ANALYSIS: The COVID Burden on Black Physicians, and Hospitals in Black Rural areas

Institutional Problems, Individual Solutions — The Burden on Black Physicians | NEJM Perspective from The New England Journal of Medicine — Institutional Problems, Individual Solutions — The Burden on Black Physicians Alyssa M. Newman New England Journal of Medicine

The racially disparate impact of the Covid-19 pandemic has attracted increasing attention and concern. Black Americans have been disproportionately affected throughout the pandemic, and gaps replicating the same well-worn patterns of racial inequity are visible in the early rollout of vaccines.

According to the Centers for Disease Control and Prevention, Black populations in the United States are nearly three times as likely to be hospitalized and twice as likely to die from Covid as White populations.¹ Yet available data from about half the states reveal that only 5% of vaccine doses have gone to Black residents, with vaccination rates among White residents two or even three times those among Black residents in many states.² This emergent vaccination gap is particularly troubling given that many Covid mitigation strategies, such as working from home or avoiding public transportation, have largely been inaccessible to low-income Black communities and therefore fail to protect them. Thus, vaccines are among the last remaining strategies for curbing the pandemic in disproportionately affected groups.

One factor often brought up in connection with low vaccination rates is Black mistrust of medical institutions and its current extension to Covid vaccines. The level of vaccine hesitancy is cause for alarm: polling from December showed that 35% of Black respondents said they probably or definitely would not get vaccinated, as compared with 27% of the public as a whole.³ Though an urgent response is clearly needed, it is important that the problem of mistrust and suggested remedies are accurately characterized and do not exacerbate racial inequities in medicine and health care. Such caution is warranted because the type of response demanded by the acute crisis is largely incompatible with addressing the long historical arc of medical mistrust.

One commonly proposed solution has been to position Black physicians and investigators at the forefront of vaccine-rollout efforts to provide more trusted and racially concordant messaging to the Black public.⁴ Rather than actually addressing the problem of Black mistrust, however, this solution attempts to circumvent it. Deploying a group representing only 5% of the medical profession is a strategy that hinges on favorable perceptions of these individual physicians, who must be seen as sufficiently personally trustworthy to overcome Black apprehension about medical institutions at large. The proposed solution responds to the problem of low vaccine uptake among Black Americans — not the problem of Black mistrust. Understanding this distinction is essential, because the response demanded by the immediate problem has critical implications for the future of Black trust and for equity in medicine and health care. ...

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