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  • Society of Bioethics and Medicine

Black American Underrepresentation: The COVID-19 Vaccine

By - Elizabeth Badalov, Edited By - Ishraq Nihal

Months of ethical deliberation have resulted in a strategy for the rollout of the COVID-19 vaccine in the United States. These past few months, however, have demonstrated that the rollout of the vaccine as it stands does not mitigate the structural inequities that have been exposed by the pandemic. Instead, we continue to witness how a public health crisis only exacerbates these perennial inequities.


Recent data indicates that Black Americans are receiving COVID vaccines at drastically lower rates than White Americans—two to three times less, in certain cases.[1] In Pennsylvania, where 1.2% of White Pennsylvanians have received their vaccine as of January 14th, only 0.3% of Black Pennsylvanians have been vaccinated.


The vaccine rollout assigns the highest priority to front-line essential workers: physicians, nurses, janitorial staff, and hospital service employees. The demographic of these essential workers are racially diverse, and vaccination percentages should represent this. Unfortunately, Black Americans have been dramatically underrepresented among vaccination statistics in every state.[1]


The role that structural discrimination plays in this disparity is twofold. Firstly, underrepresented populations harbor a deep-seated mistrust of the American healthcare system that has been perpetuated by centuries of ethical violations such as the Tuskegee syphilis experiment. One-third of Black adults in the US have said that they will not get vaccinated, fearing for their personal safety out of skepticism towards unknown side effects due to the novelty of the vaccine.[1] Half of these respondents cited concerns that they would get the virus as a result of the vaccination, which is an incorrect assumption. Misinformation has perpetuated this distrust, as inaccuracies spread through mainstream media. A step forward in the right direction towards mitigating structural inequities and overcoming common misconceptions would involve education and alternate strategies to reach and get through to skeptical populations. It would take community outreach and personal interactions to reestablish the relationship between the healthcare system and minority patients. Restoring trust, brick by brick, would require a more sensitive and personal approach to underrepresented populations rather than simply offering the vaccine.


And even though the vaccine is being offered, minority populations who are willing to get vaccinated face difficulties with access. Vaccine registration information is largely conveyed to hospital staff by email. Though this seems to be an effective strategy, it can leave out essential personnel with limited internet access. Within the University of Virginia Health System, members of environmental services, the janitorial staff, do not even have access to hospital email, meaning important information regarding vaccination will never reach them.[1]


It has been observed that Black, Hispanic, and Native American populations die from COVID at a rate nearly 3 times higher than White Americans.[1] This disparity is an indication that these populations should be receiving more representation with protective measures such as the vaccine rather than less. Physicians and health equity researchers alike agree that “if we don’t vaccinate the population that’s highest-risk, we’re going to see even more disproportional deaths in Black and Brown communities.”[1] Vaccinating historically underrepresented populations is an endeavor that will take time, patience, and education on all sides. It is necessary to expend these additional resources to begin to mitigate the centuries of discrimination that have landed us here. We, as a nation, are only as strong and healthy as our most vulnerable populations. Continuing to ignore this will have disastrous consequences that will be felt for generations to come.





Reference(s):

1. Recht, H. and L. Weber, Black Americans receiving Covid vaccines at lower rates than whites. The Guardian 2021.



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