It has been almost 11 months since the first case of covid-19 was identified in the United States. In that time, more than 300,000 Americans have died from the virus, and our daily lives have changed dramatically as we try to limit its spread. Promising results from several vaccine trials and an approved vaccine gives us some hope the end is in sight, but a major problem remains: not all Americans trust these vaccines will be safe and effective.

Attitudes about coronavirus vaccines vary significantly by race, and this disparity could prove a major challenge in protecting people’s lives. Although 71 percent of Black Americans know someone who has been hospitalized or died of covid-19, a recent survey by Pew Research Center reveals only 42 percent say they would get such a vaccine if it were available today. This number is low when compared to over 60 percent of White and Hispanic adults who say they would immediately take the vaccine.

This may come as a surprise to many since Black Americans have been among the hardest hit by covid-19. Black people in the United States are 1.4 times as likely as non-Hispanic Whites to contract the disease, and 2.8 times as likely to die of it. At the beginning of the pandemic, Black Americans were also more likely to be laid off than Whites and have had a harder time finding employment as the economy slowly recovers.

But suspicion of the coronavirus vaccines among many segments of the Black population is tied to a widespread lack of trust in mainstream medicine. The root of the problem lies not in Black communities themselves, but in a medical system that has historically dehumanized them and continues to do so. The result is that the history of medical racism in the United States presents a significant barrier to anything approaching equitable care in the present and future.

This history of medical racism is often shorthanded to a single word: Tuskegee. For 40 years the United States Public Health Service, working with the Tuskegee Institute in Alabama, tracked the progression of untreated syphilis in poor Black men, even after effective treatments for the disease became available — an appalling ethical violation that cost Black people their lives. News coverage in 1972 drew attention to the study, and the resulting public pressure brought it to an end. But the Tuskegee study is just one of the more recent and well-known episodes in the centuries-long history of medical neglect, abuse and exploitation of Black Americans.

The exploitation of Black people in the future United States began the moment enslaved Africans first disembarked on these shores, and the medical abuse of the enslaved was inextricably linked to their bondage. Doctors plied their trade in the slave quarters of Southern plantations to protect the slaveholder’s bottom line, rather than to ensure the well-being of the enslaved, and the cures they offered were often worse than the diseases they aimed to treat. In return, they got to practice their craft on non-consenting patients with no access to legal remedies should they be harmed in the course of treatment, as many were.

For example, J. Marion Sims, the “father of modern gynecology,” developed his technique for repairing vaginal fistulae by experimenting on enslaved women, without anesthesia. In his autobiography he recalled operating one woman, Lucy, whose “agony was extreme”; another, named Anarcha, endured 30 such operations at Sims’ hands. (A statue of Sims remained on display in Central Park until 2018, when it was removed under public pressure.)

The medical abuse of Black people in the name of medicine continued even after their death. Medical colleges paid enslavers and grave robbers alike for bodies of the Black dead, which were then used to teach cadres of young doctors about human anatomy. This practice continued after the end of the Civil War, and stories of “night doctors” who murdered Black Southerners ran rampant amid the larger climate of post-bellum racial terrorism.

Similar stories continued to circulate over the course of the next century. In the 1930s, Cornelius Gardner, a formerly enslaved man, told an interviewer from the Works Progress Administration about the time that he “bumped into … a passel o’ young Baltimore Doctors” who tried to kidnap him for their medical experiments. Decades later, Bobbette Lacks told journalist Rebecca Skloot about growing up in the predominantly Black neighborhood of East Baltimore, near Johns Hopkins Hospital, in the 1950s, “When it got dark and we were young, we had to be on the steps, or Hopkins might get us.” Likewise, when dozens of Black children went missing in Atlanta between 1979 and 1981, some African Americans in the city suggested they had been kidnapped by the Centers for Disease Control.

Bobbette Lacks’s mother-in-law, Henrietta Lacks, had gone to Johns Hopkins Hospital seeking treatment for a tumor on her cervix in January 1951, and died later that year. Cells from her tumor were harvested without her consent and have been used in biomedical research ever since. For decades her family was unaware that Lacks’s cells (known as “HeLa”) had been used in this way, and despite the cells’ commercial use, did not receive compensation until earlier this year.

Beginning in the early 20th century, doctors also forcibly sterilized women who were deemed mentally or morally unfit for reproduction; these women were disproportionately Black. Involuntary sterilizations targeting poor women and women of color continued into at least the 1970s in a number of states, including Alabama and California, and has continued up until the present day in women’s prisons. African Americans also made up a disproportionate number of those who were exposed to radioactive materials without consent as part of experiments to determine their effect on the human body — some were injected with massive doses of plutonium, while others were bombarded with radiation under the guise of some other treatment.

Stories of abuse such as these have continued to fuel distrust of medical authorities within Black communities. At times that mistrust manifests in stories that are not factually accurate, but that nevertheless communicate powerful truths rooted in history. According to the Black folklorist John W. Roberts, they also serve an important function: to warn community members about “potential dangers or threats to their well-being and survival.”

This collective memory is also reinforced by Black patients’ everyday encounters with the medical system. Here they are treated according to stereotypes that they are trying to get access to painkillers, or are incapable of following a doctor’s recommendations. A 2016 study found medical trainees and residents perceive Black patients as less susceptible to pain than White patients, reflecting the persistence of misconceptions about Black bodies that date back to slavery. As a result, Black patients are sicker and suffer higher mortality than their White counterparts. This disparity is especially notable in the country’s maternity wards, where Black new mothers are three times as likely to die during or after childbirth compared with White mothers.

Statistics like these give added weight to the collective memory of the medical exploitation of Black bodies. With this history in mind, Black Americans’ suspicion of a coronavirus vaccine makes sense. However, that very suspicion is a threat to Black survival if it means African Americans forgo vaccination.

This is a problem that defies easy solutions, but there are places to start. In the short term, Black influencers can play a role in shaping community attitudes about the vaccine. Implicit bias training for doctors and nurses may help them to make decisions about diagnosis and treatment based on their patients’ symptoms, rather than their skin color. More racial diversity in the medical professions could help improve the experiences of Black patients.

But none of these will treat the underlying cause of the problem — they’re like treating a gunshot wound with a band aid. Black distrust of mainstream medicine is only a symptom of our failure to truly grapple as a nation with our long and deadly history of white supremacy.