By Colleen Campbell
Recent calls for racial inclusivity in vaccine trials, which often rely on genetic rationales while emphasizing medical distrust among African Americans, unfortunately lack an equally robust critique of medical racism and the ongoing reasons for this distrust.
Even though race lacks genetic meaning, the COVID-19 discourse is rife with biological notions of race. Because of “[g]enetics related to racial differences” African Americans must be involved in clinical trials, said Dr. Larry Graham in an NBC News article. He continued: “We must be sure it works in Black folks.” For this reason, companies like biotech firm Moderna are enlisting Black religious leaders to heavily recruit African American participants. They are also exploiting networks previously used for HIV clinical trials.
Administrative agencies give credence to these categories as well. NIH Policy and Guidelines mandate the inclusion of “minorities” in clinical trials to investigate whether therapies affect groups differently. Despite the surge in race-based therapies through the administrative apparatus, race-based drugs like BiDil, for example, are used by clinicians to treat patients across ethno-racial categories. Nevertheless, biological race remains resonant.
Participation in clinical trials is important. We desperately need a broadly effective vaccine. Yet, recruitment strategies that reinforce biological race risk justifying the disparities they are designed to address; they also harm people of color by reifying “stigmatizing notions of racial difference.” For African Americans, it means constantly being framed as biologically at risk because of race.
African Americans’ storied past with medical racism has been anchored in biological difference. In the antebellum south, slavery satiated America’s burgeoning medical profession by supplying clinical material — Black bodies that were presumably anatomically distinct. The field of modern gynecology was founded upon unanesthetized surgeries on Black women whom physicians assumed were invulnerable to pain.
In the 20th century, researchers with the U.S. Public Health Service withheld therapy (penicillin) from Black men over several decades, believing that syphilis progressed fundamentally differently in the Black body. The study, known as the Tuskegee Syphilis Study, exposed the pathogenesis of racism rather than that of syphilis.
Today, Black patients are systematically undertreated for pain because of the narrative of biological difference. Physicians continue to use a controversial race-based kidney test that assumes Black people have higher muscle mass. Black women are dying from childbirth more than their white counterparts because of racism. Yet, public health discourses often construct Black women’s bodies as biologically distinct and defective. Biological racism infects policing as well. Consider police officer Darren Wilson’s description of 18 year-old Michael Brown as a superhuman “devil” who could withstand bullets.
African Americans (and Latinx and Indigenous groups) are indeed more at risk for COVID-19 infection. But it is not because of genetics. It is because they lack access to testing, adequate health care, and providers who recognize their full humanity. We cannot ignore that the ability to socially distance varies with income. These groups are more likely to be designated “essential workers,” to take public transportation, and to live in housing conditions that are not conducive to social distancing.
The pandemic has exposed the profound race and class fissures in our public health system—that is, the multifarious and ongoing reasons why African Americans distrust medical institutions. Rampant police violence and the state’s unflinching need to blame African Americans for their plight merely add insult to injury. To be clear, reducing African Americans’ skepticism to anxieties resulting from the U.S. Public Health Service Syphilis Study is a misguided and myopic rhetorical ploy that obscures the very long arc of medical racism in the U.S.
Moreover, the inconsistent public health messages from the administration, against the backdrop of the geopolitical jockeying for a therapy, have exacerbated this trust vacuum. State vaccine initiatives such as Operation Sputnik and Operation Warp Speed (OWS) have adopted timelines that strain credulity and cause some experts to question whether trials are rushed for political reasons.
Beyond safety concerns, there is little guarantee that vulnerable groups who offer their bodies to science will have equal access to its fruits. If we have learned anything this year, with testing especially, it is that the wealthy are unlikely to wait in line with the poor.
The rise of vaccine nationalism and the linkage of vaccination with patriotism creates a very familiar space for stigmatizing African Americans as a moral or civic failure. However, this discourse fails to interrogate the continued treatment of Black bodies as disposable clinical material.
African Americans know, perhaps the most, what it means to be the first to be heavily recruited yet neglected by biomedicine. They understand how anti-Black racism is a risk factor for medical exploitation. A discourse that discounts this reality misses an important opportunity to grapple with longstanding issues of neglect that preceded the pandemic and will undoubtedly remain long after we escape this quagmire. Importantly, the deployment of biological difference reinforces the differential treatment of Black bodies in biomedicine, which inevitably augments distrust.
Colleen Campbell, JD, is an Acting Assistant Professor of Lawyering at NYU School of Law and a PhD Candidate in Sociology and African American Studies at Princeton University.