Ten years ago, my father-in-law fell 4 meters from the top of his trailer. Only after finishing the delivery, driving 35 miles home and taking a shower, did he finally go to the emergency room. Although he had five broken ribs and a lung contusion, he was discharged. He returned to the doctor with difficulty breathing, but it would take several visits (during which symptoms were ignored and test results were misinterpreted) to diagnose fluid around his lungs and heart. He needed surgery and suffered post-operative cardiac arrest. Your survival is a miracle.
All the while, our family remained vigilant about my father-in-law’s medical care. We carefully monitor your interactions with healthcare professionals to ensure that your pain is treated properly, that your symptoms are taken seriously and that your discharge instructions are well explained. We are black and we know that these standards are not always guaranteed for us. I am a doctor and I have seen black patients being treated with disrespect; your concerns and symptoms discarded.
I reflected on this complex relationship between racism and distrust while considering whether to get the Covid-19 vaccine. As an emergency physician with regular exposure to patients with Covid-19, I knew I would be prioritized for vaccination. However, for many months, I was decided and definitely against being one of the first to receive the photo. Instead, I planned to wait and see how others did with the vaccine. I suppose I am suspicious of the very system to which I have dedicated almost two decades of my career.
To be clear, I’m not a skeptic about the vaccine – my three children are fully vaccinated and I obediently get my flu shot year after year. But I had serious doubts about the speed of the Covid-19 vaccine development process, which seemed to me to be a political tool that then President Donald Trump was trying to use to win re-election. How could a vaccine developed under a president who exhibited repeated acts of racism and who actively activated white supremacist groups to be trusted? Across the country, many Americans are grappling with similar concerns.
And yet, on December 17, 2020, I received my first dose of the vaccine.
Here’s what helped me change my mind. First, I had to educate myself about how the vaccine was created. The mRNA technology behind the Covid-19 vaccine has been in development for decades. Yes, its compacted schedule was aided by government funding, but the vaccine has been worked on by thousands of scientists, has gone through a rigorous three-phase clinical testing process and has been approved by two federal advisory boards (Food and Drug Administration and the Centers for Control and disease prevention). Also, seeing photos of Kizzmekia Corbett, a black scientist at the center of vaccine development at Moderna, in her laboratory was powerful. Representation is important and critical to repair centuries of structural racism that contributes to medical distrust.
Second, I read the experiences of people of color and trust Black doctors who participated in vaccine tests. Reading their thought processes, how they weighed risks and benefits and what their symptoms were after the second dose helped me to imagine getting the vaccine. Never doubt the power of social media and the written word to influence behavior.
Third, my mother practically begged me to get the vaccine. Since March, she has heard my own terrifying stories about patients with Covid-19. The tears of a young woman with only mild symptoms, who was concerned with exposing her elderly father in her small home. The healthy middle-aged health professional who came in with shortness of breath; the fear in his eyes as we talked about the need for intubation. She survived. Many do not.
Still, I was undecided until the Pfizer study was published. The graph in that study that shows the continued increase in Covid-19 infection in the placebo group compared to the almost complete drop in those who received the vaccine will forever be etched in my mind. Besides being a doctor, I’m a scientist. And while the historical examples of experimenting with black bodies in the name of science are too numerous to count and concerns about racism and prejudice in research persist, I still trust rigorous science. I was almost ready to say yes.
My final concern was the risk of a rare, serious and undocumented side effect of the vaccine in the long term. The Pfizer study followed people for just two months. But I was calm to learn that, for vaccines in general, adverse reactions occur more commonly in the first days or weeks after vaccination. I weighed these unknowns against the risks of contracting the coronavirus – death, a prolonged hospital stay or, perhaps most convincing to me, the increasingly documented and not uncommon long-term complications of Covid-19 itself: brain fog, difficulty breathing, fatigue extreme, depression.
The choice was clear. I would get the vaccine.
I didn’t feel well for three days after my second injection of Covid-19. I had fever, body aches and headaches for 24 hours; then fatigue. Motrin and Tylenol helped with my symptoms, which were a minor inconvenience to gain the freedom to finally be able to work in the emergency room without fear.
We will normalize the hesitation to get a new vaccine. Shaming people who have doubts does not encourage acceptance. Skepticism is especially salient for blacks, for whom centuries of mistreatment and damage caused by systems designed to serve and protect have generated mistrust.
Health systems and public health agencies that rush to address vaccine hesitation among blacks must first recognize their own role in creating and perpetuating distrust. The goal, then, should be, in partnership with blacks, to create forums for conversations and opportunities to have questions answered noncritically by trusted messengers.
I am concerned that the under-representation of blacks among those who have received the vaccine so far will lead to an even greater increase in racial disparities in Covid-19 infection and in mortality rates. And then I share my journey from “no” to “yes”, my own #BlackWhysMatter, with whoever wants to listen, to calm fears and open doors for conversations. I want to help people make informed decisions.
And if you’re wondering, yes, my father-in-law just signed up for the vaccine.