African Americans Hesitancy to Receive Vaccines and the Tuskegee Experiment

Abstract

COVID-19 pandemic effects on people’s health and economies can only be reduced by enhancing the campaigns on disease vaccination across the world. However, in the United States, high COVID-19 vaccine hesitance was reported since 2020. The African-Americans population has noted high hesitancy than any other race across the United States. For the United States of America to reduce the high mortality rates among its people, the African-American population must be included in the vaccination program in large numbers. The high vaccine hesitance, therefore, need to be addressed. According to scholars and scientists, the negative perspective towards vaccines in the United States has been motivated by mistrust between the United States health care and the African-Americans.

One case of bias is the Tuskegee Syphilis test of 1932. This paper studies whether the Tuskegee Syphilis test is related to the high Covid-19 vaccine hesitance among African-Americans. It applies a hypothetical analysis approach where the impact of the Tuskegee Syphilis test is tested alongside other factors, including disparity and discrimination in health care, whether they cause an increase in Covid-19 cases hesitance. The hypotheses are then analyzed through quantitative methods, including collecting the data through surveys and using statistical software. The survey method will be preferred since it assists in collecting raw data from the participants, which is more reliable and effective.

Topic Overview

The COVID-19 pandemic has devastated the world for more than two years, where America and Europe are suffering more than other continents. In the United States, Laurencin (2021) explains that more than twenty million cases have been recorded, and more than 365000 patients have lost the fight against the pandemic. The number of COVID-19 cases is also prevalent in the African-American population. The death toll related to COVID-19 complications among the African-Americans population is 2.7 times more than in the white American population. It’s estimated that one patient in 825 affected African-Americans succumb to the disease while one in 3125 White American people (Laurencin, 2021) dies from the COVID-19.

Several factors have contributed to the disparity in the COVID-19 cases. Laurencin (2021) states that discrimination of the minority African-Americans in the health sector contributes to the high spread of COVID-19 cases and deaths in the United States black population. Bunch (2021), in support of Laurencin’s (2021) argument, also states that racial disparities have contributed to the high rates of African-Americans infected by the virus and the related deaths. However, the vaccine has been produced, although it’s on initial stages. Different scholars and stakeholders in the health sector have found that the hesitancy to receive the COVID-19 vaccine is high among African-Americans (Laurencin, 2021: Bunch 2021).

Scholars have initiated the research process to determine the main factors leading to the COVID-19 vaccine resistance among the most-hit African-American population. No definite conclusion has been reached, with most scholars and stakeholders in health sectors believing that mistrust of African-Americans on health care is caused by continuous discrimination and mistreatment of African Americans. In addition, inequality is depicted in the bias in the hiring of African-Americans physicians and practitioners. Laurencin (2021) recommends that African-Americans’ mistrust of health care can be reduced by increasing the number of health workers of African descent. This study, however, holds a contrary opinion from Laurencin (2021) and Bunch (2021) by introducing the Tuskegee syphilis experiment as one of the significant factors contributing to the COVID-19 vaccine hesitancy among the African-American community.

Problem Statement

According to Graber (2016), African-Americans have faced mistreatment, especially from the law enforcement agencies, including the police. They have been the victims of injustice since the slavery period, after the slavery abolishment period and it is an exacerbated situation in the twenty-first century. Eighty-nine years ago, in 1932, the United States Public Health Service, in conjunction with the Centers for Disease Control and Prevention (CDC), initiated the Tuskegee Study of Untreated Syphilis in the Negro Male. The study is commonly referred to as Tuskegee Syphilis Experiment (Alsan et al., 2019: Alsan & Wanamaker, 2017). The study continued for forty years until 1972, when the scandalous experiment was unearthed by the journalist and reported by different media houses include New York Times (Alsan & Wanamaker, 2017). It was conducted by Public Health Service in partnership with the Tuskegee Institute (the modern Tuskegee University) (Alsan & Wanamaker, 2017). The program recruited six hundred African-Americans from the poverty-stricken population of Macon County in Alabama.

In the forty years that the experiment was carried out, the African-American men recruited continued to suffer from syphilis, and most of them had died by 1972. The number of men that was alive had infected their wives and children with syphilis. It was a controversial study since the participants were exploited by being promised compensation to their families. Some studies argue that the men were already syphilis patients before being recruited, while others believed they were infected with the syphilis bacteria. Since the scandalous Tuskegee Syphilis Experiment was reported, the number of African-American mortality rates increased (Alsan et al., 2019). The trust for American health care by African-Americans men reduced (Graber, 2016), which forms the basis of this study paper.

Eighty-nine years later, the world is faced with a deadly pandemic, COVID-19, but African-Americans are hesitant of receiving its vaccine. Different scholars give controversial findings of the impact of the Tuskegee Syphilis experiment on the willingness of African-Americans to receive other vaccines in the future. This study paper evaluates whether African-Americans who choose to take the COVID-19 vaccine are influenced by the Tuskegee scenario and how the negative mentality can be overcome to increase the campaign’s effectiveness against the COVID-19 pandemic.

Purpose of the Study

This study aims at investigating the impact of the Tuskegee Syphilis experiment on the acceptance or rejection of the COVID-19 vaccine by African-Americans. The current situation where the mistrust of African-Americans hinders the COVID-19 vaccination concerns both African-Americans and the health stakeholders since it affects the campaign against the pandemic negatively. The study will apply a quantitative research approach to get the views from the African-Americans on their positions about the COVID-19 vaccine and whether their decision is influenced by the forty years Tuskegee Syphilis experiment.

Significance of the Study

Although different scholars have studied the factors impacting African-Americans decision to get a vaccine, most of them are focused on discrimination and racism. Few studies have explored the impact of past injustices, especially in health care which could have contributed to vaccine hesitancy in the group. This study will be among the first studies seeking the connection between COVID-19 vaccine reluctance and the Tuskegee Syphilis Experiment in the history of African-Americans. The study will contribute knowledge and will be used by other scholars who will continue with the research on Tuskegee Syphilis Experiment and its Impact on future vaccinations and trials.

Social Significance of the Study

Health is one aspect that has high social significance in society. According to Lankarani and Ghahramani (2018), health improvement is a factor dependent on the conditions and lifestyle of the people. People are also encouraged to apply health interventions that might reduce the probability of being unhealthy. Health inequity is among the social determinants of health. The Tuskegee Experiment represents the social and health faces of human life. In one aspect, it portrays how human mistreatment might lead to a long-term mental impact on the affected people, and on the other hand, it is linked with the increasingly poor health of African-Americans. The people need to address the social inequality, and their health systems will operate effectively.

The research is also of social importance since it addresses the differences in perception about vaccination between people of the two genders and ages. Gender differences in health care have been a matter of concern for the health stakeholders in the United States and other countries worldwide. The structure of social health advocates for the inclusion of social needs to improve their health (Lankarani & Ghahramani, 2018). An example of social need includes basic human necessities such as food, water, housing, and protection against human rights violations. The Tuskegee Syphilis experiment is representative of the denial of human rights for African-Americans. Its impact on health is felt until now, and the evidence is the high rate of COVID-19 vaccine hesitance.

Research Questions and Hypothesis

Racism has affected the quality of sexual and reproductive health of African-American women. The research by Prather et al. (2018) is one of the studies that represent the state of health in the United States. The disparity in health care is evident, and it has transformed into mistrust between African-Americans and United States health system. The Tuskegee Syphilis experiment is one of the most non-ethical discrimination and exploitation in the history of American health care. The following research question, therefore, guides this study:

• RQ1: Is there a relationship between mistrust of African-Americans receiving the COVID-19 vaccine and the Tuskegee Syphilis Experiment?

For this study to answer the research question, it conducts a hypothetical analysis guided by several hypotheses. The summary of the hypotheses are listed as follows:

• H1: Tuskegee Syphilis Experiment has a long-term impact on the African-Americans desire to participate in the vaccination process or vaccination trials.
• H2: Tuskegee Syphilis Experiment does not impact the decision by the African-Americans to be vaccinated against COVID-19 trials.
• H3: African Americans are impacted differently by the Tuskegee Syphilis Experiment memories, and their decision to acquire the COVID-19 vaccine also varies according to age or gender.
• H4: other factors, including continued discrimination and disparity in health care, also contribute to the persistence of negative mentality on African-Americans on vaccines, and it is a factor contributing to hesitancy in receiving the COVID-19 vaccine.

Definition of Key Terms

Key terms are important in experimental research since they explain the central ideas from which the ideas have been drawn. In this paper, some terms will be common and important in the whole of the article. They include:

• Tuskegee Syphilis Experiment- A study that was initiated in 1932 and ended up in 1972. It included African-American men as the participants. Unfortunately, the result of the survey was disastrous, and many of them died.
• Disparity in health- a term used to refer to the bias in the health sector where some people are favored over others.
• Vaccination hesitance- a term used to refer to the non-willingness of some group of people to participate in the vaccination process.
• African-Americans- United States’ citizens of African descent

Literature Review

Introduction

In this section, this paper analyzes different views, thoughts, and findings on the long-term impact of the Tuskegee Syphilis experiment on vaccination and its relation to COVID-19 vaccination hesitancy. The study collects the data observed and analyzed by other scholars and stakeholders in health education through qualitative analysis of secondary sources. According to Nakano and Muniz (2018), a literature review provides prior knowledge on the topic of interest and identifies inconsistencies in the findings. From the different sources reviewed, the data collected contrasted each other since some authors held that the Tuskegee Syphilis experiment had long-term effects on vaccination while others found no absolute relationship. The sources identified and used in this review showed a great deficit of research articles on the Tuskegee impact on COVID-19 vaccination.

Most of the research articles that exist on the topic are qualitative. Therefore, this paper will be among the few contributing to the quantitatively researched articles on the impacts of the Tuskegee Syphilis Experiment on COVID-19 vaccination. It applied hypothetical analysis where hypothetical questions were answered through the survey questions. The findings from the analyzed sources will be presented in the subheading, including COVID-19 hesitancy, Tuskegee Syphilis experiment impact on COVID-19 vaccination.

COVID-19 Hesitancy

The United States and other developed countries have prioritized the COVID-19 vaccination to combat the COVID-19 pandemic. Unfortunately, the minority groups have shown higher hesitancy to the vaccine, and in the United States, the African-Americans have recorded low vaccination turnout (Reid & Mabhala, 2021). Main hindrances to the higher uptake of the vaccine by the minority groups in the United States and other developed nations as follows: 1) There is mistrust and low levels of confidence in the COVID-19 vaccine safety and efficiency, 2) socio-economic barriers including racism and low level of education and 3) inconvenience barriers and higher costs of the vaccination process. COVID-19 vaccination hesitancy among the minority groups is contributed by a range of factors, including risk perception, bad experience with a vaccination process, among other factors.

Tuskegee Syphilis Experiment impact on COVID-19 Vaccination

Public health officials in the United States raised concerns about high COVID-19 vaccine hesitancy motivated by historical injustices Tuskegee Syphilis Experiment scandal. The past scandals, including the Tuskegee Syphilis experiment, create distrust among the vaccine users reducing their interest in the whole process (Peteet et al., 2021). Addressing historical malpractices in vaccination is one of the relevant authorities’ methods to combat the high vaccine hesitancy and enroll more people from a minority group to benefit from the program. Jaiswal and Halkitis (2019) found that there has been growing mistrust among the general public about medical advances and medical professions. The hesitancy to vaccine existed even before the COVID-19 pandemic, with parents worldwide being concerned about their children’s vaccination. United States population has developed measles vaccines hesitancy before the COVID-19 pandemic outbreak.

The mistrust and low confidence in vaccination contribute to the highest percentage of African-American men willing to seek health care in United States facilities. The Tuskegee experiment contributed to the highest level of medical mistrust. It also increased mortality among the older black men in many parts of the United States. Wells and Gowda (2020) argue that for a clear understanding of the causes of the distrust among the African-Americans on scientific and medical trials, exploration of historical injustices is necessary. One of the historical injustices in United States health care is the black men’s exploitation during the Tuskegee Syphilis experiment. The experiment was observed as the continuation of the exploitation witnessed during the 19th century, where African-Americans were slaves and were subjected to medical experimentation without their consent (Barash, 2020; Wells and Gowda, 2020). Many African-Americans have a perception that the Tuskegee Syphilis experiment is not the only medical experiment exposing disparity in the United States health care. Tuskegee Syphilis experiment caused irreversible damage to the trust of African-Americans in vaccination and scientific experimentation.

Apart from factors like needle phobia, literacy rates, and access to the vaccination, the Tuskegee experiment contributed significantly to the low turnout of African-Americans for the vaccination. The hesitancy is also escalated by the continued mistreatment and racism directed to the minority groups, including African-Americans. Many people from marginalized groups in the United States believe that vaccination is not in the best interest of their health. Another study by Callaghan et al. (2021) states that several factors contribute to the high COVID-19 vaccine hesitancy. Those factors include the fear that the vaccine would be unsafe and ineffective, they do not have medical insurance, financial resources, and other factors. Most of the factors addressed by Callaghan (2021) were also evident in the Tuskegee experiment since the victims were from economically struggling backgrounds. Therefore, many African-Americans living in poverty fears exploitation and being used as experimentation samples in the vaccine development like the victims of untreated Tuskegee Syphilis study.

Tuskegee Syphilis Experiment effects on African-Americans Participation in Vaccination

Morbidity and mortality rates are higher among the African American population than among the white population. Higher mortality rate is partially caused by the disparity in the vaccine uptake of some immunizable diseases. Quinn et al. (2020) state that African-Americans have the highest percentage of the victims that die from flu, an immunizable disease. Although the United States government creates awareness on the importance of the vaccination, the hesitance witnessed in the African-American population is prevalently high. Quinn et al. (2017) found that there was low uptake of influenza vaccine in the 2015-2016 influenza season. The high influenza vaccination hesitance among the African-American population is impacted by the Tuskegee Syphilis test outcomes and disparity in health care. Another study by Evans and Gusmano (2021) found that the HPV vaccination uptake among African-American male adolescents is low despite being proven safe and efficient. Mistrust is a significant factor contributing to the HPV vaccine hesitancy and the low confidence in the vaccines limits the effectiveness of the vaccination process of the Africans-Americans. Tuskegee syphilis experiment reduced the confidence among the black population.

Hesitancy has attracted different views from different scholars and health officials in the United States. Some believe that the study impacts the decision of African-Americans to take the vaccine, while some believe there is no concrete relationship. Rusoja and Thomas (2021) state that African-Americans receiving the COVID-19 vaccine are half the white population. Tuskegee Syphilis Experiment is one of the historical injustices discouraging minority groups from receiving the vaccine. Behavioral beliefs also cause COVID-19 vaccine hesitancy among African-Americans. However, mistrust of the information sources on the COVID-19 vaccine did not contribute to the low vaccine uptake in the African-Americans population.

Older men are more haunted by Syphilis Experiment Test

According to Alsan and Wanamaker (2017), African-Americans expectancy men dropped by 1.5 years than their white counterparts since the scandal was unearthed in 1972. The men’s life expectancy also dropped by 25 percent than that of black women. Therefore, it is essential to consider age and sex in the study relating to the Tuskegee experiment and its impacts on COVID-19 vaccination. Alsan and Wanamaker (2017) found that older African-American men are more affected by negative perceptions on vaccines motivated by the Tuskegee syphilis experiment than younger men. The young generation has a higher tendency to participate in a vaccination process than the elderly men. Therefore, older men were more haunted by Tuskegee Syphilis experiment memories than younger men and women.

Although some scholars and health stakeholders are attributing the COVID-19 vaccine hesitancy among African-Americans to the Tuskegee Syphilis experiment, others believe that the disparity in health care contributes to the situation. Some are also concerned that they may end up being sick after taking the vaccine. According to Bogart et al. (2021), more than thirty percent of black adults in this study commented that they were unwilling to participate in COVID-19 vaccination. Although Bogart et al. (2021) still include mistrust as the factor contributing to fewer African-Americans’ willingness to be vaccinated, other factors such as disparity in the United States health sector play a significant role.

Disparity and Discrimination in United States Health Care impact on Covid-19 Vaccination

Mistrust caused by the government’s failure to be transparent has more effects than the Tuskegee Syphilis test implications. Not only are the African Americans reluctant to participate in COVID-19 vaccination but also influenza vaccination. Racism and mistrust continue to reduce the willingness of African-Americans to receive the COVID-19 vaccine, misinformation on the general public is also a significant factor. The United States needs to create enough awareness on the importance and safety of the vaccines to counteract the misinformation about the COVID-19 vaccination process. Inequitable access to the vaccine has also been listed as a possible factor contributing to the high COVID-19 vaccine hesitancy.

Conclusion

In conclusion, there exist contrasting scholarly views on the impact of the Tuskegee Syphilis experiment on the COVID-19 vaccination. Most of the authors cite mistrust caused by the experiment as the major factor affecting COVID-19 vaccination. However, other researchers found that other factors, including racism and disparity in the United States health care, contribute to the high vaccine hesitancy than the memories of the Tuskegee Syphilis Experiment. From the sources reviewed, there is a need for more research articles especially quantitative on the impact of Tuskegee Syphilis Experiment on COVID-19 vaccine hesitancy.

Methods

The success of research is dependent on the method applied in data collection and analysis (Opoku et al., 2016). The choice of this study’s research questions is guided by the hypothetical questions and the research questions. This section explains the quantitative data analysis method used, the participants, and the procedure followed during the process. The study will apply a quantitative method where the data will be collected from the participants through the questionnaires.

Research Question and Hypothesis

Akhtar (2016) explains various guidelines to be used by researchers while doing exploratory, experimental or descriptive analysis. The first step in exploratory and descriptive research is the formulation of relevant hypotheses. The hypotheses should then be tested whether they are true or not. The research question in this study seeks to determine whether the mistrust of African-Americans on COVID-19 vaccination was motivated by the Tuskegee Syphilis test. The variables to be tested will, therefore, be derived from the hypothesis and defined as follows:

1. Tuskegee Syphilis Experiment had a prolonged impact on African-Americans desire to participate in the vaccination process.
2. Tuskegee Syphilis Experiment did not impact the decision of African Americans to be vaccinated against COVID-19 trials.
3. Tuskegee Syphilis Experiment impacted the decision by African-Americans to participate in the COVID-19 vaccination process.
4. Other factors (disparity and discrimination) contributed to African-Americans negative mentality on vaccination participation.

Participants

The research targets the population of all African-Americans living in the states of Florida, Texas, New York, Georgia, Alabama and North Carolina. They are selected since they are among the states in the U.S.A with the highest population of African-Americans. According to Allen (2017), a researcher has the choice to select whether to do a research on a broad or a narrow population. Since the population may be costly and time-consuming, Allen (2017) advises researchers to choose a sample from the population. The study will employ simple random sampling where the list of the chosen states (the population) will be created, and each state have an equal probability of being selected as a sample. Although Taherdoost (2016) found that simple random sampling has high standard errors, the study assumes that minimum error will exist after selecting the state of Alabama as a representative sample. The participants from the sample (Alabama) will have to meet the following criteria:

1. They have to be of African-American descent.
2. They also need to be from different age groups, and both genders have equal chances to participate in the research.
3. Minors will not be included in the research, and the minimum age of the participants will be set to be eighteen years old.

The Procedure of Data Collection

Muhammad and Kabir (2016) define data collection as the process of gathering and measuring data on test variables to answer research questions, test hypotheses and analyze the results. The study will use quantitative data since it is a cheaper method to implement when testing a hypothesis. A survey approach will be applied where the research questionnaires will be distributed through social media platforms including Facebook, LinkedIn and WhatsApp to the African-Americans living in Alabama. Social media platforms will be selected since, in the digital age, they have proven to be efficient and cost-friendly since most of the participants are connected to internet services.

Ethical Consideration and Informed Consent

Ethical consideration in research is critical to ensuring successful and safe data collection for both investigators and participants. There are several types of harm that can meet the participants, including Psychological, financial and social harm (Broesch et al., 2020). An ethical study, therefore, prevents any harm that can affect its participants. The college Institutional Review Board will assess the ethical perspectives of this study. The research will include informed consent, where the investigators will thoroughly explain the meaning and purpose of the study. The participants will then accept voluntarily to contribute to the process. The investigators will also inform the participants that they are free to exit the research at any stage. Since the participants’ data confidentiality is vital to consider (Chesser et al, 2020), the participants will be assured that their data will be used for the research only and will not be disposed to third parties.

Instrumentation

The research will use questionnaires, developed in three stages. The first stage will be drafting the questionnaire, then sending it to the institution Review Board (IRB) for approval and finally creating the final draft. The questions will be answered by the participants on a five-point Likert scale where one

1. Represents strongly disagree.
2. Disagree.
3. Neither agree nor disagree.
4. Agree.
5. Strongly agree.

The questionnaire will be framed to include questions addressing the variables of the research. The participant will be prompted first to fill the first section, which includes demographic characteristics such as age, gender, and residence state. Finally, the study will included a section that will state the rights and privileges of the participants contributing to the research. The questionnaire will then be included in an online survey system, and the link will be availed to the participants through social media.

Variables and Data Analysis

The research variables will be derived from each hypothesis, and they will be added to the research questionnaires. Each hypothesis has independent and dependent variables. For the first hypothesis, the study will test whether it is true using two variables stated below.

1. Variable 1: The participant is ready to participate in a vaccination process
2. Variable 2: The participant is haunted by the Tuskegee Syphilis Experiment. For the second hypothesis, the relationship between the Tuskegee Syphilis experiment and Covid-19 will be tested using the two variables below.
3. Variable 3: There was high Covid-19 Vaccination hesitance among the participants
4. Variable 4: The high Covid-19 vaccination hesitance was caused by the memories of Tuskegee, Syphilis test. The following variables will be applied to test the truth of the third hypothesis.
5. Variable 5: Older people are discouraged by the Tuskegee Syphilis test to take vaccines than younger people (African-Americans)
6. Variable 6: Men are more impacted by the Tuskegee Syphilis test memories than Women. The final hypothesis will be used to test how other factors, including discrimination and disparity in health care, impacts the African-Americans’ decision to participate in the vaccination process. The following variables will be used to test it.
7. Variable 7: Discrimination and disparity in health care in the United States contributed to high vaccine hesitance

After the data will be collected, analysis will follow using the IBM SPSS software. The analysis will include simple descriptive statistics where the mean, frequencies and bar charts of the demographic characteristics will be first computed. The study will then calculate the Pearson correlation factors and determine the significance of the data by comparing the p-value to a significance level of 0.05. Spearman correlation coefficients will then be computed to evaluate the monotonic relationship between the variables.

Limitation of the Study

The main challenge the study will face will be convincing the African-Americans population to participate. The mode of communication will be social media platforms, therefore, the research might take more time to gather considerable data for analysis. However, the investigators will apply persuasive approach, including awarding some participants to encourage them to participate. The success of the data collection will be measured by high number of participants. Therefore the study requires resources to reach the participants including the internet connection.

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