Source: The Atlantic

Months of cajoling and pressure haven’t worked. Neither has bringing home the COVID-19 vaccine and offering to administer it myself. I got my own vaccine as soon as I could—as did my husband and sons—with little to no side effects.

Yet my mother, a 93-year-old Black woman, still won’t get vaccinated.

Her excuses vary. One day she’ll insist, “I don’t know what’s in it,” even though I’ve explained it to her in detail. Another day: “I already have too many medications in my body,” or “I’m just not comfortable with it.” What she hasn’t said, but what I think is really the point: She doesn’t trust the medical system. And if you don’t trust a system, you don’t trust what the system is trying to do.

My mom is a college-educated woman who married a mathematician and raised three kids in a neighborhood chosen for its good schools. My degrees from Harvard, Case Western Reserve University, and UCLA are a testament to her determination and devotion to learning.

She’s well aware of my credentials. I’ve been a medical doctor for more than 30 years. I am a member of the National Academy of Medicine. I run an award-winning hospital and health system serving 1.5 million residents of South Los Angeles.

Mom lives with us. She listened closely and sympathetically over the past year and a half as I talked about COVID-19’s devastating toll on our largely Black and Latino community. She knows that my hospital was at one of the epicenters of the pandemic. She knows that COVID-19 would almost certainly kill a woman of her age. And yet, in spite of all this, something is still keeping her from getting her shots.

Before you judge her, consider this: What’s driving my mom’s refusal is stronger than even the threat of death.

I think there’s a connection between Black vaccine hesitancy, how Black people are treated within the existing health-care system, and the need for a more diverse workforce that will treat Black people with the respect and compassion that builds trust. And I think my mother’s story illustrates this connection.

A couple of years ago, my mom broke her arm. She went to the hospital associated with her insurance. The staff at the emergency department did not take sufficient actions to control her pain. When the technicians manipulated her arm to take an X-ray, she screamed in agony until she lost consciousness.

Every trip to the hospital since then—and there have been many—has been fraught with anxiety on top of needless discomfort and pain. Why? Because she is a Black woman? The stress of being Black in America is that you don’t know.

Pundits often talk about the Tuskegee Study—a shameful experiment that the U.S. government performed on African Americans beginning in the 1930s—when trying to understand present-day Black resistance to COVID-19 vaccination. But you don’t have to look back that far.

Black Americans experience higher rates of illness and lower life expectancy than other demographic groups. Wealth and fame did not protect Serena Williams from nearly dying in childbirth due to medical complications that are too often ignored and dismissed. A chilling 2020 study from George Mason University demonstrated that Black infants are three times more likely to die than white babies when cared for by white doctors.

My mother sees me railing against an unfair and unequal health-care system for the poor, many of whom are people of color. This system, Medicaid, allows states to pay doctors serving low-income patients lower rates than private insurance or even Medicare, which starves these communities of quality doctors and access to care, so preventable chronic illnesses run rampant. She knows that because of this, the rate of diabetes mortality in South L.A. is 77 percent higher than the national average.

Through her own experience and through data, my mother sees how our society disregards the pain of Black people. Her hesitancy to trust a COVID-19 vaccine is the result. Soothing words won’t be enough to overcome her fears. Only a deep commitment to reversing the structural racial disparities of American health care will.

Want to build Black trust in the medical system? Demand that Congress repair and realign our separate and unequal systems of health care. Demand an increase in public and private funding for scholarships for people of color at all of our medical schools. Fund medical-residency programs at hospitals that serve communities of color. Fix the payment inequities that make it nearly impossible for doctors to afford to practice in minority communities.

Last week, when my mother’s arm pain flared up again to unmanageable levels, I decided to take a different approach. I sent her to the emergency department at my own hospital, Martin Luther King, Jr. Community Hospital. Soon after she arrived, a nurse observed her distress and administered pain relief. A technician carefully took an X-ray at her bedside. A doctor talked to her with respect. In short, she was treated with kindness and compassion.

What made the difference? Her medical team looked a lot more like her than the team at the other hospital had. That’s because 89 percent of our staff are people of color. Doctors and nurses who may themselves have lived the American experience of racism and neglect are more likely to treat their patients of color with sensitivity.

That’s what we need more of. We need to demonstrate to Black and other underserved communities that America’s medical system stands for justice as well as health.

I fervently hope that my mother will get a COVID-19 shot soon. This week, her caregiver, a Black woman in her 50s, stopped holding out and got the vaccine. She told me that what had made the difference was that she knew three people—all Black men and women in their 30s—who died from COVID-19 this summer and were not vaccinated, while another Black friend, with cancer, survived COVID-19 and credited the vaccine. Her fear of dying overcame her distrust.

My mom remains unconvinced. I hoped she would get the shots at my hospital, reassured by the conduct and presence of Black doctors and nurses. But she’s still not ready. It will take more than one experience to overcome her deep distrust that our medical system works in her best interest. She may never get there.

Meanwhile, I have a shot ready to go. I will do my best to demonstrate to her that the vaccine is safe. And I will do my best to bring about changes to make every American patient feel cared for and seen by a health-care system that is fair, equal, and safe for all.

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