Content warning: This article contains descriptions of medical racism.
Vaccine hesitancy – the uncertainty surrounding the benefits of a vaccine leading to the refusal of receiving one – is present within every population group in Canada and the United States. In fact, only 48% of surveyed Canadians indicated they would be willing to get a vaccine for COVID-19 as soon as it was available to them, while 14% claimed that they would never choose to receive one. Although there is very little race-based data concerning vaccine uptake in Canada, African Americans have the highest rate of vaccine hesitancy of any racial group in the United States.
However, vaccine hesitancy must be understood as separate from the growing “anti-vax” movement on social media, which works to spread misinformation about the science and side-effects of vaccines. On the other hand, vaccine hesitancy is a valid reaction to centuries of systemic abuse by health care systems, which often performed unethical vaccine trials and other medical experiments on Black and Indigenous peoples without their consent. Unfortunately, these communities have also experienced some of the highest rates of COVID-19 per capita. For example, First Nations in Manitoba make up 71% of active cases and 51% of people in the intensive care unit, despite only constituting 10% of the province’s population.
It is also important to note that Black and Indigenous peoples do not represent a monolith of opinion or experience, and that many people are very vocal about the importance of vaccines for keeping their communities safe and healthy. Yet these disproportional statistics shed light on the impacts of systemic racism within health care, and the ways these inequities have manifested in the face of the pandemic.
One of the most referenced examples of racist medical misconduct in the United States is the “Tuskegee Study of Untreated Syphilis in the Negro Male” conducted by the Public Health Service from 1932 to 1972. Lasting for 40 years, the researchers injected syphilis into African American men without their informed consent. The participants were unaware that the researchers had no intent to cure them of syphilis, even though antibiotics such as penicillin became popular at the time for treating the illness. While the Centers of Disease Control and Prevention has since denounced the study, this is just one example of an experiment that has sown seeds of medical distrust among African American communities, and alerted them to the issues of coerced consent within healthcare.
However, anti-racist scholars and activists argue that this study is just one instance of racist abuse within the country’s “Medical Apartheid.” In other words, the entire health-care system in the United States is based upon centuries of racism that has forced unconsenting African Americans into very dangerous medical studies for the sake of research. This history of racism persists in the modern day through documented instances of African Americans being given less pain medication than white people, and having their symptoms perceived as less serious. It is believed that an increase in vaccine hesitancy within these marginalized communities is in part due to the trauma they have faced at the hands of the medical establishment.
In Canada, a similar story unfolds when examining the role of colonial policies, which have ensured that some Indigenous peoples on reservations have limited access to proper medical treatment, among other systemic conditions that prevent their access to clean drinking water and safe housing. During the 1930s, the government tested new tuberculosis vaccines on poor and underhoused Aboriginal peoples. This was done despite Canada’s documentation at the time proving that the root cause of disease spread in Aboriginal communities was their terrible living conditions on government-funded reserves. To this day, housing conditions and lack of clean drinking water on many reserves are pressing problems, and their tokenistic acknowledgement by Prime Minister Trudeau is highlighted by his recent failure at addressing these forefront issues by his self-imposed March 31, 2021 deadline.
Other instances of systemic racism in healthcare include the 29 racially segregated and poorly constructed “Indian Hospitals” operated by the Canadian government from 1945 to 1981. Not only were victims experimented on without their consent, including being forced to participate in vaccine trials, but the Indigenous patients also recall being physically and sexually assaulted by staff, starved, and restrained to their beds. In a more recent collective memory, the federal government sent shipments of body bags rather than antivirals to four Manitoba First Nations during the 2009 outbreak of H1N1, leaving communities with the impression that their lives were disposable. Further, at least hundreds of Indigenous women have been forcibly sterilized without their informed consent, with some instances dating to as recently as 2017.
Without a national inquiry into the historical and present-day manifestations of systemic racism within Canadian healthcare, in combination with the lack of specific race-based COVID-19 data, it is difficult to understand the full extent of vaccine hesitancy among Indigenous peoples. However, the stories that Indigenous folks and communities have shared about their experiences of abuse within medical care shed light on why distrust with the healthcare system may be a factor of vaccine hesitancy.
Addressing the Problems
In instances where race-based data shows that COVID-19 has had a disproportionate effect on racialized groups, it does not necessarily mean that the inequities will be adequately addressed. For example, while data reveals higher rates of infection and hospitalization due to COVID-19 within Black communities in Toronto, the province of Ontario has not implemented any specific strategies tackling the impacts of systemic racism to slow down the rate of virus transmission. For many Black communities, the existence of government data proving their particular vulnerabilities to COVID-19 is not a sufficient tool for building trust with public health agencies. Instead, actions that work to repair relationships with marginalized communities, from acknowledging the harms caused by the medical system on Black people to actively working on dismantling systemic racism, are essential to decrease rates of vaccine hesitancy.
Similarly, addressing the issue of vaccine hesitancy in Indigenous communities should be approached from a perspective that works to understand the negative impacts of systemic racism on the relationship between Indigenous peoples and their government medical systems. An example of such an approach could have Indigenous Elders and healthcare providers lead vaccine messaging that speaks to the specific experiences of Indigenous communities with the medical system whilst highlighting important principles surrounding family, community, and the land. Additionally, letting Indigenous healthcare providers run vaccine clinics within their own communities and training practitioners to work with anti-racist and trauma-informed perspectives are some of the short-term solutions to ethically deliver COVID-19 vaccines.
Efforts that work towards meaningful reconciliation and reducing vaccine hesitancy go hand-in-hand, and centuries of colonial Canadian governance have put in place the systemic racism and distrust that Indigenous communities experience in healthcare today. There exist short-term solutions that address the vaccine hesitancy of Black and Indigenous communities during the COVID-19 pandemic. However, truly undertaking the problems of systemic racism and distrust requires policy-makers to address socio-economic inequities faced by racialized populations that impact their health. Some of these include providing adequate housing and clean drinking water, increased access to jobs that pay a living wage, and stopping energy projects that contribute to environmental racism and poor health. Envisioning healthy futures for BIPOC communities beyond COVID-19 is a long-haul effort.