With 2020 finally behind us, we’re now seeing the full effects of the COVID-19 pandemic on life expectancy in the United States. As expected, it wasn’t good. In the first half of 2020, American life expectancy dropped by an entire year—an unprecedented drop. But what’s even more astounding, is that among Black Americans it dropped by THREE years.

This should come at no surprise to anyone who’s been paying attention to the way COVID-19 and its response have disproportionately burdened Black people. Through the first half of the pandemic, Black Americans were two to three times as likely to get COVID-19, and two to three times as likely to die of the disease after getting it.

Early in the pandemic, it was en vogue to explain away these disparities through “pre-existing conditions'' like asthma, diabetes, or heart disease. But few asked: why do Black people suffer more pre-existing conditions? The answer has nothing to do with biology. Instead, it has everything to do with the ways racism shapes access to basic resources—as simple as clean air or as complex as hospital care—that themselves pattern disease, whether pre-existing or infectious.

Now, with vaccines available and the end of COVID-19 in sight, the Black community is once again shouldering the heaviest burden. Since the vaccines have come to market, Black Americans are substantially less likely to have gotten it than their white counterparts.

As I wrote in The Incision last week, relying on our underfunded, overworked public health system to deliver vaccinations to the people was always fraught. The problem is even worse in predominantly Black communities which have been hit hardest by COVID-19 and where public health departments have suffered worse underinvestment for longer.

When I was appointed health director in Detroit, my job was to rebuild a 185-year-old department that had been shuttered when Detroit went through bankruptcy in 2012. In that respect, Detroit is facing down a pandemic with a health department that’s functionally five years old, never mind its history. The kind of depth, insight, and worker tenure that was lost matters when it comes to taking on the worst pandemic in over a century.

It follows that the supply of vaccines to Black communities would suffer. And it has. The other supply problem, of course, is that white folks clamoring for their vaccines are figuring out how to jump ahead of the line in Black communities.

But demand for the vaccine is lower as well. Vaccine hesitancy is high in the Black community, the result of a truly horrific history of racist exploitation of Black Americans in the name of science. There are two responses I often hear to this: “just trust the science,” and “Give it to the people who want it!” The first ignores the brutal history of exploitation of Black people by scientists, and the other accommodates it. Let’s cut in.

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“Just trust the science!”

The first knee-jerk response to vaccine hesitancy I hear often is that Black people should “just trust the science.” This response erases all of the ways that science has broken Black peoples’ trust in the past.

Consider the case of Henrietta Lacks. Almost everything we know about the biology of cancer—even cells—we owe to this poor Black woman from Baltimore. She unlocked the secrets to the ways that cancer cells grow and multiply, how they interact with the immune system, and how they respond to cancer treatment. She ought to be recognized as a hero to modern science.

But she never had a choice in the matter. Instead, her cells were stolen without consent by a white doctor at Johns Hopkins whom she trusted to provide her care. These cells, known as “HeLa,” are known worldwide and have been involved in almost every major scientific breakthrough on cell and cancer biology over the half century.

And then there was the Tuskegee syphilis experiment—or officially the “Tuskegee study of untreated syphilis in the Negro male.” For decades, poor Black sharecroppers in Alabama were allowed to suffer the long term consequences of syphilis for a full quarter century after it was discovered that it could be treated with a simple course of penicillin—just so government scientists at the US Public Health Service and the CDC could observe how late-stage syphilis manifested. The sharecroppers were told that they were receiving free government healthcare even as they were denied care for their disease.

And then there was J. Marion Sims, the surgeon who experimented on enslaved Black women in the South to devise new treatments for obstetric complications. They were not anesthetized—though anesthesia had been available before he conducted his experimental surgeries.

Though it’s true that exploitation this blatant no longer occurs, as far as we know, don’t assume that it means we’ve achieved perfect equity in clinics and hospitals around the country. The numbers tell a different story. Black infants die at two to three times the rate as their white counterparts—as do their Black mothers. And these numbers don’t simply emerge in the data, they’re written into the experiences Black people face in clinics and hospitals around the country.

When you’re denied care, or your pain is ignored, or you’re told that your disease is your fault—it changes the way you interact with the healthcare system. Nearly every Black person I know has a story about the mistreatment they received in a clinic or hospital—the very place they entrust their lives. Even if you haven’t experienced it, so many of the people around you have. Mistrust becomes a matter of course, a function of your experiences or those of the people you love.

And neither wealth nor fame guarantees a better experience: When Serena Williams was convalescing after the birth of her son, she experienced symptoms of a pulmonary embolism—something she’d in fact had before. When she tried to alert her providers, they brushed it off. And that was one of the most famous Black women in the world—what about the experiences of people who don’t have her fame and fortune?

Scientific racism persists to this day. For example former New York Times Science writer Nicholas Wade wrote a book called “A Troublesome Inheritance” that situates regional differences in economic outcomes in genetic terms—in effect arguing Black people to be racially inferior to whites. That book was written in 2014. And many scientists carry around the conventional wisdom that race carries genetic differences between people, despite the fact that research has documented more genetic variation within races than between them.

The problem of course, isn’t science—which is simply a process of asking questions, posing hypotheses and working to disprove them through experimentation and interpretation. Instead, the problem is scientists. And because the barrier to entry to a career of science has often left Black people out, it carries the same biases as the rest of our society. And these biases have crept into the very science we are asking Black people to trust.

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“Give it to the people who want it!”

The second response I hear from otherwise well-meaning people is that we should concentrate on giving the vaccine to the people (read that as white people) who want it rather than worry so much about addressing vaccine hesitancy right now. We need to maximize our vaccine numbers, they argue, and any time invested in engaging with people who are hesitant is wasted time.

Though it may seem conventionally obvious, it has two pernicious flaws. First, it rather frankly accommodates the historical consequences of past racism. Never mind the fact that Black people are skeptical about taking a vaccine they are being told will help them now by the same people who exploited them by telling them they were there to help them before—they argue we should just ignore that justified skepticism and deny them the vaccine by delivering it to communities that “want” it. And when I write it out like that, the moral fallacy of this should become clear.

But this approach is also self-defeating. Not every vaccine has the same impact on our overall viral transmission. To understand why consider this: The virus doesn’t just sit in the ether, infecting people at random. Instead, it has to be communicated from one person to another. Its reservoir is the bodies of other people. More contact with bodies that are infected means a higher risk that you’ll be infected. Vaccinating someone who’s less likely to be exposed to COVID-19 in the first place is less important for stopping the overall transmission of the virus than vaccinating someone who’s at higher risk.

Segregation puts Black people at higher risk. It’s an important, if unspoken, mechanism of perpetuating racial disparities in COVID-19. Segregation compounds the material consequences of racism. But it also means that when the virus takes hold in Black communities, it’s more likely to ricochet within the community. Though that has meant more COVID-19 in these communities, it also means that every additional vaccine we deliver to the heavily-affected Black community has a greater impact on the overall transmission of COVID-19 than an additional vaccine in less affected communities. And that’s important for all of us.

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Black Vaccinations Matter.

So if we care about saving lives, it’s critical to make sure we’re vaccinating the most vulnerable people first. And in America, Black people are almost always more vulnerable. Using vaccine hesitancy as an excuse not to vaccinate Black Americans defeats our effort to stamp it out everywhere. And telling them to just “trust the science,” simply denies the veracity of their experiences.

But there’s something deeper. Our country has a long history of devaluing Black lives—even when it means devaluing all lives in the process. Doing the work of taking on vaccine hesitancy requires us to value the Black lives we are trying to protect with these vaccines in the first place. Doing this requires us to own up to the historical legacy of exploitation of Black people by the biomedical establishment—and to lead with an honest, transparent account of what has happened and what’s happening now.

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The Incision

Stop telling Black people to "just trust…