of Modern Gynecology” because of surgical advances he pioneered and a medical device he invented, which is still in use today. There are monuments to him in South Carolina, Alabama and in New York City’s Central Park. The inscription on the South Carolina monument reads: “The first surgeon of the ages in ministry of women, treating alike empress and slave.”
That’s not exactly true. He did treat an empress from France; however, he didn’t treat enslaved women. Instead, he experimented on them without their consent or the benefit of anesthesia, according to a 1993 article in the Journal of Medical Ethics. Titled “The medical ethics of the ‘Father of Gynecology’, Dr. J. Marion Sims,” the article noted the doctor experimented on seven enslaved women from 1845 to 1849, but just three of the women’s names—Lucy, Anarcha and Betsey—are known.
Vanessa Northington Gamble, a physician, medical historian, and professor of American Studies at George Washington University explained in a 2017 National Public Radio (NPR) interview that the enslaved women all had a condition that sometimes occurs after a difficult childbirth. The condition, if not corrected, makes it impossible to have more children, Dr. Gamble said, and it would also be difficult for them to continue working.
“These women were property. These women could not consent,” Dr. Gamble told NPR. “These women also had value to the slaveholders for production and reproduction—how much work they could do in the field, how many enslaved children they could produce.”
According to the Journal of Medical Ethics article, Dr. Sims’ first operation was performed on Lucy. “The surgery lasted for an hour and Lucy endured excruciating pain…She must have felt extreme humiliation as twelve doctors observed the operation,” the article stated.
“There was a belief at the time that Black people did not feel pain in the same way. They were not vulnerable to pain, especially Black women,” Dr. Gamble told NPR.
That perception endures to this day, according to a 2016 study conducted by researchers at the University of Virginia and published in Proceedings of the National Academy of Sciences, a peer-reviewed scientific journal. The study revealed that many medical school students, particularly those who are white, believe there are biological differences between Black and white people and that Blacks feel less pain. The study revealed that because of this misinformed belief “Black Americans are systematically undertreated for pain relative to white Americans.”
In a 2007 study, published in the Journal of the National Medical Association, physicians were asked to rate how much pain their patients were experiencing. “Physicians were more likely to underestimate the pain of Black patients relative to nonblack patients.” The study addressed the origins of these beliefs.
“Beliefs that Blacks and whites are fundamentally and biologically different have been prevalent in various forms for centuries,” the study states. “In the United States, these beliefs were championed by scientists, physicians, and slave owners alike to justify slavery and the inhumane treatment of Black men and women in medical research.”
As for Dr. Sims, having perfected his surgical technique, after performing 30 surgeries on Anaracha alone, he moved to New York and opened a women’s hospital in 1855. There, he would treat white women with the same condition, although those women would be given the benefit of anesthesia. Despite Dr. Sims’ accomplishments, as Dr. Gamble told NPR, “The foundations of modern Gynecology are based on the body and the pain of enslaved Black women.”
Tuskegee experiment
Perhaps no incident sowed more distrust among the African American community toward the medical profession than the “Tuskegee Study of Untreated Syphilis in the Negro Male,” an experiment conducted by the U.S. Public Health Service and Alabama’s Tuskegee Institute beginning in 1932. According to the CDC, the study involved 600 Black men, 399 of whom had syphilis, an infectious, sexually transmitted disease. The other 201 men were used as a control group. According to the Tuskegee University’s website, which describes the study in detail, the participants were poor and illiterate sharecroppers who were enticed with the prospect of “medical exams, meals on examination days, free treatment for minor ailments and guarantees that provisions would be made after their deaths in terms of burial stipends paid to their survivors.” The website states: “The men were offered what most Negroes could only dream of in terms of medical care and survivors’ insurance.”
The patients were told that they were being treated for “bad blood,” which described a number of ailments including syphilis, fatigue and anemia. Even when penicillin was deemed effective in treating syphilis and became the standard cure in 1947, the medicine was withheld for members of the study, which went on for 40 years. It ended in 1972 after the Associated Press exposed the true purpose of the study, which was to track the arc of the disease to its conclusion. By that time, many men from the study had died or gone blind from non-treatment of the disease. In addition, these men had infected their wives, girlfriends and in some cases their children, who were born with the disease.
After the study was exposed, congressional hearings were held and an advisory panel, comprised of medical professionals and healthcare administrators, was appointed to examine the study. The panel issued a report in October 1972, finding that the study was “ethically unjustified.” While the panel determined that the men were not coerced into participating in the study, they were also not offered what is known as “informed consent,” something all scientific studies now require because of what happened with the Tuskegee study.
Informed consent is permission granted from the patient with the full knowledge of possible risks and consequences of participation. For example, the men in the study never knew the specific name of the study or its purpose. They were never told the possible consequences of non-treatment of the disease or the impact on their wives, girlfriends, and future children. In addition, the panel’s investigation concluded that when penicillin became available as a treatment, the participants should have been offered the antibiotic and the opportunity to quit the study.
In 1973, a class action lawsuit was filed on behalf of the men in the study, as well as their families. A settlement of nearly $10 million was reached. In addition to the monetary settlement, the U.S. government agreed to provide free medical and burial services to the survivors of the study and their wives, widows and children.
Hesitant to trust
In a May 1996 White House ceremony, former President William Clinton issued a formal apology to the surviving participants of the Tuskegee experiment, as well as to their families and the families of the deceased. Still, the damage done by this experiment eroded trust in the government and health care systems for the Black community and in part explains Covid-19 vaccine hesitancy in that community.
“Few families escaped the study. Everyone here knows someone who was in the study,” Omar Neal, a former Tuskegee mayor, told The New York Times. Three of Neal’s relatives were participants in the study, and he wavered on getting the vaccine. “And the betrayal—because that is what the study was—is often conjured whenever people are questioning something related to mistrusting medicine or science.”
Dr. Rueben C. Warren, director of the National Center for Bioethics in Research and Health Care at Tuskegee University, told The New York Times, “The questions being asked about the vaccine should be understood in the larger context of historic inequities in health care,” Dr. Warren said. “The hope, of course, is they finally decide to get the vaccine.”
In the summer of 2021, the Ad Council, a nonprofit organization that produces public service announcements, teamed up with the Black Coalition Against Covid, and Voices for Our Fathers Legacy Foundation, an organization that preserves the histories of the men who took part in the Tuskegee study, to create a national campaign aimed at reducing vaccine hesitancy among Black communities. The Ad Council created a short documentary that encouraged African Americans to get the Covid-19 vaccine but first confronted the horrors of the Tuskegee study head on, including the false narrative that the men were intentionally injected with syphilis, which was not true.
“We don’t want the horror of that study to be used as the reason why people do not get the vaccine to protect themselves,” Amy Haggins Pack, a retired nurse whose great uncle was one of the men in the study and who co-chairs the Voices for Our Fathers Legacy Foundation, says in the documentary. “Our ancestors were denied treatment. This is the opposite. The vaccine is available for everyone. We want people to take it to protect themselves and others.”
Dr. Reed Tuckson, co-founder of the Black Coalition Against Covid, points out in the video that as a result of the Tuskegee study reforms were made to how scientific research is conducted, including the creation of institutional review boards. Carmen Head Thornton, with the American Academy of Child and Adolescent Psychiatry, whose grandfather was part of the study, notes in the film that informed consent became the standard, not just for clinical trials, but also whenever someone has a medical procedure.
It seems that national campaigns like this influenced Covid vaccine numbers. According to a study conducted by researchers at Ohio State University College of Public Health and published in the Journal of the American Medical Association in January 2022, vaccine hesitancy decreased more rapidly among the Black community compared to other ethnic communities.
“We tend to assume that this mistrust of the health care system and of health care innovations like vaccines—that’s based in a history of racism and systematic mistreatment of Black populations by American health organizations—is something that can’t be moved and that there is nothing we can do about it,” the study’s lead author told U.S. News & World Report. “Clearly that is not true.”
Discussion Questions
- According to the article, there are monuments to Dr. Sims for his contributions to Gynecology. How do you think the contributions of Lucy, Anarcha and Betsey should be recognized?
- The article mentions a documentary that was produced to alleviate medical mistrust from the Black community. What else could be done to address the problem? What can medical professionals do to inspire trust from this community? Explain your answer.
Glossary Words
anesthesia—administration of drugs or gases so that a patient is not sensitive to pain during a surgical procedure.
emancipation — the release from slavery.
Gynecology—branch of medicine that deals with the functions and diseases specific to women and girls, especially those affecting the reproductive system.
illiterate—unable to read or write.
This article originally appeared in Respect’s Special Issue: Challenging Racism from Past to Present.