As Britain went into lockdown last March, people eagerly watched from their homes as the infection rate and, unfortunately, the death toll continued to increase. With uncertainty surrounding the virus and how it operated, it seemed the only entity spreading faster than the virus was fear. Fear was a very prevalent and urgent feeling in many homes, especially within the Black community in Britain.
A report by the Office for National Statistics (ONS) found that ‘people from a Black ethnic background are at a greater risk of death involving COVID-19 than all other ethnic groups’ (White and Nafilyan, 2)[2]. The report concludes Black males are ‘2.9 times’ greater to die from COVID-19 than White males (White and Nafilyan, 8). Additionally, the report notes females of Black ethnic backgrounds had the ‘highest rate of death involving COVID-19, at 119.8 deaths per 100,000,’ which was ‘2.3 times higher than White females’ (White and Nafilyan, 9).
These statistics, in context to the fact that Britain’s population of individuals from Black ethnic groups make up only 3.3%, were surprising[3]. Black ethnic groups in the UK are a minority population and yet are overrepresented in the COVID-19 death toll. Confronted by these statistics, we in the Black British community wanted answers.
There were several accounts as to why COVID-19 affected and killed more Black people than any other ethnic group. Mohammad Razzai et al note that ethnic minority groups are ‘more likely to live in urban, overcrowded, and more deprived communities and to work in lower paid jobs’[4]. Also, ethnic minorities are ‘over-represented in the NHS workforce’ (Chouhan and Nazroo, 74)[5].
These factors do not allow ideal circumstances for Black and ethnic minorities to properly socially distance or decrease interaction with COVID infected patients. So, the high risk exposure of COVID-19 paired with the unpredictability of the virus could increase risk of death.
Additionally, another account to consider surrounds the existing health conditions of individuals within the Black community. Specifically, there are ‘higher rates of hypertension and stroke among Caribbean and African people’ (Chouhan and Nazroo, 78). According to WHO, acknowledgement of pre-existing conditions is important to note, as it would make an individual more vulnerable if infected with the virus. So, in addition to increased exposure, pre-existing conditions also contributes to the increased risk factor.
However, the socioeconomical factors and pre-existing conditions do not entirely account for the deaths of Black patients due to COVID. The second ONS report, which updates the previous report, now accounted for the previously mentioned factors but found ‘it does not explain the remaining ethnic background differences in mortality’[6]. There is another factor, a silent killer –
But a vaccine was in the works.
However, according to a UK longitudinal study, the most hesitant to the vaccine was the Black community[7]. According to the study, Black ethnic groups were 71.8% hesitant to the vaccine in comparison to White British groups who were 84.8% likely to take the vaccine (Robertson et al, 9).
There are numerous reasons for hesitancy.
For example, Black participants were not used in the testing of the vaccinations, it is unknown whether there are differences in effects depending on ethnicity[8]. Nevertheless, the lack of participants from Black ethnic groups was due to hesitancy to the vaccine (Dr Hilary, Good Morning Britain).
However, it seems the media have settled on one particular reason above others. As so eloquently exemplified by Dr Hilary in a segment for Good Morning Britain, there is a lack of education surrounding the vaccine in the Black community. Therefore, the solution is to educate the Black community so, as Dr Hilary says – directing his gaze into the souls of Black folks – ‘we can protect you’.
But protect who? Who is protecting the Black community? And what – or who – are we, in the Black community, truly being protected from?
It would be insufficient to write that there was no misinformation in the Black community. Credited to social media, especially chain messages on WhatsApp, there has been a lot of misinformation, spread quickly, advising against the vaccine. However, this misinformation is not due exclusively to the Black community, many people from various ethnic groups have been hesitant to take the vaccine.
However, it is important to analyse this narrative closely to understand the message it is spreading about the Black community. The reports previously noted highlight two findings: 1) COVID-19 is killing Black people more than any other ethnic groups. 2) Black people are more hesitant to the COVID-19 vaccine. The conclusion drawn suggests if Black people continue to die from COVID-19, it would simply be their own fault because they did not want the vaccine.
The narrative created and perpetuated by the media, medical community, and government indicate the benevolence of white people towards the black population. And, when observed from a different perspective, highlights and perpetuates a narrative, which is too familiar. The notion that blames the Black community, calls for education, and disparities in death, stems from racism and white supremacy.
Historically, the medical community has failed to understand and provide adequate healthcare to Black patients. As Deirdre Cooper Owens notes, since the 18th and 19th century, doctors and physicians, based on their experiences alone, believed ‘black people experienced pain that was not as severe as white people’s pain’ (114)[10]. These historical beliefs in the medical institution impinge on the present as healthcare professionals have been known to ‘stereotype or misunderstand symptoms’ of Black patients (Chouhan and Narzoo, 87). Consequently, Black patients mistrust and often fear these medical services (Chouhan and Narzoo, 87).
Additionally,Black and ethnic minorities have an ‘increased risk of poor health’ compared to white people (Chouhan and Nazroo, 73). The assumptions concerning the disparities in health is understood as a ‘consequence of supposed biological and cultural differences’ (Chouhan and Nazroo, 78). However, such explanations have rarely been tested and thus have no sufficient scientific evidence (Chouhan and Narzoo, 78). But there is more evidence that Black and ethnic minorities have poorer health due to less quality of care.
The 2017 GP Experience Survey found ethnic minorities reported fewer good experiences with GPs than white British patients (Chouhan and Narzoo, 83-84). Ethnic minorities must wait longer for an appointment and face cultural insensitivities, such as language barriers, during consultations (Chouhan and Narzoo, 82).
Seen in the case of the late Evan Smith, a young black man with sickle cell disease who, from his hospital bed, called the London Ambulance Service after being denied oxygen, because ‘he thought it was the only way to get help’[11].
In an inquest into Evan Smith’s death, the coroner, Dr Andrew Walker, said, ‘Mr Smith's life may have been saved if a blood transfusion had been given when he requested help’ (BBC News). As unfortunately exemplified, the inadequacy and neglect of care received by Black and ethnic minorities leads to an increased risk of poor health. The neglect of Black COVID-19 patients increased the risk of death.
Lastly, the media, medical community and government have failed to recognise the overwhelming use and exploitation of Black bodies in medical testing. For centuries, Black bodies have been used for medical purposes.
In the 19th century, white men exploited the bodies of enslaved black women in gynecology, forcing them to endure inhuman conditions, which grounded ideas about ‘black subjugation and white control’ (Owens, 120). In the 20th century, researchers deceived African American men in Tuskegee and gave them syphilis to observe the effects of the untreated disease. However, there was no intention of providing these men with treatment[12].
Recently, two French doctors debated trials for the COVID vaccine should be done in Africa to ‘prove effective against coronavirus’[13]. The racial and colonial tones echoed throughout the conversation as it was reminiscent of the millions of Sub-Saharan Africans, who were forcibly subjected to various medical injections by the French colonial government between the 1920s and 1950s[14].
There seems to be two reactions to black people from the white Western medical community. A contrast of overwhelming enthusiasm to use and exploit black bodies like guinea pigs for the benefit of white people and a lack of care for the actual health and safety of black people.
It's racism.
Razzi et al notes ‘racism is a fundamental cause and driver of adverse health outcomes in ethnic minorities as well as inequalities in health’. However, it’s the failure to acknowledge the racial bias that are costing the lives of black people in this country. It is the failure to acknowledge not simply the unconscious bias of medical professionals, but the racist notions that have been comfortably and institutionally ingrained for centuries.
Black people are not uneducated or wrong to be hesitant about the vaccine. We have every valid right to be sceptical of the systems which continuously fail and harm us. We have the right to be untrusting due to the history of exploitation for the benefit of white people. We don’t just need a better explanation of the vaccine in the Black community, we need a radical transformation of the medical system at large.
Resources:
[1] ‘Introduction to COVID-19: methods for detection, prevention, response and control,’ World Health Organization, <https://openwho.org/courses/introduction-to-ncov> (accessed 4 April 2021). Subsequent references in text.
[2] Chris White and Vahé Nafilyan, Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 15 May 2020, (Newport: Office National Statistics, 2020), 2-9. Subsequent page references in text.
[3] Population of England and Wales – Ethnicity facts and figures,’ GOV.UK, <https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/population-of-england-and-wales/latest#full-page-history> (accessed 4 April 2021).
[4] Mohammad Razzai et al, ‘Mitigating ethnic disparities in covid-19 and beyond,’ BMJ v. 372 (January2021), < https://www.bmj.com/content/372/bmj.m4921> Subsequent references in text.
[5] Karen Chouhan and James Nazroo, ‘Health Inequalities,’ in Ethnicity and Race in the UK: State of the Nation, ed. Byrne Bridget, Alexander Claire, Khan Omar, James Nazroo, and William Shankley, (Bristol: Bristol University Press, 2020) 73-78. Subsequent page references in text.
[6] Chris White and Daniel Ayoubkhani, Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England and Wales: deaths occurring 2 March to 28 July 2020, (Newport: Office National Statistics, 2020), 2.
[7] Robertson et al, Predictors of COVID-19 vaccine hesitancy in the UK Household Longitudinal Study, (Glasgow: medRxiv, 2020), 9.
[8] Good Morning Britain, ‘Why is There Vaccine Scepticism in the BAME Community? | Good Morning Britain,’ YouTube, < https://www.youtube.com/watch?v=aZrQ2D7R8NA> (accessed 4 April 2021). Subsequent references in text.
[10] Deirdre Cooper Owens, ‘Historical Black Superbodies and the Medical Gaze,’ in Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: University of Georgia Press, 2017), 109-120. Subsequent page references in text.
[11] ‘Evan Smith inquest: Hospital 'failure' led to sepsis patient's death,’ BBC News, <https://www.bbc.co.uk/news/uk-england-london-56647361> (accessed 12 April 2021). Subsequent references in text.
[12] Alankaar Sharma, ‘Diseased Race, Racialized Disease: The Story of the Negro Project of American Social Hygiene Association Against the Backdrop of the Tuskegee Syphilis Experiment,’ Journal of African American Studies 14, no. 2 (2010): 256.
[13] ‘Coronavirus: France racism row over doctors' Africa testing comments,’ BBC News, <https://www.bbc.co.uk/news/world-europe-52151722> (accessed 4 April 2021).
[14] Sara Lowes and Eduardo Montero, ‘The Legacy of Colonial Medicine in Central Africa,’ Cato Institute no. 209 (2020):1.