How Does Racism in the Medical System Affect Attitudes towards Vaccinations?
The newly elected president Joseph R. Biden Junior has called for an expansion in vaccinations against COVID-19 detailing his efforts to vaccinate 100 million US-Americans in his first 100 days.1 But before Biden was able to start with his ambitious plan, vaccinations were already carried out in the USA. The first vaccination gathered special attention; pictures of the first US-American getting a COVID-19 vaccine were broadcasted live on television and heavily discussed by most media outlets.2 Sandra Lindsay, the director of nursing for critical care at Long Island Jewish Medical Center in Queens, was the first person in the USA to be vaccinated with one of the newly authorized COVID-19 vaccines. On Sunday night December 13th Lindsay got a call asking whether she would be interested in getting vaccinated and agreed immediately.3 That is how she became widely known as the first person in the USA to receive a remedy against the contagious disease caused by severe acute respiratory syndrome coronavirus that seems to keep the world breathless. Another attention-grabbing aspect might be that Lindsay is part of several demographics that are disproportionately affected by the coronavirus: BlPoC, medical worker and immigrant.4 This article will draw a connection between the current distrust in vaccinations and Michel Foucault’s concept of Biopolitics. Biopolitics contain a type of power, Biopower, which is able to regulate the citizens’ health. In order to link these topics, a historical perspective with a focus on the Tuskegee Study will be provided.
A historic moment – the first COVID-19 vaccine in the USA
The picture above depicts the moment seconds before the first person in the USA gets the authorized COVID-19 vaccine by Pfizer and Biontech on December 14, 2020, in New York City. Analysing the picture, the viewer can split it vertically in half: on the left, there is a woman getting vaccinated, on the right is the woman vaccinating her. The central focus of the photograph is on the middle of the picture, showing the moment before the vaccine is inoculated in the upper arm.
Having a closer look at both protagonists helps to embed the situation in context. The protagonists are two middle-aged, black women. Continuing with the similarities we notice that both wear oronasal masks and white workwear. Particularly the latter leads to the assumption that they work in the medical sector and are medical experts. This assumption is supported by the lettering on the left woman’s T-Shirt: The wording on her left-hand side is not fully legible but shows the word “Nurse”. On her right-hand side is a colourful logo next to the words “Long Island Jewish Medical Center Northwell Health”.
The vaccinating woman on the right takes on the active role. The picture shows her upper body from a side view. She is standing and leaning down towards her patient. The injection has her undivided attention. With her left hand, she touches the patient’s left upper arm to localise the injection spot. In her right hand, she is holding the vaccine, indicating to be ready for the historic moment. Meanwhile, the other protagonist is sitting with rolled-up sleeves in a massive blue chair turning towards the viewer. She is gazing straight ahead thus not making eye contact with the other woman. Her relaxed posture and her clasped hands are signs of serenity and transfer a feeling of ease.
Several details complement the situation. In the foreground on the viewers right side is a table with two pink plastic shells. It is reasonable to suggest that these contain the medical supplies for the vaccination. In the background the scenery is emphasised by a white wall inscribed with the word “Northwell”, which is New York State’s largest healthcare provider, and the same colourful logo as the left woman’s clothing shows.
The picture is a screenshot of the article “African-American Resistance to the COVID-19 Vaccine Reflects A Broader Problem” published in the New Yorker.5 It depicts the subtitle ”Conversations about the vaccine are balancing acts between the unknown likelihood of contracting the virus and the known medical history of African-Americans.” This area of tension will be elaborated in the following.
More than a vaccine – the fight against hesitation
To this day, partly limited trust in medical studies, new remedies and the government’s health policy amongst black communities are perceptible. Lindsay volunteered because she wanted to lead by example and to “inspire people who look like [her].“6 She was eager to send the message that vaccination is safe and that science can be trusted.7The idea was to show Black, Indigenous and People of Colour (BIPoC), who have historically often been ill-treated or even not-treated by the medical system, that they can have trust in the new COVID-19 vaccine. Particularly as a black medical care worker who understands the relevance of historically unequal and deeply racist medical treatment Lindsay had a chance to change the perception of medical innovations. “Unfortunately, due to history, my population – minorities, people that look like me – are hesitant to take vaccines,”8 Lindsay stated. Taking into account the racial experimentation on BIPoC worldwide and, in this case, especially in the US[A]9, Lindsay emphasizes that the affected minority communities should reconsider their fears: “What they should be afraid of is contracting COVID-19.”10 Her objective is obvious: to promote the confidence of the black population in this new vaccine as well as in the government’s intentions. Lindsay, the director of critical care nursing at a hospital in Queens, experienced lingering scepticism about the vaccine and vaccination in general. Even among some of her staff fears eroded.11 She accentuates her intention: “Not to be the first one to take the vaccine, but to inspire people who look like me, who are sceptical in general about taking vaccines.”12 Her colleagues and family quickly embraced her efforts: “This is the whole reason she became a nurse, especially growing up in a third-world country like we did. She’s so passionate about people’s health,” said her brother Garfield Lindsay. He emphasizes: “To be able to be an example like this for getting the vaccine, it’s so meaningful.”13
The legacy of Tuskegee – how history constitutes justified distrust
This article refers to how the US administration tries to succeed in imposing the idea of correct medical history. It focuses on elements which could be brushed aside as details of a unique incident: the organisation of administrative correspondence, the secrecy of the medical staff involved, the censorship of medical information transparency, or the inadequate reconditioning of these crimes. The historical background constitutes an important explanatory factor to the current distrust of vaccines: as stated, Lindsay’s objective was not to create history but to volunteer in an effort to appeal directly to fellow BIPoC who might be sceptical of medical acquisitions in general and vaccinations in particular. Moreover, she especially pointed out that the legacy of the infamous Tuskegee Study, which enabled the leading doctors to withhold medical treatment from Black men who suffered from syphilis, is still widespread amongst the affected communities. The Tuskegee Study was conducted from 1932 to 1972 in Tuskegee, Alabama.14 When it began, the medical community did not know much about the treatment of syphilis; despite the disease existing for over five centuries, there was no successful remedy for it. In the early 20th century, the US Public Health Service was in charge of the development of remedies for sexually transmittable diseases such as syphilis: a division of the Department of Health and Human Services authorised the execution of the Tuskegee Study and observed the leading doctors.15 None of the participants knew what the Tuskegee Study was for. Instead, they were lured in by promised free meals and comprehensive medical help as well as burial insurance. Further, the general medical responsibility was not fulfilled by the authorized medical workers: for those participants who suffered from syphilis there was no treatment for their illness nor were they informed of their diagnosis.16 Additionally, painful and unnecessary spinal taps were performed on many participants of the study.17
It was stated that the reason for these maligned measures was that it would be the only option for the men to stay in the study and that the researchers would be able to examine a large sample size to analyse the course of the disease up until possible death. It should be remarked that these measures seemed to resolve from the lack of respect the doctors had for the men’s intellectual capabilities. This can be seen in the researchers pointing out the patient’s illiteracy as helpful because it would be harder for individuals to suspect what was going on in Tuskegee. By 1945 penicillin was the commonly accepted treatment for syphilis.18 Despite that, the participants of the Tuskegee Syphilis Experiment were never treated or offered treatment with penicillin as the researchers intended to examine the progression of the disease amongst the infected participants. This course of action had severe consequences: In total, it is estimated that 182 of the men died, either directly from syphilis or complications related to the infection.19 Despite relatively limited monetary compensation for the participants or their families, the extensive impacts of the Tuskegee Study are not being acknowledged to this day.20
In general, the medical history of many BIPoC-Americans has still not been promoted into the phase of historical reappraisal. This confirms the need for medical staff and researchers as well as media outlets to confront the issue of the Tuskegee Study and its continuing impact on BIPoC-Americans’ trust of medical research studies and new medical treatments. The public discussion should embrace the discourse about historically conditioned responsibility and support the recondition of systemic racist crimes. This can also be discussed from a theoretical point of view: in Society Must be Defended Foucault argues that in the shift from the defence of the sovereign to the defence of society as the overarching political rationality of the state, the notion of state racism is born.21 Foucault defines state racism as “a racism that society will direct against itself, against its own elements and its own products […] the internal racism of permanent purification, and it will become one of the basic dimensions of social normalization.”22 State racism is thus for Foucault the essential characteristic of the modern biopolitical state: It is both the function of the modern state and that which constitutes it.23 With the government’s increasing possibility to imply Biopolitics, the government’s responsibility for its citizens grows.
Systemic medical racism keeps prevailing
In order to understand the distrust in medical care nowadays, we described exemplary aspects of medical racism in the 20th century. Nonetheless, we have to bear in mind that the mistreatment can at least be traced back to the era of slavery. The disparities in the treatment of white people and BIPoC were not only then constructed and reinforced by medicine but are also nowadays. Current and systemic problems are highlighted by the following statistics concerning the situation in the USA: eight out of ten white people trust their doctors; regarding Black people, this number is, with six out of ten people, lower. Another number calls attention to deficits in the US-American healthcare: one in five Black adults state that due to their race or ethnicity they were treated unfairly when getting health care. Last but not least, 21 per cent of Black people claim that it is hard to find a doctor who treats them with dignity and respect.24 These numbers show: Statistics are not only the sensorium of Biopower but its main option of communication to the citizens.
Not only the historic background but also experiences nowadays contribute to this profound distrust. Cara James, president of the nonprofit organisation Grantmakers in Health, gives one famous example: “Everyone has heard the story about Serena Williams and her experience of being discounted with her symptoms when she almost died after delivering her daughter. Unfortunately, that is something that is shared by far too many people of colo[u]r, especially Black women.”25
Experiences of medical failure due to racism are being reinforced by the current pandemic. A disproportionate number of BIPoC are being affected by the COVID-19 Virus.26 From beginning, with an increased likelihood of infection for BIPoC due to socioeconomic disadvantages, to end, with the lack of access to medical treatment due to the private system of health insurance, the struggles of BIPoC in the USA have been exposed by the pandemic. With reference to Foucault this evidence must be understood as a dimension of racism which is a manifestation of biopolitical sovereignty.
The intertwining of biology and politics
Inspired by the pioneering research of Michel Foucault and subsequent studies in a variety of theoretical papers since the 1970s, political scientists have started to address different rationalities of power that go beyond some of the traditional sovereign-territorial logics and rather take the vital processes of specific populations as their object.27
One of the central objectives of Biopolitics has been the relation between the positive, productive orientation of Biopower and the negative power of annihilation and exclusion, which Foucault pairs with general sovereign power. In The Will to Knowledge, Foucault thinks about a “power that exerts a positive influence on life, that endeavours to administer, optimize, and multiply it, subjecting it to precise controls and comprehensive regulations.”28
Before situating Foucault’s concepts within the broader context of medical treatments, brief definitions of Biopower and Biopolitics are necessary. Biopolitics can be understood as a political rationality which controls the administration of life (and likewise death); additionally, it has the power to administer populations as it aims “to ensure, sustain, and multiply life, to put this life in order”.29 The concept of Biopower thus depicts the form in which Biopolitics are used to make an impact within societies, and could evolve into what Foucault would describe as “a very profound transformation of [the] mechanisms of power of the Western classic age.”30
Biopolitics, addressing the state’s idea of a healthy society, are embodied by preventive medicine. Modern preventing health care started around the mid 19th century. Nowadays immunization through vaccines is one main field of disease prevention – vaccination is being described as one “prime example”31 for Foucault’s concept of Biopolitics. According to Foucault Biopower is implemented by the state’s force – but how is it legitimized? Biopower and the resulting Biopolitics are often associated with no public legitimation source. The Tuskegee Study, conducted inter alia by a division department of the Department of Health and Human Services, can be seen as a cruel example for the exercise of Biopower. The much-cited phrase “to make live and to let die”32, especially the latter, describes this type of abuse of power by governmental authority. As described this government-authorised medical ill-treatment translated into great distrust among BIPoC.
Attempting to understand the current pandemic situation from Foucault’s point of view, one must bear in mind that according to him power is neither “bad” nor “good” itself; it is rather a possible threat that must be questioned. From a normative perspective, Biopolitics are often declared as a danger which must be opposed under all circumstances. Referring to the legitimacy question we argue against this. There are cases in which Biopolitics are the result of a democratic deliberative procedure. Deliberation can be localised in different arenas of the democratic process. John Rawls locates deliberation particularly in established institutions, whilst Jürgen Habermas understands deliberation as an exchange by the critical and autonomous public.33 Undoubtedly, the political system of the USA entails aspects of both – and the COVID-19 measurements are no exception. The facial masks, the possibility of getting the vaccine, the shutting down of venues with too many people – all of these measures taken by the federal government are the result of a democratic process underlying public (external) and institutional (internal) deliberation, they are preceded by the popularisation of knowledge and have the objective of getting through the pandemic with the least possible harm. Therefore, it is a fallacy to condemn the government’s measures as illegitimate legislation implemented by unauthorized bodies. It is a noticeable finding that theorists who claim to work and think in Foucault’s tradition get into a narrative which stresses the mentioned accusations. To be more concrete, this is one quote by the Italian philosopher and psychoanalyst Sergio Benvenuto: “The panic that has stricken Italy (but not only, all over the world people are talking about nothing else) was basically a political choice – or a biopolitical one […] – established first and foremost by the World Health Organization.”34 Giorgio Agamben, one of the most important theoreticians carrying forth the work of Foucault, misses the point equally by neglecting the democratic process and the aim of the measures whilst breaking the whole topic down to a biopolitical one: “Men have become so used to living in conditions of permanent crisis and emergency that they don’t seem to notice that their lives have been reduced to a purely biological condition, one that has lost not only any social and political dimension, but even any compassionate and emotional one.”35
Sandra Lindsay is an icon
Never before in history has there been such a globalised issue connected to so many question marks. Underlying the warnings about vaccination issues and the scepticism against the medical system emerges a growing fear that some kind of union of powerful actors – such as the governments, the science establishment, the pharmaceutical lobby and even the workers in the medical institutions – aim to conspire against the people.36 This promotes governments implying Biopolitics to the position of having to answer fundamental questions relating to topics such as legitimacy and community and explain intersections with empirical inquiries relating to the governance of reproduction, health promotion and pandemics. All members of society are entitled to deliberate these range of topics and to demand answers to biopolitical measurements taken to fight the virus. Taking into account the far-reaching consequences of the Tuskegee Study and other failures of the US-American medical system this type of deliberation by the civil society is even more important. The only remedy for the current allegations is the transfer of reliable knowledge. Listening to experts is crucial to be able to refute the fears of an immoral and conspired union. To support the argument of legitimacy, one must consider that the starting point of all adopted policies is the US-American constituency: preceding a democratic election president Biden is entitled to expand the vaccination campaign in the same manner as former president Trump prevented a lockdown.37
Knowing the deeply rooted problem of hesitancy on getting the vaccine, especially among BIPoC, Lindsay volunteered to be the first one to be vaccinated and sent a strong message to hesitators. The picture depicting this moment and its iconographic power will surely let her go down in history for her dedicated effort to fight against the pandemic.
1 Jessica Glenza, “Biden details sweeping effort to vaccinate 100m Americans in 100 days”, The Guardian, January 15, 2021, https://www.theguardian.com/us-news/2021/jan/15/biden-coronavirus-pandemic-covid-vaccination-plan, accessed on January 20, 2021.
2 Sharon Otterman, “‘I Trust Science,’ Says Nurse Who Is First to Get Vaccine in U.S.”, The New York Times, December 17, 2020, https://www.nytimes.com/2020/12/14/nyregion/us-covid-vaccine-first-sandra-lindsay.html, accessed on January 20, 2021; Ben Guarino and William Wan, “Why this New York Nurse got the country’s first coronavirus shot: ‘We were scared’”, Washingtonpost, December 15, 2020, https://www.washingtonpost.com/health/2020/12/14/sandra-lindsay-first-covid-vaccine/, accessed on January 20, 2021; Eric Levensen, ICU nurse in New York among the first people in the US to get authorized coronavirus vaccine, CNN, December 14, 2020, https://edition.cnn.com/2020/12/14/us/coronavirus-vaccine-first-shot/index.html, accessed on January 20, 2021.
3 The Washington Post Podcast, “The vaccine is here. She got it first.” Post Reports, December 15, 2020, https://www.washingtonpost.com/podcasts/post-reports/the-vaccine-is-here-she-got-it-first/, accessed on January 20, 2021.
5 Cobb Jelani, African-American Resistance to the Covid-10 Reflects A Broader Problem, The New Yorker, December 19, 2020, https://www.newyorker.com/news/daily-comment/african-american-resistance-to-the-covid-19-vaccine-reflects-a-broader-problem, accessed on January 20, 2021.
6 Sharon Otterman, “‘I Trust Science,’ Says Nurse Who Is First to Get Vaccine in U.S.”.
8 Ben Guarino and William Wan, “Why this New York Nurse got the country’s first coronavirus shot: ‘We were scared’”.
9 Sharon Otterman, “‘I Trust Science,’ Says Nurse Who Is First to Get Vaccine in U.S.”; Vanessa Northington Gamble, “Under the shadow of Tuskegee: African Americans and health care”, American Journal of Public Health 87(11) (1997), 1773-1778.
10 The Washington Post Podcast, “The vaccine is here. She got it first.”.
11 Sharon Otterman, “‘I Trust Science,’ Says Nurse Who Is First to Get Vaccine in U.S.”.
13 Ben Guarino and William Wan, “Why this New York Nurse got the country’s first coronavirus shot: ‘We were scared’”.
14 Susam Reverby, “More than Fact and Fiction: Cultural Memory and the Tuskegee Syphilis Study”, The Hastings Center Report 31(5) (2001), 22-28.
17 Allan Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Study”, The Hastings Center Report 8(6) (1978), 21-29.
18 John Douglas, “Penicillin Treatment of Syphilis”. JAMA, 301(7) (2009): 769–771.
19 Allan Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Study”.
20 Vicki Freimuth, Sandra Crouse Quinn, Stephen Thomas, Galen Cole, Eric Zook and Ted Duncan, “African Americans’ views on research and the Tuskegee Syphilis study”, Social Science and Medicine 52(5) (2001), 797–808.
21 Michel Foucault, Society Must Be Defended Lectures at the Collège de France. (London: St Martins Press, 2003).
22 Ibid., 62.
23 Michel Foucault, The Will to Knowledge: The History of Sexuality, Volume 1 (München: Penguin, 1998): 136ff.
24 Jesse Washington, “New poll shows Black Americans put far less trust in doctors and hospitals than white people” , The Undefeated, n.d., https://theundefeated.com/features/new-poll-shows-black-americans-put-far-less-trust-in-doctors-and-hospitals-than-white-people/, accessed on January 20, 2021.
26 Thor Christensen, “Black, Hispanic people hospitalized for COVID-19 at disproportionately high rates”, American Heart Association News, November 17, 2020, https://www.heart.org/en/news/2020/11/17/black-hispanic-people-hospitalized-for-covid-19-at-disproportionately-high-rates#:~:text=Black%2C%20Hispanic%20people%20hospitalized%20for%20COVID%2D19%20at%20disproportionately%20high%20rates,-By%20Thor%20Christensen&text=Black%20and%20Hispanic%20people%20made,among%20racial%20and%20ethnic%20groups, accessed on January 20, 2021.
27 Thomas Lemke, Biopolitik. (Hamburg: Junius Verlag, 2007).
28 Michel Foucault, The Will to Knowledge: The History of Sexuality, 137.
29 Ibid, 138.
30 Michel Foucault, The Will to Knowledge: The History of Sexuality, 136.
31 Malte Thießen, Vom immunisierte Volkskörper zum ´präventiven Selbst´. Impfen als Biopolitik und soziale Praxis vom Kaiserreich zur Bundesrepublik. (Oldenbourg: De Gruyter, 2013): 35–64.
32 Michel Foucault, Society Must Be Defended Lectures at the Collège de France, 240-241.
33 Claudia Landwehr, Demokratische Legitimation durch rationale Kommunikation. (Wiesbaden: Verlag für Sozialwissenschaften, 2012): 355-386.
34 Sergio Benvenuto, “Paradoxia Epidemica – Benvenuto in clausura”, published in Italian on Antinomie, March 5, 2020, https://antinomie.it/index.php/2020/03/05/benvenuto-in-clausura/, accessed on January 20, 2021.
35 Giorgio Agamben, “Chiarimenti”, published in Italian on Quodlibet, March 17, 2020, https://www.quodlibet.it/giorgio-agamben-chiarimenti, accessed on January 20, 2021.
36 Roberto Esposito, “The Immunization Paradigm”, Diacritics 36(2) (2006): 23-48.
37 Franco Ordonez, “Trump Talks About Coronavirus Vaccine”, National Public Radio, November 13, 2020, https://www.npr.org/2020/11/13/934718153/trump-talks-about-coronavirus-vaccine?t=161125663086, accessed on January 20, 2021.
Written by Sarah Hegazy and Nora Wacker. Short intro:
– What do you identify as? NW: she/her SH:she/her
– What is your guilty pleasure? NW: Listening to 80s music on full blast. Especially to Whitney Houston. SH:Listening to and singing with Udo Lindenberg and Udo Jürgens.
– Which book do you recommend? NW: Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason. London: Tavistock, 1969. SH:Carolin Emcke, Weil es sagbar ist: Über Zeugenschaft und Gerechtigkeit. Frankfurt am Main: Fischer, 2013. (unfortunately in German only)
In all fairness and admitting that all above is correct, still AKK was the main person since she was inaugurated…