We must reckon with the history of medical racism and violence in order to address vaccine hesitancy in African, Caribbean, Black and Indigenous communities

Posted on Tuesday, February 23, 2021

Author: Stephanie Wiafe and Prof. Stacey Smith?

Communications and Engagement Officer,
HealthBridge Foundation of Canada

Faculty Affiliate, ISSP
Full Professor, Disease Modelling, Faculty of Science, uOttawa

Vaccination is extremely effective in controlling and preventing outbreaks of diseases when administered to a substantial percentage of the population. Sufficient vaccination can achieve herd immunity, but a significant challenge in effective coverage is vaccine hesitancy, the reluctance or refusal to be vaccinated. Any and all forms of vaccine hesitancy should be taken seriously by healthcare decision makers. 

There are many different possible contributors as to why someone may be hesitant to receive a vaccine. These include worries regarding possible side effects, exposure to and beliefs in misinformation and disinformation (such as government surveillance), as well as conflicting religious or philosophical beliefs. However, due to historic medical violence, vaccine hesitancy — and general distrust in the health and medical systems — amongst African, Caribbean, and Black (ACB) and Indigenous communities is rarely discussed or addressed by healthcare decision-makers. The global ACB community’s distrust of health and medical systems in the global North is rooted in an often-ignored history of medical racism,violence and violations of human rights

Much of the history of medical racism and violence is not taught in the health and medical fields. As with many issues related to injustice — especially outstanding and unrepaired injustice — the details, depth and breadth of medical racism and violence is frequently ignored, leading to further silencing of and ignorance to the issues. This practice is dangerous, both for the health of ACB and Indigenous communities and for larger health concerns such as reaching critical vaccination thresholds across Canada.

The health and medical community needs to understand and address the ways in which anti-ACB and Indigenous racism has been and remains insidious in health and medicine. Without doing so, racism and racial medical violence, in addition to residual and persistent ideals of white supremacy in health and medicine, will continue to be upheld and harm racialized communities. 

Medical racism and violence is rarely a benign experience for racialized people. It has had serious, lifelong and lethal effects on both health and well-being. An overt and widespread form of medical racism and violence subjected upon ACB and Indigenous peoples is forced and coerced sterilization, a permanent medical procedure that prevents pregnancy. Forced and coerced sterilization of Indigenous peoples in Canada has obvious systemic roots; the violent and racist medical practice was legislated in Alberta (1928–1972) and British Columbia (1933–1973), although it occurs both within and outside of legislation, as a part of a eugenic movement to prevent Indigenous people from reproducing. Ultimately, forced and coerced sterilization goes far beyond a violent act at an individual level, instead seeking to break Indigenous lineages and dismantle and destroy Indigenous cultures and communities. 

The lack of culturally responsive health care services to people of African descent living in Canada has been a long-standing barrier to health care. The lack of research and culturally relevant health resources has been identified as health issues of concern in the African Canadian community. There is an urgent need for healthcare professionals to develop awareness, sensitivity and knowledge about the needs of the clients from different cultural backgrounds.

Traumas experienced by individuals and generations of ACB and Indigenous people — who were subjected to various tortuous forms of medical violence, mostly from white colonizers — not only lead to adverse health effects but can be passed down from generation to generation through epigenetics, resulting in intergenerational racial trauma. Such trauma, coupled with knowledge of the violent history of medical racism and violence that ACB people have experienced, has contributed to widespread vaccine hesitancy amongst ACB and Indigenous communities in North America. Medical racism has a recent history and also persists today, creating new generations of ACB people with racial trauma and fuelling distrust in health and medical systems. Ignorance, indifference and ultimately failure to recognise the history and present-day manifestations of medical racism among healthcare providers perpetuates distrust, racist medical practices and current disparities in health.

Acknowledging the history of medical racism and violence in the medical system is necessary but not sufficient. Healthcare decision-makers, clinicians and practitioners need to actively dismantle racism in health and medicine (which will also address distrust, vaccine hesitancy and disparities in health). Systems, structures, practices and procedures need to change in order to provide the most comprehensive and intellectually honest care. 

While many healthcare professionals may be aware of how various forms of racism (including interpersonal, institutional and systemic) lead to adverse and long-lasting negative health outcomes amongst racialized individuals and communities, ACB and Indigenous communities in North America are still disproportionately at risk for, and suffering from, an array of diseases. For instance, ACB communities are disproportionately affected by COVID-19, and distrust is a barrier to accessing and receiving quality care. Vaccine uptake in Indigenous communities has traditionally been significantly lower than throughout the rest of Canada. 

Healthcare provided to ACB and Indigenous people must include a culturally and racially appropriate approach, which considers local contexts, historic and present manifestations of racism in medicine and healthcare, in addition to acknowledging and addressing distrust. Such culturally and racially appropriate care should be community-focused and community-led. For example, healthcare decision makers can address vaccine hesitancy among ACB and Indigenous communities, from a structural level, by fostering trust with such communities and by collaborating with community leaders and members on vaccine distribution, information and implementation. Community-focused health programming has seen great success in vaccine engagement among marginalised populations in the global South; lessons learned from success stories in places with more experience in vaccinating large populations should be considered in a Canadian context.

To work upstream in preventing ACB and Indigenous people from disproportionately suffering during public-health emergencies, we also propose that federal, provincial and municipal governments not only acknowledge this history but also outline how they will address it in future public-health emergencies and in medical systems in general. Without an explicit acknowledgement of past wrongdoing and a community-focused, bottom-up plan for avoiding previous mistakes, little will be accomplished, the status quo of medical racism and violence will persist, and many lives will be lost.

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