In Episode 6 of the Antiracism in Medicine series, “Racism, Trustworthiness, and the #COVID19 vaccine,” we are joined by two forces in the field of health equity and academic medicine, Dr. Giselle Corbie-Smith and Dr. Kimberly Manning, to discuss why the pandemic is the moment to ensure trust in medicine.
Learning Objectives
After listening to this episode listeners will be able to…
- Recognize the importance of yielding privilege and power to better center marginalized voices and communities through individual, interpersonal, institutional, and systemic actions.
- Understand the importance of looking beyond isolated and individual instances of mistrust, in recognition that the continued and ubiquitous insults of structural and systemic racism are the primary forces perpetuating mistrust among minoritized communities.
- Identify potential individual, institutional, and policy-level actions to address COVID-19 vaccine inequities.
Credits
- Written and produced by: Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
- Hosts: Utibe, Lash, Jenny
- Infographic: Creative Edge Design
- Show Notes: Rohan Khazanchi
- Guests: Kimberly Manning MD (@gradydoctor) and Giselle Corbie-Smith MD, MSc (@gcsmd)
Show Notes – Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine
Rohan Khazanchi
February 23rd, 2021
Summary
In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Dr. Kimberly Manning, Professor of Medicine and Associate Vice Chair for Diversity, Equity, and Inclusion at Emory University, and Dr. Giselle Corbie-Smith, the Kenan Distinguished Professor of Social Medicine and Director of the Center for Health Equity Research at University of North Carolina-Chapel Hill. We dig into Dr. Manning’s leading perspectives on trust in the Black community and Dr. Corbie-Smith’s longstanding community-engaged research agenda, and we discuss implications for ongoing discourse about COVID-19 vaccine equity.
Timestamps
00:00 Music/Intro
1:25 Guest Introductions
02:34 Reflecting upon the current “moment of hope” in the COVID-19 pandemic
07:46 Why is Mistrust the “Tip of a 400-Year-Old Iceberg”?
12:04 Getting to the Individual “Why” of Declining the COVID-19 Vaccine
13:01 Is Mistrust the True Root Cause?
16:28 Moving past our preconceptions about vaccine mistrust
19:01 “When your immune system is knuckin’ and buckin’, it’s gonna be a little raucous!”
22:43 Shifting our framing from “vaccine hesitant” to vaccine deliberations
27:58 Recognizing our biases, centering the margins, and avoiding diluted generalizations
37:20 Valuing diversity rather than classifying minoritized groups as monoliths
43:34 Why Dr. Manning chose to participate in the Moderna vaccine trial
49:20 The “allostatic load” of the minority tax in a white supremacist system
55:45 Performative advocacy and the “musical chairs” of representation in medicine
58:12 The fallacy of the meritocracy
59:10 What can health systems do to reduce vaccine disparities?
1:06:20 Takeaways and conclusions
1:08:51 Outtakes
Takeaways
Medical Mistrust in the Black Community is More than Tuskegee
Framing medical mistrust solely around watershed incidents like the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee is harmful. It treats Black Americans as a monolith, when there is an enormous diversity and heterogeneity within the Black community. It treats mistrust as an isolated construct, when medical mistrust is intertwined with broader societal injustices. Lastly, our rhetoric often treats mistrust as an individual failing or “uninformed belief”, rather than a consequence of structural inequity.
In contrast, scholarship and clinical care which acknowledges within-group differences and shifts from a deficit-based to an asset-based view of marginalized groups can help us better serve our minoritized patients. Dr. Manning reaffirmed what Dr. Camara Jones told us last episode– that solutions lie in simultaneously emphasizing the importance of individual humanity and value in “hard to reach” (hardly reached) communities and dismantling the structures which push those communities down.
“Black Why’s Matter”
“Simply telling people what to do doesn’t work on your children, and it doesn’t work on your patients.” – Dr. Kimberly Manning
Every person who declines a COVID-19 vaccine has a reason to do so which is theirs, and theirs alone. As clinicians, we need to slow down and demonstrate our willingness to hear the “why’s” of our patients, colleagues, neighbors, and community members. In particular, racial concordance is a key piece of doing this work; authentic communication styles from people who personally understand the needs of their community and can better help motivate a “slow yes” through shared decision-making.
Addressing Racial Vaccine Inequities Requires Race and Community-Informed Solutions
This pandemic has highlighted a faultline between public health and medicine. Crossing that breach must involve organizing with faith-based and community-based organizations, community health workers, and beyond. Geographically-based interventions need to prioritize individuals from those communities, rather than allowing outsiders to take designated slots. Scapegoating mistrust can no longer be an excuse for not meeting people where they are and addressing longstanding, long-understood barriers.
Pearls
Reframe “Vaccine Hesitancy” as “Vaccine Deliberations”
“Vaccine hesitancy” is a symptom of a larger, chronic issue about the way Black and Brown people are treated in the United States. Yet, our narrow focus on the individual drives us to assign blame to those who decline a vaccine as “hesitant” or “distrusting” when there are a plurality of reasons why. Deliberating on big decisions is quite normal, especially when the lived experiences of individuals in historically marginalized groups inform their reasonable apprehension about inequities in U.S. systems writ large.
Minority Tax and the “Musical Chairs” of Representation in Medicine
“My taxation is not without representation… [musical chairs] is all fun and games until somebody has to give up their seat. If everything has been built on privilege, you have to be willing to give something up” – Dr. Kimberly Manning
Dr. Manning presented an analogy to us about a game of musical chairs, in which everyone is happy to participate and speak up for marginalized groups until the music stops and only one seat is left. Minoritized clinicians and researchers face the allostatic burden of stepping up to fix a broken system designed within a white supremacist culture. Performative activism only goes so far; when our colleagues with privilege aren’t willing to give up that power, the needle doesn’t get moved.
“I’m not interested in changing hearts and minds; I’m interested in seeing behavior change and changes in policies, practices, and norms.” – Dr. Giselle Corbie-Smith
References Mentioned
08:14
Manning KD. More than medical mistrust. The Lancet. 2020 Nov; 396(10261): 1481-1482. doi:10.1016/S0140-6736(20)32286-8.
13:01
Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.
32:18
Corbie-Smith G, Miller WC, Ransohoff DF. Interpretations of ‘appropriate’ minority inclusion in clinical research. Am J Med. 2004 Feb 15;116(4):249-52. doi: 10.1016/j.amjmed.2003.09.032. PMID: 14969653.
33:56
Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.
Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999 Sep;14(9):537-46. doi: 10.1046/j.1525-1497.1999.07048.x. PMID: 10491242; PMCID: PMC1496744.
39:42
Wilkerson, I. (2020). Caste: The origins of our discontents.
59:10
Corbie-Smith, G. “A Different Kind of Leader” Podcast. Retrieved from https://adifferentkindofleader.buzzsprout.com/
Additional References
- Sengupta S, Corbie-Smith G, Thrasher A, Strauss RP. African American elders’ perceptions of the influenza vaccine in Durham, North Carolina. N C Med J. 2004 Jul-Aug;65(4):194-9. PMID: 15481486.
- Quinn SC, Jamison A, An J, Freimuth VS, Hancock GR, Musa D. Breaking down the monolith: Understanding flu vaccine uptake among African Americans. SSM Popul Health. 2017 Nov 14;4:25-36. doi: 10.1016/j.ssmph.2017.11.003. PMID: 29349270; PMCID: PMC5769118.
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
Manning KD, Corbie-Smith G, Khazanchi R, Nolen L, Fields N, Ogunwole M, Onuoha C, Tsai J, Paul D, Essien UR. “Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. February 23, 2021.