Mr. Moore had been in the hospital for weeks with trouble breathing due to COVID-19 infection. His oxygen support fluctuated, and his condition eventually deteriorated. He didn’t make it. Mr. Moore was 61-years old. He was Black. And he was unvaccinated. This sad story reverberates across America.
Mr. Moore was not unvaccinated by choice. He was unvaccinated by circumstance. His wife got her COVID vaccine through her job in public transportation. Mr. Moore, a contractor on the South side of Chicago, faced significant barriers to getting his COVID vaccine including a lack of transportation, access to care, and the ability to take time off work.
Given that it has been over a year since the COVID vaccine first became available, it is natural to assume that anyone who remains unvaccinated is in some way opposed to vaccination. It is important to remember, however, that despite widespread availability of vaccines, many still have difficulty accessing them through no fault of their own — a fact that remains especially true in Black and Brown communities. Of course, this phenomenon is not new. For centuries in America, Black and Brown people have been systemically separated from white society in a through-line that can be drawn straight from slavery to reconstruction to Jim Crow to the Civil Rights movement – to, today, massively disproportionate rates of incarceration, police shootings, and poverty.
The aftershocks of this history – too often untold – exist everywhere. They’re seen in housing policies that separate Black communities, in food policies that severely limit access to healthy foods, in public transportation that doesn’t extend to Black communities, in voting access that makes reaching the ballot much more difficult for Black people. And, of course, it extends to health outcomes. All of these factors play a role in individuals like Mr. Moore not getting vaccinated on time. If he had lived in close proximity to a pharmacy, he may have been able to easily receive a shot. If Chicago’s public transportation system extended into the mostly-Black deep South side, he could have hopped on a train to get to a clinic. If Black people had been afforded the opportunity to obtain a fraction of the education attainment of white people in previous generations, perhaps he would have worked at a job where taking time off to receive a vaccine would not cost him his livelihood. If he had health care and easy access to a consistent primary care provider who could speak to hesitancy issues and offer vaccine advice, things may have been different.
Black and Brown communities all over the country continue to encounter significant obstacles to getting people vaccinated, and vaccination rates within these communities remain the lowest of any demographic group. Being Black is a risk factor for health conditions such as diabetes, autoimmune disease, and hypertension (high blood pressure) – not because of a biological difference in Black people, but because of poor social determinants of health. All of these conditions also happen to increase the morbidity and mortality of infections and diseases such as COVID. In fact, though Black people make up just 14% of the population in Michigan, they represent 40% of Michigan COVID deaths. At the time of Mr. Moore’s death, the numbers reported by the Michigan Coronavirus Task Force on Racial Disparities showed that, as of August 13, Black people represented 23% of those hospitalized with COVID and 43.7% of children hospitalized with multisystem inflammatory syndrome (MIS-C.) Though, the task force has taken steps to lessen the disparities – including sending volunteers door to door to talk with and immunize people in their homes – these efforts take a lot of time and manpower and meanwhile the divide remains.
As pediatricians and mothers, one of whom is Black, we believe it is imperative for all physicians and healthcare workers, as well as the general public, to understand the significance of the barriers that many Black and Brown communities face to receiving preventative medical care, particularly as vaccine eligibility expands to include children ages 5 and up.
Physicians on the frontlines have told their stories of sacrifice over the course of the pandemic. What kept many going during the most difficult days was the hope that once a vaccine arrived there would be a return to some kind normalcy. Sadly, despite the incredible scientific achievement and cross-sector collaboration that led to highly effective vaccines in record time, disinformation campaigns, laws banning mask and vaccine mandates, and, remarkably, politics, have placed physicians unfairly in a position where their role as promoters of public health is being discounted by those whom we have sworn to protect. As a result, many have understandably grown bitter caring for those with COVID who’ve refused to get what could be a life-saving vaccine. But like Mr. Moore, for some, being unvaccinated is not so much a conscious decision as it is a byproduct of circumstance. In his case, of being Black and living in America.
Oppression, systemic racism, and the social determinants of health that contribute to disproportionate vaccination rates also lead to increased COVID deaths and worse health outcomes in Black communities. Our segregated society is functioning exactly as it was created to function, and Mr. Moore’s death was preventable if he had been provided easier access to the COVID vaccine. Going forward, we must do a better job of ensuring equal access to vaccination among all communities. Policies that allow for time off school or work to get vaccinated and mobile vaccination units that bring vaccine clinics to Black and brown communities are a good way to start. In the meantime, it remains absolutely essential that the healthcare community remain aware of the disparities that persist, advocate for expanded access to vaccines, and perhaps, most importantly, stay openminded and conscious of their biases.