If you thought that the mask wars were bad, brace yourself for the coming clash over the coronavirus vaccine. And in America — should anyone be surprised? — part of that battle is going to be fought along racial lines.

As hospitalizations and deaths surge from the novel coronavirus that has claimed more than 258,000 lives, we are told that help is on the way. Pfizer and Moderna hope to have functional coronavirus vaccines ready to begin distribution within weeks; on Monday, AstraZeneca announced that its vaccine, too, had proved highly effective in late-stage trials. Pfizer and Moderna are hoping to get emergency-use authorization from the Food and Drug Administration.

All great news, except as others have noted, vaccines in vials are no good unless people take them. That requires trust on the part of patients, and therein lies the problem. For many Black Americans, generations of systemic medical racism and predatory experimentation on Black bodies have generated deep distrust of a system that was never built to serve them.

Given that Black people in the United States are also more likely to die of covid-19, we find ourselves between the rock of a deadly virus and the hard place of a historically racist health-care system.

To be clear: Getting vaccinated is probably the best shot we all have at protecting ourselves and each other from this horrific virus. Modern vaccines are a medical miracle, and I know I’ll be getting vaccinated as soon as I possibly can, for two simple reasons: I don’t want to get covid-19, and I don’t want to spread the disease to anyone else.

But I have heard from Black friends and family members who say they don’t want to take a coronavirus vaccine. Some have misgivings about whether a vaccine produced so fast would be safe; others say they don’t trust pharmaceutical companies to be transparent about risks. They aren’t alone. A September survey by the nonprofit COVID Collaborative found that fewer than half of Black people said they would definitely or probably take a vaccine made available at no charge. Just 14 percent said they trusted it would be safe. A Pew Research Center poll, also from September, illuminated the stark difference in attitudes by race: It found that 32 percent of Black adults would definitely or probably take a vaccine when available, compared with 52 percent of Whites and 56 percent of Hispanics.

I push back against all this, but it can be a hard conversation. These are not ill-informed people. They aren’t prone to conspiracy theories or hoaxes. I have had family friends contract the virus; one of them died. But it’s important to remember that Black skeptics often don’t come to the question assuming that the medical industry has their best interests at heart — and I understand why.

The history weighs heavily here. We’ll get nowhere by denying the gravitational pull it exerts.

Consider this abridged list of horrors: In the Old South, enslaved persons were seen as suitable human specimens for medical experiment and demonstration. In 1839, abolitionist Theodore Dwight Weld said “'Public opinion’ would tolerate surgical experiments, operations, processes, performed upon [slaves] which it would execrate if performed upon their master or other whites.” Indeed, White doctors would buy slaves to experiment upon, and, no, the medical brutality did not end with slavery. The 40-year Tuskegee experiments, in which Black men with syphilis were purposefully left untreated by the U.S. government, continued until 1972. According to one 2017 study, that crime left such a deep psychic scar that the distrust it created reduced life expectancy among Black men in America by more than a year.

This all cuts even deeper in families of African immigrants like mine. We joked darkly that Western companies would try to experiment with covid-19 vaccines on Africans, and sure enough two French doctors suggested that a coronavirus intervention be tested in Africa first. The World Health Organization was forced to step in: Director-General Tedros Adhanom Ghebreyesus said he was “appalled” at the “racist remarks” and that “Africa can not and will not be a testing ground for any vaccine.” Ghebreyesus added, the “hangover from the colonial mentality has to stop,” but the history goes beyond colonialism. Just this past decade, Pfizer had to create a $35 million fund in a settlement with Nigeria after experimental drug trials left 11 children dead.

Given such a history, mistrust is not irrational, and the only way to overcome it will be to treat it with respect. Ultimately, the answer is to end the medical racism that affects so many Black people around the world — the belief that Black bodies don’t feel pain, the inability of doctors to recognize life-threatening symptoms on darker skin and the inequitable care given to Black patients across the board.

Those wrongs are going to take a long time to right, and covid-19 isn’t going to wait. So as a vaccine becomes available, public health advocates will have their work cut out for them. They will need to ask Black people to believe in a health-care system that in so many ways has failed to care for us. Getting to the answer we all need right now — getting to yes — begins by understanding the weight of what is being asked.

It is good news that a coronavirus vaccine is almost here. But the cure for generations of mistrust cannot be fast-tracked.

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