By Claudia Barned

In Dec 2020, provinces moved swiftly to roll out the Pfizer vaccine amongst healthcare workers and other prioritized groups. Government officials, bioethicists, and other healthcare professionals strategized on how to fairly distribute the vaccine. Despite this, there are numerous equity concerns regarding its allocation, prioritization and access within and across hospitals and care facilities. As decision-makers continue to strategize the now dual vaccine (Pfizer and Moderna) rollout, there are larger concerns regarding vaccine hesitancy. There is need for much pause and reflection here as this begs the question: what good is a rollout plan if a large percentage of the population refuses to take the vaccine?

Vaccine hesitancy and public trust are major themes raised in conversations concerning the current rollout. Reports reveal that  less than half (43%) of the 3000 workers in city-owned homes across Toronto have received the first dose or given consent for the vaccine (in comparison to the 91 per cent of long-term care residents who have taken the vaccine). The lack of uptake suggests a deeper, more significant issue at hand, one that must be addressed if widespread uptake is the aim.

Hesitancy amongst healthcare workers who identify as Black, Indigenous or People of Colour (BIPOC) has not received sufficient attention, despite its far-reaching implications. As COVID-19 continues to disproportionately impact BIPOC communities in many countries, there have been numerous calls for meaningful engagement and consultation with the BIPOC community. Some healthcare workers have taken to publicizing their inoculation through social media posts, with the aim of showing solidarity in efforts to fight the spread. While it is somewhat encouraging to see vaccine selfies floating around social media, there will likely be a rise in vaccine hesitancy amongst the healthcare workforce if culturally sensitive materials directed toward the BIPOC community are missing.

Vaccine hesitancy for some BIPOC members is simply a small component of what I’d like to term “healthcare hesitancy”. For racialized people, healthcare experiences are often accompanied by experiences of bias, discrimination and racism. After prolonged exposure to this, one becomes less trusting of the healthcare system. In fact, for some members of these communities, health recommendations are routinely read and interpreted with much scrutiny and anxiety. The violent atrocities committed against Canada’s Indigenous peoples provides a basis for why we must engage with BIPOC communities and address fears concerning the vaccine. Admittedly, the difficulty with this relates to uncertainty surrounding the long-term effects of the vaccine. It is likely that the concerns relayed and questions posed might be met with no definitive answers; and in a time in which there are multiple restrictions on one’s freedom (much of which is experienced differently for those whose lived realities already include marginalization), it is likely that the decision to take the vaccine is weighed within the context of the need to preserve one’s autonomy and the few aspects of one’s life that is seemingly in one’s control.

In an era in which hospitals and other healthcare institutions are establishing anti-black racism and/or anti-racism policies, it’s important to acknowledge how unsafe hospitals are for racialized people. There are members of the community who, at times, would rather endure pain than open the doors to any hospital building. For as long as this vaccine remains voluntary, it is likely that members of the BIPOC community will watch, observe and gather as much information as they can before rolling up their sleeves. Healthcare hesitancy has contributed to this, so too has the deep-seated history of abuse and experimentation experienced by racialized groups. In case we have forgotten about the deep history of racist treatment and medical experimentation that Black and Indigenous people across North America were subjected to, perhaps a quick recap is necessary. Most would have read about the atrocities perpetrated against the 400 Black men in Tuskegee, Alabama who were unknowingly enrolled as experimental subjects in a 40 year Syphilis study because the United States Government, and Public Health Service wanted to study the effects of untreated Syphilis. Advances in gynecology are linked to vile forms of experimentation on Black women – the version of the speculum most commonly used in OBGYN is credited to James Marion Sims who improved this device for the treatment of vesicovaginal fistulas at the painful expense of several Black women to whom he performed countless procedures without the use of anesthesia. Henrietta Lacks, a Black woman whose cancer cells were taken for further study without her consent, and were used to create the first immortalized human cell line. Many scientific advances (e.g. polio vaccine) are due to experimentation with her cell line, widely known as HeLa cells.

In Canada, we need to look no further than the decades-long medical experimentation and abuse inflicted upon Indigenous youth in Canadian residential schools and sanatoriums without their consent. From the 1930’s to the 1970’s, Canada subjected Indigenous people to cruel medical procedures and experiments including but not limited to: skin graft testing, vaccine experimentation, nutrition experiments, and dental observations amongst other violent acts. Breakthroughs from the copious medical testing and research done on aboriginal children were later used to treat the wider Canadian population, yet these same medicines were withheld from them.

Despite this history, these larger sociocultural impacts are not widely taken up in contemporary discourse pertaining to COVID-19 vaccine hesitancy. Government focused research excludes this as well; for example, a recent Statcan COVID-19 study examined Canadian willingness to get a COVID-19 vaccine by exploring group differences and reasons for vaccine hesitancy. Several sociodemographic factors were explored including: age, education, employment status, marital status, immigrant status and region of residence, yet, race; a factor likely to impact how vaccines are viewed, was not examined. This is astounding, especially when compared to the U.S. National Institute of Health (NIH), whose Institute on Minority Health and Health Disparities issued a funding opportunity to address vaccine hesitancy, uptake and implementation among populations that experience health disparities. This type of awareness and acknowledgment is necessary in the Canadian context as well – where are the funding opportunities and research efforts dedicated to exploring these issues here?

If we are to be true to values such as equity, justice, transparency, and accountability, then we must ensure that we are attentive to the needs of all, especially those who have been underserved, underrepresented, and historically silenced. What is needed is cultural compassion, understanding and culturally sensitive materials, education, and engagement that include workarounds for BIPOC groups.

We cannot put a Band-Aid on what is a deep, open wound for some. What is necessary is debridement (through meaningful, respectful and thorough engagement with communities), sutures and healing – we need to engage with the communities, truly address the histories of abuse and harm and work towards building trust from the ground up before rolling out any plans, requests or orders.

Claudia Barned, PhD, is a Toronto-based bioethicist and an associate research member in the Pragmatic Health Ethics Research Unit at Institute de recherches cliniques de Montreal.