SHOLA AJAO

Dear Mr Andrew Selous,  

It is unfortunate that I find myself writing to you again during these unprecedented times. As you may recall, I wrote July of last year concerning the case of Belly Mujinga, a black woman, a victim of a racially motivated attack, who later died after being spat on whilst working on the frontline. I write again because of her and the over 100,000 lives including several hundred from our constituency that have been taken, not only as a consequence of this deadly COVID-19 virus but as a result of a series of systematic failures by this Government and others before it. I write to ensure that these failures are not repeated with the emergence of vaccine ‘hesitancy’. It is not a coincidence that this ‘hesitancy’ has been found in 71.8% of black people in the UK (Robertson et al 2021, 2), the reasons are clear when we know where to look. Although solutions may seem complex using the tools I will outline, it is far from impossible.  

The WHO declared vaccine hesitancy among the top ten threats to global health in 2019, defining it as the ‘reluctance to vaccinate despite the availability of vaccination services’ (WHO, 2019). As found by Ben Kasstan (2020) in his work with Haredi Jews in the UK, responses to vaccination can range from ‘acceptance’ to ‘outright refusal’ (5). Between these antithetical positions is where ‘hesitancy’ precariously lies. There is a pendulum skewed to the latter, with your help it is imperative that we right this wrong for the benefit of a community disproportionately impacted by this pandemic (Geddes, 2021). Understanding the reasons for this in the black community is pivotal for the formation and implementation of any intervention. Trust has been a recurring theme. For this reason, we must question the use of the term ‘hesitancy’ as it distorts the valid reasons for wariness, whilst implying that these groups are indecisive about their own health. Victims are blamed for their own health and the collective health of the nation, changing the language to vaccine distrust is key as I will demonstrate. Vaccine distrust despite its persistence is being overlooked by this government. Now is the time to listen, to avert a coming crisis and its resultant commissioned report in years to come describing avoidable shortcomings (Iacobucci, 2020).  

Many within my own family have expressed apprehension when it comes to accepting this vaccine, despite the vast number being healthcare professionals that have worked and are working on the frontline. ‘Why should we trust them?’ This was the response reverberating in every conversation. A short supply of trust has its origins tied to the racial history of medical research, where black and brown bodies become casualties of research without benefiting from the knowledge extracted (Tuhiwai smith, 1999). To look at distrust with an ahistorical lens would barely scratch the surface of the problem. Rather than conceptualising vaccine distrust as being caused by an inherent opposition to vaccination an examination of the decision-making process is required. Examining the causes without this allows for a damming and ‘damaging representation’ (Kasstan 2020, 1) of a community, whilst a closer interrogation of the root of distrust helps to contextualise the matter. It moves the discussion from blaming cultural or religious practices imbued with insidious undertones that assigns blame to marginalised groups of people.   

A historical backlog of mistreatment and exploitation by the medical institution plays a great role here. This traces far back to J Sims, ‘the father of modern gynaecology’ and his experimental procedures on enslaved black women without the use of available anaesthesia, a torturous procedure disguised as medical research (Cooper Owens, 2017). In more recent memory is the Tuskegee syphilis study, involving over 300 black men with syphilis who, firstly, were not told they had syphilis and secondly, were never given the treatment for it despite its availability. This study has been said to have a ‘lingering’ impact on the ‘acceptance of vaccines ever since’ (Singer 2016, 188). If these cases are not sufficient examples to depict the justification for a mistrust of western medicine, I will provide one more. Pfizer, the company that manufactured the first widely used COVID-19 vaccine was forced to pay 4 Nigerian families £107, 000 each after the death of their children during the trials of experimental antibiotics for meningitis in Kano state, Nigeria 1996 (Lenzer 2011, 1). Of the over 200 families enrolled, none were informed that they were involved in a trial. They were not afforded the basic liberty of a choice between an experimental drug and the effective drug available within that same hospital (Lenzer, 2011). I hope you can see a pattern of deception, misinformation, and exploitation that cannot be reduced to accidental harm but targeted systematic violence which normalises the production of knowledge from the oppression of black and brown bodies (Farmer, 2001). It is time for this to be acknowledged so that the work can begin to answer the question laced with a history of pain, ‘why should we trust them?’. 

As found by Sabo (2016) when studying vaccine uptake at a school in California, vaccine refusal, acceptance or ‘hesitancy’ was pinned to ‘whom one is’ as well as ‘with whom one identifies’ (345). Identifying and being racialised as black for many comes with a unifying experience of overt and covert forms of racism. There is an imprint of historical memory that is reinforced in the lack of acknowledgement of past sins in the present day by the same medical institution that has and continues to uphold inequalities in research protocols. This is then translated into experiences within GP and hospital setting. Where the ‘everyday wear and tear’ (Kuzawa and Gravlee 2016) of being racialised as black is reduced to outcomes as a consequence of race rather than racism. Education is often stipulated as the solution due to assumptions that this ‘hesitancy’ stems from its absence but in this context, intervention must transcend that.   

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Three variables are important in vaccine uptake: ‘confidence, complacency and convenience’ (Tankwanchi et al 2020, 2). Out of these 3 options, vaccine distrust is predominantly contingent on a lack of confidence, so I will focus on this (Kasttan 2020). I ask you to begin with the government acknowledging the reasons for this distrust, as an example of transparency for all to see, doing such lays the foundation to tackle the issue of confidence. As I mentioned earlier education is not enough, but it is useful when it is liberatory. Instead of health care practitioners telling the benefits of vaccination a dialogue is needed. One where they work collaboratively with their black patients to reveal their ‘contextual reality’ (Freiri 1970, 104) by identifying problems, addressing these concerns, and overcoming them.   

 As a new anthropology student, I have learnt of its many tools over this past year, I believe these tools can be used here, specifically referring to community-based interventions. This can be done through utilizing prominent voices within the black community (Kelechi Okafor) and others to promote community derived messaging as well as messengers. It is time for our local health authority to partner up with its black community members to begin to bridge the divide. It is important that among these local public health officials are black practitioners because representation matters. I cannot stress enough how vital seeing familiar faces within these structures is in cementing real positive change in the uptake of the COVID-19 vaccine (Schensul 2017).  

I also wish to draw your attention to the Vaccine Confidence project spearheaded by the London School of Hygiene and Tropical Medicine. I believe that a government that works closely with such an initiative will be better able to appreciate the complexities in vaccine ‘hesitancy’, it helps to support engagement of the public regarding vaccination and from there devise solutions that partners with the people. 

In witing to you about addressing vaccine distrust among our black community both locally and nationally it is vital that the language surrounding this issue does not collapse to the rhetoric of a ‘non-compliant community’ (Kasstan 2020, 6) as was postulated around the stay-at-home and social distancing mandates. These discussions are dangerous due to the erasure of context and lack of acknowledgement of factors that contribute to them. It tends to be a racialised discourse, imbued with classist privilege of those disregarding mass wealth inequalities and the plight of some of the most in need within our community. All that such a language will achieve is an expansion of the ever-growing chasm of mistrust between marginalised communities and public health services.  

I understand these are difficult times that comes with extraordinarily busy schedules, but I implore you to take up these concerns and the given measures with great urgency. Vaccine distrust among the black community is more than just about a non-compliant community, it has developed from years of institutional racism. I call you to act now so that we do not fail this community the same way many others like Belly Mujinga were failed and continue to be failed by the system.  

I look forward to hearing your response in due course.  

Sincerely  ,

Shola Ajao  

References 

Cooper Owens, Deirdre. 2017. Medical Bondage: Race, Gender, And The Origins Of American Gynecology. 1st ed. Athens: University of Georgia, pp.108-122. 

Farmer, Paul. 2004. “An Anthropology Of Structural Violence”. Current Anthropology 45 (3): 305-325. doi:10.1086/382250. 

Freire, Paulo. (1970). Pedagogy of the oppressed. New York: Continuum. 

Geddes, Linda. 2021. “Covid Vaccine: 72% Of Black People Unlikely To Have Jab, UK Survey Finds”. The Guardian. https://www.theguardian.com/world/2021/jan/16/covid-vaccine-black-people-unlikely-covid-jab-uk. 

Iacobucci, Gareth. 2020. “Covid-19: PHE Review Has Failed Ethnic Minorities, Leaders Tell BMJ”. BMJ, no. 369: 1-3. doi:10.1136/bmj.m2264. 

Kasstan, Ben. 2020. “Vaccines And Vitriol: An Anthropological Commentary On Vaccine Hesitancy, Decision-Making And Interventionism Among Religious Minorities”. Anthropology & Medicine, 1-9. doi:10.1080/13648470.2020.1825618. 

Kuzawa, Christopher W, and Clarence C Gravlee. 2016. “Beyond Genetic Race: Biocultural Insights Into The Causes Of Racial Health Disparities”. In New Directions In Biocultural Anthropology, 1st ed., 89-105. New Jersey: John Wiley & Sons. 

Lenzer, Jeanne. 2011. “Pfizer Settles With Victims Of Nigerian Drug Trial”. BMJ 343 (5268): 1. doi:10.1136/bmj.d5268. 

Robertson, Elaine, Kelly S Reeve, Claire L Niedzwiedz, Jamie Moore, Margaret Blake, Michael Green, Srinivasa Vittal Katikireddi, and Michaela J Benzeval. 2021. “Predictors Of COVID-19 Vaccine Hesitancy In The UK Household Longitudinal Study”, 1-11. doi:10.1101/2020.12.27.20248899. 

Schensul, Jean J. 2017. “Community-Based Research Organizations: Co-constructing Public Knowledge and Bridging Knowledge/Action Communities Through Participatory Action Research.” In Public Anthropology in a Borderless World, edited by Beck Sam and Maida Carl A., 36-65. NEW YORK; OXFORD: Berghahn Books.  

Singer, Merrill. 2016. Anthropology Of Infectious Disease. 1st ed. London: Routledge. 

Sobo, Elisa J. 2016. “Theorizing (Vaccine) Refusal: Through The Looking Glass”. Cultural Anthropology 31 (3): 342-350. doi:10.14506/ca31.3.04. 

Tankwanchi, Akhenaten Siankam, Anelisa Jaca, Heidi J Larson, Charles S Wiysonge, and Sten H Vermund. 2020. “Taking Stock Of Vaccine Hesitancy Among Migrants: A Scoping Review Protocol”. BMJ Open 10 (5): e035225. doi:10.1136/bmjopen-2019-035225. 

Tuhiwai Smith, Professor Linda. 1999. Decolonizing Methodologies: Research And Indigenous Peoples. 1st ed. London: Zed Books Ltd. 

World Health Organization. 2019. “Ten Threats to Global Health in 2019.” Accessed 5 September 2020. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019z