As the coronavirus vaccine is slowly making its way to people across the United States, with hopes of it being expedited by the Biden-Harris administration, many people wait anxiously to receive their doses. Others remain skeptical, and among many lingering questions are: How much can we trust the process of approvals for the vaccine? How effective is the vaccine, especially against rising variants? How will the vaccine impact people living with HIV and those managing chronic illnesses? Furthermore, in hopes of contributing to society’s herd immunity, how do we address LGBTQ people as well as Black and Brown folks who, after decades of being treated like an afterthought, may mistrust the medical industry?
Leading drug companies like Pfizer and Moderna have been at the forefront of rapidly developing vaccines to combat one of the deadliest and most destructive pandemics in history. A single-shot vaccine by Johnson & Johnson was authorized for emergency use in late February, increasing the nation's vaccine supply. The Biden-Harris administration’s optimistic effort to ramp up weekly distribution by 16% aims to vaccinate around 300 million Americans by the end of the summer or early fall.
Despite these advances, many continue to be unsure about receiving a vaccine, even after they have been widely endorsed by medical experts and professional groups.
Historically, communities that are underrepresented in medical trials, including those for vaccines, have developed considerable mistrust in the overall effect certain medicines and products will have on their health. During the beginning of the Pfizer and Moderna coronavirus vaccine trials, people living with HIV were excluded. They were included only after advocates such as the Latino Commission on AIDS and the National Minority AIDS Council demanded that people living with HIV have a place in the vaccine trials.
Many LGBTQ people, particularly older LGBTQ folks and LGBTQ people of color, are also wary of receiving the vaccine because medical institutions have pathologized sexuality and gender in the past. The medical community has an extensive history of performing unwanted medical procedures on LGBTQ people, like electric shock therapy, or denying necessary medical care outright, like transgender-affirming care. Many also fear being discriminated against and profiled by the medical staff once specific information, including their HIV status, race or gender identity, is revealed. In a recent study from the Center for American Progress, 8% of LGBQ respondents said medical professionals refused to see them because of their perceived sexual orientation, a figure that jumps to 29% for transgender people regarding their “actual or perceived gender identity.”
These findings are often coupled with stories of past dangerous clinical trials, which perpetuate uncertainty among communities of color — from the infamous Tuskegee syphilis trials, to the unconsented sterilization of non-white women, to the Johns Hopkins free child-care program which, in actuality, was a program to perform unconsented genetic testing on over 7,000 young Black boys.
These conversations make some LGBTQ Black and Latinx folks wary about receiving the vaccine, a wariness that is amplified by complicated, chaotic and misinformed messaging by conspiracy theorists, anti-vaxxers and radical medical professionals.
“In communities of color, especially poorer communities, many people obtain their information both from readily accessible professional sources and their friends and family,” said Jason Starr, HRC litigation director. Starr recently presented during a virtual fireside chat hosted by the New York State Vaccine Equity Task Force.
“When we speak about meeting people where they are, we need to talk about meeting with people who continue to mistrust the medical system,” said Starr. “Many people have seen the breaking of trust come from their engagement with medical institutions today and, if they haven’t, they’ve surely heard of it from their families and friends. Within my own circle, there’s a 50/50 ratio of who trusts the vaccine and who doesn’t. While resolving medical mistrust won’t happen overnight, we need community leaders, especially those in medicine, to create interventions that will motivate people with mistrust to get the vaccine. We need to step up to it, namely by not talking only about the past, but talking about the present.”
Bobby Watts, executive director of the National Health Care for the Homeless Council, also spoke at the same virtual fireside chat. During the event, Watts said that the “key to reach all marginalized groups is to supplement mass education campaigns with micro campaigns.”
“Mistrust is real and it’s also valid,” said Watts. “But when people see that it works with people that they know and they see that they aren’t getting sick, that’s the most powerful way of getting those who don’t trust the vaccine to get the vaccine. They might not trust the healthcare system, but they trust the experience of their friend.”
The hard truth is that the virus has a disproportionate impact on communities of color, both health-wise and economically. Amid the first notable wave of coronavirus infections during the summer, Black and Latinx people made up more than 40% of deaths due to COVID-19, yet together they make up only about 30% of the overall United States population. At the same time, LGBTQ communities of color suffered significant economic hardships: 22% of LGBTQ people of color and 26% of transgender people of color were unemployed due to the pandemic.
of LGBTQ adults of color and 32% of transgender adults of color have no form of health insurance
of all employed LGBTQ adults work in restaurants and food services, hospitals, retail, K-12 and higher education
of all food service workers, janitors, cashiers and stockers are Black; almost one-fifth of nursing assistants, slaughterers and meatpackers, industrial truck operators and correctional officers are Latinx
We can attribute these disparities to many of the risks LGBTQ people of color face. One of the greatest ongoing threats to both the health and economic security of LGBTQ people of color during this pandemic is their sheer lack of health insurance coverage. 23% of LGBTQ adults of color and 32% of transgender adults of color have no form of health coverage. This can lead to avoidance of medical care even when necessary, or to severe economic hardship when medical care is ultimately accessed.
Compounding these findings is the fact that many people of color work in jobs that frequently expose them to COVID-19. For example, Black people comprise one-fifth of food service workers, janitors, cashiers and stockers. Close to one-fifth of nursing assistants, slaughterers and meatpackers, industrial truck operators and correctional officers are Latinx. LGBTQ people work in highly affected industries as well. In fact, approximately 40% of all employed LGBTQ adults work in restaurants and food services, hospitals, retail, K-12 and higher education.
These findings substantiate that many LGBTQ people and LGBTQ people of color will be among those who need to get vaccinated, and soon.
Perhaps adding to the wariness is the rapid development of the vaccine, which is unprecedented. So far, no serious safety concerns have been reported for either of the vaccines, although it is highly recommended that those with allergies do consult their primary doctor or physician before inoculation.
Regarding the fast development of the vaccine, a few factors contributed to the phenomenon, mainly the existence of mRNA technology and the global financial contribution to vaccine trials. In stark contrast to the 30 years of research to develop an HIV vaccine, the COVID vaccine was able to be developed quickly, largely based on the human body’s natural response to coronavirus infection, which, unfortunately, is not the case with HIV.
Still, the last time the LGBTQ community was faced with a devastating health crisis of this proportion was the AIDS epidemic of the 1980s and early 1990s, and we’ve yet to see an HIV vaccine. The AIDS epidemic left the community with ravaging and overwhelming health mistrust. While advanced and groundbreaking HIV treatments have been developed, the LGBTQ community understandably continues to question why the coronavirus vaccine came into fruition far more quickly than any HIV vaccine has.
However, we must continue to fight mistrust with public education. When the FDA granted emergency use authorizations for both of the available vaccines, it did so by determining that the known data in favor of the benefits of the vaccine overpowered the harms of becoming infected with COVID-19. It also developed rigorous standards with which developers must comply. Both the Food and Drug Administration and the Centers for Disease Control and Prevention have been and continue to monitor those who have been vaccinated, largely those who participated in the vaccine trials. The CDC has also issued recommendations pertaining to inoculation.
Throughout the global pandemic, HRC has continuously identified ways of supporting the LGBTQ community and connecting everyone to reliable and accurate information. HRC has hosted numerous virtual convenings with health care professionals and community leaders. We have provided tangible support in forms of grants, both in the U.S. and internationally, to assist other LGBTQ advocates and organizations continue their own efforts in the COVID-19 environment. We have also diligently kept an eye on public safety during the pandemic.
Our own efforts to encourage people to get vaccinated will include an extensive social media and public education campaign to help address medical mistrust within our community, including partnerships with community influencers, health experts and public officials. Additionally, HRC’s social media platforms will be used to gather direct responses from our followers about their most pressing questions. Through direct reply, HRC will be able to meet its followers where they are and learn more about their questions and concerns. Additionally, HRC will identify opportunities to engage in virtual conversations with leading experts on the vaccine’s distribution and its impact on our community.
Here at HRC, our values provide a framework to serve our community with heart and a sense of responsibility. As we continue to monitor the vaccine distribution and develop helpful resources to encourage everyone in our community to get vaccinated, we urge you to continue abiding by safety measures and protocols to ensure yours and your family’s safety.
For more information, visit hrc.im/COVID19Resources