You might have heard of the Tuskegee experiment. It was initially pitched as a six-month study of Black men with syphilis who, in exchange for their cooperation, were told they would be treated for free by the federal government.

They never received treatment and the experiment continued for 40 years. Of the 399 participants, 28 died of syphilis and 100 died of related complications. As many as 40 of their wives were also infected and 19 babies were born with congenital syphilis.

That experiment, which ended in 1972, is among the most cited abuses that has eroded African American trust in the U.S. medical establishment. Half a century later, the study continues to have a chilling effect, even as the country faces one of its most deadly medical emergencies in history.

A February poll showed that more than half of African Americans are undecided about taking the Covid-19 vaccine, according to data released by the National Foundation for Infectious Diseases. The survey found that 49% of Black adults plan to get the vaccine. Of those people, 19% said they would get it right away and 31% said they would wait.

The study also showed that 31% of Black adults said they will not get the vaccine and 20% are unsure.

According to one study, white people are being vaccinated at twice the rate of Black people. However, a new U.S. Centers for Disease and Control study shows that of those who have received at least the first dose of a vaccine, 5.4% are Black, compared to 60% who are white.

Skepticism over the vaccine among people of color persists despite their being four times more likely to be hospitalized and nearly three times more likely to die of COVID-19 than white people, according to a different CDC study.

So what can be done about the low numbers of African American people being vaccinated?

Reckon spoke to Dr. Greg Hall, former chairman of the Ohio commission for minority health and current president of the Cuyahoga County board of health, the second largest in Ohio. Dr. Hall is an expert on racial health disparities and also makes vitamins for health issues that disproportionately affect the Black community.

There’s been a lot of reporting recently about vaccine skepticism within African American communities. I’ve read reports about a general mistrust of the medical establishment. Where does that skepticism come from?

Well, there’s a long history of abuse. The medical establishment has not been good to African Americans over a long history that probably goes back before the country was established. There was grave robbing for the medical schools. The so-called father of gynecology, Marion Sims, developed most of his gynecological surgical techniques on unanesthetized slave girls. It wasn’t against the law to do that. To say African Americans were second class citizens is an under exaggeration. You can do what you want to a slave. Even up until the late 1960s there was a heart transplant that was done in Richmond, Virginia. A Black guy was sitting on a three-foot wall, he fell and hit his head, and within 24 hours he was given an experimental heart transplant.

That’s all on top of the Tuskegee syphilis study which carried on until the 1970s.

So I see a lack of trust even among my patients. I’m African American. And that distrust is very pervasive. There was a study that showed 44% of African Americans don’t trust healthcare providers, regardless of race and we have to try to react to that by earning their trust because no one’s going to take any advice from someone they don’t trust.

And there’s a long history of mistrust when it comes to vaccines. They don’t want tetanus shots. The hepatitis B vaccine, which is perfectly safe and has no side effects, has very low acceptance rates among African Americans. Same with the newer HPV vaccine. If you put a vaccine in front of an African American they really aren’t interested. The COVID-19 vaccine is just the latest.

Just because there’s a pandemic, there’s no reason to change that fundamental belief system.

And how does somebody in your position fight through that skepticism with your African American patients?

One patient at a time. I got the vaccination in December because I knew I’d have to be able to tell my patients I got it. That’s why when I get the flu vaccine, I give myself a shot and my staff. Seeing community leaders getting it all helps to chip away at the reluctance. There’s also pervasive conspiracy theories about the vaccine to deal with. And when they’re taken down by social media, my patients think they took it down because it’s real. Some people think they’re being sterilized.

White people in Northeast Ohio are falling over each other to get the vaccine and the Black people are falling over each other running away. How do we selectively vaccinate Black people? It’s a multipronged approach. I am personally trying to do it one person at a time. We are also trying to get prominent people to get it. The Cleveland Cavaliers would love to get it, but then people would ask how they get it before others. I think once more established and trusted people get it and don’t have any adverse outcomes, there’ll be more acceptance.

You talked about the history, specifically what African American people have been through in the medical realm. That seems to be a generational thing, possibly among older people. Is there a different conversation you have with younger people about the vaccine?

Yeah, with older people you’re more trying to get them to trust the medical provider in front of you. Younger people’s issues are more related to these crazy stories they see on social media and YouTube. They seem to put a lot of value on those conspiracy theories because the platforms sort of gives them a degree of credence. The data shows that people who are less educated, younger, have less, less money, part of a lower socioeconomic group tend to gravitate toward conspiracy theories.

But part of that is because those historical medical abuses of the past were at one-point all conspiracy theories.

Say a young African American guy comes into your office and he’s got these conspiracies swirling around in his head. He’s just read them. What do you say to get him to take the vaccine?

Well, you have to be proactive when it comes to the crazier conspiracies. I start with the data that dispels the more common conspiracy theories that they’re going to be sterilized. I try to get to that before they can even tell me about it or some other conspiracy theory that they heard on social media. And I explain that if the government or whoever wanted to do something like this just to African Americans they wouldn’t use a vaccine because African Americans don’t like vaccines. It would be a pretty bad way of sterilizing African American people. You’re gonna have to come up with a way better plan that doesn’t scare them. And that usually helps clear the air a bit.

But there are also some good arguments. This is a new type of vaccine and they don’t know how it’s gonna turn out. To an extent that’s true, but I just try to counter it with real time health data about who’s dying in the greatest numbers from this virus: African Americans. And that’s something they can strongly relate to. They know people that have died in their community. The data is there. I know countless people that have died, but if you go to white families, they may not know anyone who’s had it or died. So I point to that and it becomes a question of them putting their family at risk and being a carrier.

Right now, white people are disproportionately getting the vaccine. It’s like 90/10 now here. And some of that’s a combination of minorities running away, but it’s also about the racist history of this country and the care Black people get from the medical establishment. And so the act of trying to build trust is a long process, but you have to start somewhere.

Talking of trust, we recently got a new administration. And obviously their messaging is really important on this issue. How do you think they should go about building trust, to kind of get this vaccination effort going among African Americans?  

I think younger people can be convinced by people they follow. So if LeBron James says, ‘I just had my shot, and all my boys just had it,’ that’s for the people who want to be like LeBron James. I think that’s going to bring a lot of young people along. If you see someone that looks like you that had it, it can almost become a status. I think with younger people you can rationalize with them a little, but they really want to see someone who they admire, or someone that they follow, so I think select people in the community need to be sort of recruited. And then you need to go on social media and make it public.

Do you think the spread of information around when and how we can get the vaccines has been dealt with well from state to state, county to county?
It’s not been great. We have limited vaccines, so we don’t know how and when those vaccines are going to be available in more numbers from week to week. How fast things accelerate is really going to depend on the availability of the vaccines. I think getting the pharmacies involved has had sort of demystified how it’s going to get to a lot of people. But having the vaccine is what’s key. So people are not sharing information because there’s nothing to really share just yet.

I just had a friend of mine call and he told me he’s been in the house with his mother for a year. He wants to know when he’s going to get the vaccine. And I don’t know. He’s 56. If one of the vaccine companies unleashes a whole bunch of vaccines it might be next month. It’s all dependent on the availability.

We talked about this history of abuse and mistrust. With that in mind, does the setting of where African American people go to get the vaccine matter? Would a community center instead of a hospital be more helpful in convincing people to get it?   

Oh goodness, yes. If you’re a person who thinks there’s a conspiracy theory and you go to a place where a bunch of white people are everywhere, that’s not going to help. And so again, if you’re in a community where you see people who look like you, see other people from your community getting the vaccine and administering the vaccine, that helps. And they will have to go into communities to get to the people who have transportation issues. If they don’t it could widen the disparity. There are people who want the vaccine but can’t get to it.