Introduction
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 provide 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, and hypothesis.
COVID-19 Hesitancy
According to Reid and Mabhala (2021), 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. Main hindrances to the higher uptake of the vaccine by the minority groups in the United States and other developed nations are 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
Peteet, Belliard, Abdul-Mutakabbir, Casey, and Simmons (2021) state that 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. 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 (Wells and Gowda, 2020: Barash, 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. The mistrust was extended to the other health care services contributing to the high mortality rates in the United States.
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. (2020) 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 don’t have medical insurance, financial resources, and other factors. Most of the factors addressed by Callaghan (2020) were also evident in the Tuskegee experiment since the victims were from economically struggling backgrounds. Therefore many African-Americans living in poverty fear exploitation and being used as experimentation samples in the vaccine development like the victims of untreated Tuskegee Syphilis study.
Hypothesis
High morbidity and Mortality rates among the African-Americans population are more than in the white population. The high 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 hesitancy 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. The effects of the Tuskegee syphilis test and mistrust on the vaccination process leads this study to its first Hypothesis.
- H1: Tuskegee Syphilis Experiment has a long-term impact on the African-Americans’ desire to participate in the vaccination process or vaccination trials.
The theory of the Tuskegee Syphilis experiment leading to high COVID-19 vaccine 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. Due to different views and findings by different scholars on the Tuskegee impact on the COVID-19 vaccination process, this paper hypothesizes the following:
- H2 (a): Tuskegee Syphilis experiment impacts the decision by African-Americans to be vaccinated against the COVID-19 pandemic.
- H2 (b): Tuskegee Syphilis experiment does not impact the decision by the African-Americans to be vaccinated against the COVID-19 vaccine.
According to Alsan and Wanamaker (2017), African-American 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 older men. Therefore older men were more haunted by Tuskegee Syphilis experiment memories than younger men and women, and the third Hypothesis is derived as follows:
- H3: African-Americans are impacted differently by the Tuskegee Syphilis Experiment memories, and their decision to acquire the COVID-19 vaccine varies according to age or gender.
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 Borgat 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 Borgat 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.
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. Therefore this study applies the Hypothesis below to answer whether other factors contribute to high COVID-19 vaccine hesitancy among the African-American population.
- 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.
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.
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