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Ten years ago my father-in-law fell 13 feet from the top of his tractor-trailer. It wasn’t until he finished his labor, driving 35 miles home and taking a shower, that he finally made it to the emergency room. Although he had five broken ribs and a lung contusion, he was fired. He returned to the doctor with difficulty breathing, but it would take several visits (during which symptoms were ruled out and test results misinterpreted) to diagnose the fluid around his lungs and heart. He had to be operated on and suffered postoperative cardiac arrest. Its survival is a miracle.
Throughout this time, our family remained vigilant about my stepfather’s medical care. We carefully observed her interactions with providers to make sure her pain was being properly treated, symptoms were taken seriously, and discharge instructions were well explained. We are black and know that these standards are not always guaranteed for us. I am a doctor and have seen black patients treated with disrespect; their concerns and symptoms dismissed.
I reflected on this complex relationship between racism and mistrust as I reflected on whether to take the Covid-19 vaccine. As an emergency doctor with regular exposure to Covid-19 patients, I knew I would be given priority for vaccination. However, for many months I was decidedly and definitely against being among the first to get the hang of it. Instead, I had planned to wait and see how the others fared with the vaccine. I guess I’m wary of the very system I’ve dedicated nearly two decades of my career to.
To be clear, I am do not a vaccine skeptic – my three children are fully immunized and I conscientiously take my flu shot year after year. But I had serious doubts about the speed of the process of developing the Covid-19 vaccine, which I felt was a political tool President Donald Trump was trying to use to win re-election. How was a vaccine developed under a president who demonstrated repeated acts of racism and who actively allowed white supremacist groups to trust? Across the country, many Americans are grappling with similar concerns.
And yet, on December 17, 2020, I received my first dose vaccine.
Here’s what made me change my mind. First, I had to find out how the vaccine was created. The mRNA technology behind the Covid-19 vaccine has been in development for decades. Yes, its compressed schedule was facilitated by government funding, but the vaccine has been worked on by thousands of scientists, has undergone a rigorous three-phase clinical trial process, and has been approved by two federal advisory boards (the Food and Drug Administration and the Centers for Disease Control and Prevention). Also, see photographs of Kizzmekia Corbett, a black scientist at the heart of Moderna’s vaccine development, in her lab was powerful. Representation is important and is essential to repairing centuries of structural racism that contributes to medical mistrust.
Second, I read the experiences of people of color and trust Black doctors who have participated in vaccine trials. Reading their thought processes, how they weighed the risks and benefits, and what their symptoms were after the second dose helped me consider taking 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 been hearing my own terrifying stories about Covid-19 patients. The tears of a young woman with mild symptoms, who feared exposing her elderly father in their small home. The healthy middle-aged health worker who ran out of steam; fear in his eyes as we spoke of the need for intubation. She survived. Many did not.
Still, I was undecided until the publication of the Pfizer trial. The graph from this study showing the continued increase in Covid-19 infection in the placebo group versus the almost complete decline in those who received the vaccine will forever be etched in my mind. In addition to being a doctor, I am a scientist. And while the historical examples of black body experimentation 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 yet undocumented long-term side effect from the vaccine. The Pfizer study only followed people for two months. But I was reassured to learn that, for vaccines in general, side effects most often occur in the first few days to a few weeks after vaccination. I weighed these unknowns against the risks of contracting the coronavirus – death, an extended hospital stay or, and perhaps most convincingly to me, the increasingly documented long-term complications, and not uncommon , from Covid-19 itself: brain fog, difficulty breathing, extreme fatigue, depression.
The choice has become clear. I would get the vaccine.
I didn’t feel well for three days after my second stroke of Covid-19. I had fever, body aches and headaches for 24 hours; then fatigue. Motrin and Tylenol helped with my symptoms which was a small inconvenience in gaining the freedom to finally be able to work in the ER without fear.
Let’s normalize the reluctance to take a new vaccine. Shaming people with questions will not encourage their adoption. Skepticism is particularly striking for blacks, for whom centuries of mistreatment and harm from systems meant to serve and protect have engendered mistrust.
Health systems and public health agencies rushing to tackle black vaccine reluctance must first recognize their own role in creating and perpetuating mistrust. The goal should then be, in partnership with blacks, to create forums for conversation and opportunities to answer questions without passing judgment through trusted messengers.
I am concerned that the under-representation of blacks among those who have received the vaccine so far will lead to worsening racial disparities in rates of infection and death from Covid-19. And so I share my journey from “no” to “yes”, mine #BlackWhysMatter, with whom to listen, to allay fears and open doors to conversation. I want to help people make informed decisions.
And if you’re wondering, yes, my stepdad just signed up for his vaccine.
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