By Lauren D. Nephew, EClinical Medicine, January 18, 2021
On December 19, 2020 I received my first dose of the coronavirus 2019 (COVID-19) vaccine. I had decided only about 10 days before to take the vaccine in the first round, if given the opportunity. My hesitation may come as a surprise to some. As a physician, scientist, and epidemiologist, many may have thought that I would be ready, with my sleeve up, as soon as the Phase 3 clinical trials began. However, long before I was a physician or a scientist, I am a Black woman. As a Black woman, I have borne witness to the very system that says it is ready to protect me with a vaccine, systematically disempower my community, putting many at risk of comorbidity and death. How could I in good conscious then agree to take a vaccine, developed, under an administration that has been nothing short of oppressive to people of color, without reviewing the data myself? Once the trial data became available, I spent several days buffing up on my immunology so that I could better understand mRNA technology. I listened to panel interviews that included physicians of color with expertise in infectious disease. I read the trials’ inclusion and exclusion criteria. I looked at every line of Table 1 to ensure there were people in the trials that looked like the people in my family. I combed over the efficacy data and every adverse event. After my immunology and vaccinology immersion, I walked into that room to be vaccinated with less trepidation in my heart.
More than 1 in 470 Black residents have died in Michigan and New Jersey from COVID-19; more than 1 in 410 Latinos in New York; more than 1 in 200 Indigenous people in New Mexico. The medical community recognized the racial disparity in COVID-19 mortality early in the pandemic. However, it should be clarified that the COVID-19 virus does not discriminate; but our systems have and do. The virus amplified and exposed for all to see structural racism—institutions, laws, policies, and regulations that lead to uneven distribution of education, job opportunities, and criminal justice between races. Structural racism and unequal distribution of the social determinants of health in turn leads to social need—housing and food insecurity, deficits in literacy and social networks. This failure leads to crowded homes, lack of private transportation, and less health care access. These unhealthy environments contributes to disease risk factors like obesity, diabetes, and hypertension which put those subjected to systemic racism at risk for death from COVID-19. The racial disparity in COVID-19 mortality has nothing to do with race and everything to do with structural racism.
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