COVID-19 Vaccine Hesitancy or Vaccine Apartheid? Correcting Misinformation about Lower Black Vaccination Rates – Interview with Dr. Lawrence T. Brown
Dr. Lawrence T. Brown is an expert on urban policy based in Baltimore, Maryland and the author of The Black Butterfly: The Harmful Politics of Race and Space in America. Dr. Brown has tirelessly sounded the alarm on COVID-19 vaccine apartheid. National Black Cultural Information Trust founder, Jessica Ann Mitchell Aiwuyor, interviewed Dr. Brown to get his perspective on media coverage and discourse concerning COVID-19 misinformation, vaccine hesitancy, and lower vaccination rates in Black communities.
COVID-19 misinformation has spread across social media like wildfire and intra-community dialogue reveals fear concerning the vaccine. Many prefer to wait and see how vaccinations go for others before getting their own. However, Dr. Brown warns that misinformation and vaccine hesitancy are possible red herrings and not the real reason behind why there are significant racial disparities in vaccinations. Dr. Brown warns that federal and local governments must address spatial equity and spatial access. He explains how medical racism and medical apartheid experienced by Black communities is deeply connected to redlining, segregation, and limited access to funding, resources, facilities, and mobility.
Dr. Brown is a crucial voice in understanding how vaccine apartheid occurs and how it must be dismantled. This interview was conducted on March 3, 2021.
J.A.M. Aiwuyor:
You often discuss how spatial equity, redlining, segregation, and hypersegregation affects access to healthcare in Black communities. How has this problem revealed itself during the COVID-19 pandemic?
Dr. Lawrence T. Brown:
American apartheid is the spatial reality of the entire nation. So before COVID-19, the country was already hypersegregated. We know that hypersegregation breeds hyperpolicing, which was the other pandemic that Black people have been dealing with for centuries now. When the virus hit, it came off of the cruise ships, went through the nursing homes, and began to spread in communities. It hit hypersegregated cities first, really hard. New York, Chicago, Detroit, Milwaukee, those post-industrial hypersegregated cities were the ones that were slammed earliest in a very powerful way. This makes a lot of sense because hypersegregation means that white neighborhoods have a hyperallocation of resources and Black neighborhoods have a hyperdeprivation of resources.
The same can be true for Native American reservations and Latino communities that are also redlined. In Jessica Trounstine’s book, Segregation by Design: Local Politics and Inequality in American Cities, she shows that the more segregated the city is, the less that it spends on public goods, which includes public health, sewer systems, roads, and parks. She also found that to be true for policing. Although I think that at the very top, most hypersegregated cities actually have the reverse relationship – where the more segregated, the more they spend on policing. But by and large, there’s an inverse relationship. The more segregated they are, the less they spend on these public goods. This means in redlined neighborhoods, they’re confronted with a dearth of resources, a dearth of goods, and a dearth of the type of services you need to protect the community.
Therefore, when a new virus comes, it’s going to find the places in society that are exposed and vulnerable. And communities that don’t have those resources are going to be hit the most. That’s exactly what happened. Once that virus went into communities, it hit those places first. Then after the beginning subsided in those cities, which are pretty much in the northern portion of the country, it went and hit the Deep South really hard, particularly the Black Belt. We know that there’s a legacy of slavery in those communities in the Black Belt. There are research papers that talk about the under-development of counties based on the legacy of slavery. They look empirically at the percentage of people enslaved in the county in 1860.
They can track resources 150 years later and show that the more slavery was a component of that county’s economy, the worst outcomes for education and health will be. Then Native American communities like Navajo County and Apache County in Arizona were hit really hard. What I talk about in my book is that hypersegregation breeds all kinds of pathologies. COVID-19 just followed the same pattern that every other pathology follows, whether you’re talking about HIV or gun violence. When you have these communities that don’t have resources, that’s where these types of issues will hit the hardest.
J.A.M. Aiwuyor:
How did all of these factors specifically affect access to COVID-19 related healthcare?
Dr. Lawrence T. Brown:
Public health has been defunded for years now. In many jurisdictions, there’s been less spending on public health and more spending on policing. Rural counties are challenged in terms of having resources. Then in urban areas, redlined Black neighborhoods often have deeply underfunded health departments. For example, the Baltimore City Health Department has a total budget of around $130 million a year pre-COVID. However, 70% of funding for the health department comes from state and federal dollars. So you’re talking about the city only kicking in about 30%. You’re relying on all these other dollars to come from other entities. Meanwhile, the city is spending over $500 million on police.
There’s $30 to $40 million that the city provides for the health department and $500 million that it’s throwing to the police department.
Health departments are deeply underfunded, and now here comes the new virus. What can the health department do when it’s been deeply underfunded the whole time? They have to write all kinds of grants to get money from the state, the federal government, the Centers for Disease Control and Prevention (CDC), and the United States Department of Health and Human Services (HHS).
When COVID-19 hit, we did not have the infrastructure that was needed to combat the disease effectively. The infrastructure I’m specifically thinking about is a well-funded pre-existing community health-worker workforce. At the inception of the pandemic, we could have had community health workers going to educate people. Saying, “We need to wear masks. Make sure you wash your hands.” And asking people in the community, “Do you need other things?”
People still needed food and weren’t going to work. Evictions were kicking in the early stages. We needed a community health-worker workforce to be engaged with people, check on their needs, and help meet those needs.
Even with the phase that we’re in now, we’re vaccinating people. But we still don’t have a strong community health-worker workforce that can go out and boost trust, help administer the vaccine, go door-to-door, and check on Mrs. Smith and Mrs. Jenkins. Talk to people in the community and ask, “Are you all doing all right? Even if you don’t want the vaccine right now, that’s all right. We are just here to check on you overall.”
Because people have other issues besides COVID-19. I think the health department here is doing a smart strategy. They plan to ramp up and get 20 mobile health units to take the vaccine out to our redlined, Black neighborhoods. But this should be a national strategy. Many local public health departments don’t have the money for a fleet of mobile health units before COVID-19, much less after the virus hit.
J.A.M. Aiwuyor:
Coverage about vaccine hesitancy and misinformation often focuses on Black intra-community discussions. However, we’ve seen a lot of misinformation coming from elected officials. Initially, President Trump was driving COVID-19 misinformation. In Maryland, Governor Hogan claimed that Baltimore received more than enough vaccination doses. However, most of the people who received doses in Baltimore were not Baltimore residents. In New York, Governor Cuomo was accused of hiding data about COVID-19 related nursing home deaths. How much do you think miscommunication and under-communication from local and national governments impact communities?
Dr. Lawrence T. Brown:
There’s definitely a lot of people getting different pieces of information from the internet. But we have poor leadership from elected officials. Officials were serving in public office and running the federal government talking about taking “hydroxychloroquine.” There were governors issuing closings in southern states and then trying to reopen early. The leadership of public officials plays a huge role. If they’re not effectively communicating, it leaves a vacuum where all the other nonsense can fill that space.
Also, remember the CDC completely failed. The CDC, the guardian of public health in America, failed with testing. They didn’t have the PPE that was needed. We weren’t protected. The CDC did not control COVID-19, and so COVID-19 broke loose. There was a vacuum because we did not have the nation’s top public health agency standing up strongly and communicating directly. It took about a month before they finally recommended that people wear masks. When you don’t do what you’re supposed to do as the leading public health agency, that leaves room for all kinds of misinformation to break loose.
J.A.M. Aiwuyor:
Do you think it’s gotten better? Some will point out that previously the CDC was under the Trump Administration. Now it’s under the Biden administration. Generally, we would hope that information and research would not change according to the administration. But do you think there’s a difference now?
Dr. Lawrence T. Brown:
On some level, I wonder if it’s too early. The biggest thing is the $1.9 trillion stimulus bill because. It’s the Biden Administration’s first funded effort to change public health departments’ realities, city and state budgets. Also, Biden invoked the Defense Production Act to scale up the vaccine production rapidly. If it works, they’re saying that we should have enough vaccines produced for all Americans by the end of May. Then you still have to deal with distribution, but at least they will be produced.
I think that’s significant just in saying you’re not waiting on private industry to get the vaccine production up to par. Still, I don’t know if Biden is driving any daily message for the people. As bad as President Trump was, he was always on social media. President Biden isn’t using technology and social media in that way. In this pandemic, that’s probably not a good idea.
J.A.M. Aiwuyor:
So you think the Biden Administration should be using social media more to help spread accurate information?
Dr. Lawrence Brown:
Yes, at least share the plan. Let people know what’s going on. I think he’s going through traditional channels like television media. A lot of people are not tuned into old media the same way. There’s a lot of new media channels. On social media timelines and the internet, they should be putting out commercials, 30-second bursts, or sound bites. They could say, “Here’s the plan for moving this forward. Let’s mobilize as a nation to defeat the pandemic.” I’m not seeing that sort of a call-to-action and solidarity in a pervasive way. This needs to be something everyone is saying in a coordinated way.
J.A.M. Aiwuyor:
Is there anything else that you think needs to be prioritized in this conversation concerning access to vaccines, misinformation, hesitancy, or otherwise?
Dr. Lawrence T. Brown:
I think what’s missing is the spatial reality. When you have the distribution of vaccines, are you allocating them equitably? When you’re the governor, are you allocating them equitably within your state? Are you saying the counties that have the most need are getting a greater share because they have a greater burden? What we’re seeing in Maryland, for instance, is counties that are rural and white getting more per capita than the counties that are more demographically Black, urban, and more burdened from COVID-19.
We see the opposite of what we should see in terms of spatial allocation of the vaccine.
That’s at the state level. Then, you get to the County level or city for Baltimore. The allocation within the city is not equitable because, as you mentioned earlier, the vaccine’s allocated to the city can be accessed by anybody that lives in Maryland. After all, it’s a state vaccination center at the Baltimore Convention Center. It’s allocated to Baltimore, but it’s not allocated “for” Baltimore. The same thing was true for the hospitals. We had many people who work at Johns Hopkins Hospital, but they live outside the City. Again, allocations went to Baltimore but weren’t for Baltimore.
The spatial allocation then becomes a huge issue. First of all, are the county or county-equivalents getting an equitable share? Then, is it being equitably administered to the people that actually live in those cities or county-equivalents? That’s what isn’t being discussed. Instead, we’re hearing the other tropes like vaccine hesitancy and all this other stuff. I think it’s a red herring to divert attention from the systemic issues taking place that are depriving urban and these large cities especially redlined Black neighborhoods, of the proportion of vaccines that should be allocated to them, reserved for, and then administered to them.
We’re chasing this rabbit of vaccine hesitancy. We’re asking, “Why are they lagging?” Or saying, “They don’t want to take the virus.” Yet, you haven’t gotten the vaccine to the people. Have you brought it to them to see if they want it? That’s not happening.
Of course, there’s hesitancy, like we both know for a good reason. But I don’t like that term because I think it sort of glosses over the reality. People hesitate, but I think it’s more of a wait-and-see. That’s what we should be calling it. Black people know that all kinds of experimentation or abuses have taken place throughout history, and they have valid questions. A lot of people will take it, but they’re going to wait-and-see if it’s going to hurt you, hurt Big Mama, or whoever lives down the street. If they seem to be doing all right, folks will say, “I guess I’ll go ahead and take it.”
That initial “no” is not a permanent no. It’s a “let me see if y’all are going to screw this up. Then I’ll look, weigh my options, and figure out if I want to take it.”
J.A.M. Aiwuyor
That is so true. I think what happened in Philadelphia with the Black Doctors COVID Consortium proves that point. If you give people the information from trustworthy sources, include people they trust, provide them with access, and prioritize them, they’re more likely to take the vaccine. So hesitancy or not, we automatically would see an increase in vaccinations.
Learn more about Dr. Lawrence T. Brown’s work at theblackbutterflyproject.com.