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Study underlines role of past injustices in medical mistrust

UGA Today

Black Americans living in Tuskegee, Alabama, closer to the location of the infamous Tuskegee Syphilis Study, were much slower to get their COVID-19 vaccines compared to white neighbors, according to a new study by University of Georgia researchers.

Published online this week in the Journal of Population Economics, the study reveals the long-term effects of the Tuskegee Study on one notable health behavior among Black populations – getting the COVID-19 vaccine.

“The mortality rate was really high in this group. They should be more likely to seek the vaccine first, right? But right after the vaccines become available, we see this gap [between white and black Americans] still exists, especially at the very beginning,” said lead author Xiaolong “Chris” Hou, a graduate student pursing a Master of Public Health in health policy and management in the UGA College of Public Health.

Nearly as soon as COVID-19 cases began spreading across the U.S., it was clear that Black Americans were experiencing more exposure, illness and death compared to other groups. These disproportionate impacts have been linked to long-standing structural and social barriers that put Blacks at higher risk for a number of chronic diseases, pre-term birth and early death, in general.

Hou says he and his co-authors were motivated to look at vaccine uptake in the South as a way of asking how past injustices enacted by health and government authorities may contribute to health disparities that persist between Black and white Americans.

Testing the impact of history

Using CDC COVID-19 vaccine tracker data and U.S. census data, the researchers compared the change in vaccine rates in Black populations across the U.S. They found that Black individuals living in counties within 750 miles of Tuskegee were slower to get vaccinated compared to white individuals in the same county, and even compared to other Black communities who lived in other regions of the U.S., where perhaps the memory of Tuskegee is less alive.

“One of our main variables is this gap between African Americans and white Americans in terms of COVID-19 vaccination, and while [the gap] actually converges over time overall, the closer you get to Tuskegee, the pace of the narrowing is much slower than locations further away,” said corresponding author Zhuo “Adam” Chen, an associate professor of health policy and management in Public Health.

In order to know that it was living close to Tuskegee that was uniquely contributing to the vaccine hesitance they observed, the researchers ran a number of analyses that acted as a kind of statistical placebo effect.

For example, they ran the same analysis comparing vaccine uptake rates in relation to distance from Tulsa, where the Tulsa Race Massacre occurred in 1921. They didn’t find the same effect. That’s because the U.S. government wasn’t involved in this event, said Hou.

“Why Tuskegee specifically matters here is because of the involvement of government agencies like the NIH and the CDC, which are also central to the current vaccine initiative and promotion,” he said.

These agencies may not inspire trust among populations who had suffered in the past, says Hou, because they were the perpetrators of past medical harms. The memory of these harms, the authors suggest, needs to be addressed and remediated.

Rebuilding trust

Hou adds that it’s important for policymakers and public health leaders who are seeking to close gaps in health disparities to take historical contexts into consideration.

Interventions to the community must be tailored and work through individuals, like faith and civic leaders, to build trust and buy-in, said Chen.

“We need to correct the wrong, and we do have a lot to do instead of taking what is there as given,” he said. “We need to customize interventions more specifically to the population, to the needs, to the context they have.”

Co-authors include Yang Jiao at Texas A&M University-Texarkana and Leilei Shen, a senior data scientist with AirBnB.

The study, “Lasting Impact of the Tuskegee Syphilis Study: COVID-19 Vaccination Hesitation among African Americans,” is available online here.

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