Trust is earned. We all know that. But if a national vaccine campaign is to succeed, we must quickly figure out how to earn the confidence and cooperation of African Americans who are justifiably wary of a coronavirus vaccine.

The world is at war with covid-19, but a successful distribution of a vaccine in the United States will be won and lost on a battlefield with a long history of medical racism. Government-approved medical experiments from the past have undermined Black America’s trust in this moment.

“Vaccine hesitancy” from Black Americans is different from an “anti-vaxxer” stance. It’s not that Black Americans don’t believe in vaccines. They don’t trust a public health system that has in too many cases engaged in grievous harm by experimenting on Black bodies without consent or ignoring the specific needs of Black people.

To understand the root of the skepticism, you must understand this history. You must consider how doctors at Johns Hopkins University took cancer cells from a dying patient named Henrietta Lacks without her consent and then used those cells to create what would become a multimillion-dollar line of biological research.

You must consider the Holmesburg Prison Experiment, where the doctor who created a popular skin cream called Retin-A conducted a series of experiments, biopsies and painful procedures on inmates without disclosing the dangers.

You must know names such as J. Marion Sims, who is known as the “father of gynecology” and lauded until 2018 with a statue in Central Park in New York. Sims performed reproductive experiments on enslaved Black women without anesthesia. One of those women, Anarcha Westcott, underwent 30 painful gynecological surgeries without any form of sedation. Sims later opened a hospital where he conducted his perfected technique on White women, who were of course anesthetized.

And I am betting that you may already know about the Tuskegee syphilis study, the best-known brand of racialized medical malpractice. The U.S. Public Health Service sponsored a 40-year experiment where hundreds of Black men with syphilis were given placebos instead of actual medicine or effective care so doctors could document the long-term progression of the disease. The Tuskegee study came to light only when an Associated Press reporter named Jean Heller published a blockbuster exposé on the “experimentation on human guinea pigs.” The study ended three months after that July 1972 story. Yes, 1972.

Twenty-five years after that, President Bill Clinton offered a formal apology with a solemn White House ceremony. But the memory of these experiments has eclipsed any apology. And that brings us to where we are today. We need Black America to trust a medical system that has not always cared for and protected Black bodies.

We are not just tussling with historical wrongs. A recent study of White medical students found that half believed that Black patients had a higher tolerance for pain and were more likely to prescribe inadequate medical treatment as a result.

And you must remember that African Americans have been in the bull’s eye of the virus due to a number of factors including underlying health conditions, low access to health care and testing, and the disproportionate number who are among the essential workers who cannot labor from home. A Post poll found that more than 30 percent of African Americans personally know someone who has been killed by the virus compared with 9 percent of White Americans and 17 percent of Hispanics.

And yet African Americans who would perhaps have the most to gain from the vaccine are the least likely to roll up their sleeves. A Pew study from mid-November found that only 42 percent of Black adults said they would get the vaccine. Other studies put the figure even lower. This is compared with 61 percent of Whites, 63 percent of Hispanics and 83 percent of (English-speaking) Asian Americans who said they would take the vaccine.

Some are working hard to turn those numbers around. Moderna and Pfizer have mounted aggressive efforts to recruit Black participants in clinical trials. Barack Obama has joined two other former presidents in pledging to take the coronavirus vaccine on TV to boost confidence. Anthony S. Fauci has been participating in Zoom calls with local congregations and town halls with public health officials to build a strategy for outreach and persuasion.

That effort must include trusted voices in Black communities, including church leaders. It must include a plan to address neighborhoods that lack drugstores that will probably become front-line distribution centers. It must include detailed information on vaccine side effects for those with diabetes, hypertension or asthma — diseases that disproportionately impact Black patients.

But all that will be for naught if our nation’s public health system cannot earn Black America’s trust. President-elect Joe Biden should use his pulpit to address this directly in prime time, with a national audience, perhaps even before he occupies the Oval Office.

The vaccine distribution plan has been dubbed Operation Warp Speed. It needs to be followed with: Operation Build Trust. Some people may dismiss an effort at atonement as an 11th-hour act of desperation. Let’s be honest: It is an act of desperation. Our collective ability to win this battle depends on collective participation. If the timing is not ideal, the message needs to be.

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