Black Americans and the Pandemic: What We Need Is Justice, Not Warp Speed!

Contributors: Dr. Sacoby Wilson & Jan-Michael Archer, M.S.

The global COVID-19 pandemic caused by the SARS-CoV-2 virus is ravaging the United States. The CDC reports a total of 2,427,448 cases with 123,751 losing their lives to the disease[1]. These numbers are potentially ten times higher[2] because of the lack of widespread testing, poor leadership from an Administration that does not believe in science, and a decimated public health infrastructure that was slow to respond to the crisis. For instance, the Administration has decided to close 41 testing sites in states across the country[3]. This includes states like Texas where numbers are currently spiking[4], a state that needs more testing, not less testing.

The lack of a strong response to the virus in the early stages of the pandemic has put the Black community in a state of emergency. Black Americans mortality rate due to the virus is much higher than other groups. At one point in time, 1 in 1,625 Black Americans had died due to the virus (or 61.6 deaths per 100,000) with a rate 2.3 times as high as the rate of Whites and Asians and 2.2 times as high as the rate for Latinos[5].

Figure 1. COVID-19 death rates by age and race. Source: Brookings.

However, a recent report from Brookings indicates that the disparities in mortality for Blacks is much higher than the White mortality rate (see Figure 1)[6]. In every age category, Black people are dying from COVID-19 at roughly the same rate as White people more than a decade older[6]. When we dig deeper into the numbers, Blacks aged 45–54 have a mortality rate six times that of Whites[6]. Additionally, we see significant differences in mortality when comparing the crude rate (2.0 times that of Whites) and the age-adjusted rate (3.6 times that of Whites)[3].

Why the virus is disproportionately killing Black people as reported in many outlets can be linked to structured inequalities including the lack of access to healthcare infrastructure, poor housing stock in the Black community, and economic Apartheid that has forced many Blacks into working in occupations seen as essential which increases their risk of exposure to SARS-CoV-2[7,8,9]. In addition, scientific racism demonstrated in the horror of the Tuskegee Experiment[10,11,12,13,14,15](Figure 2), abuse of the cells of Henrietta Lacks[16,17,18](Figure 3), and non-intervention of children exposed to lead in the Kennedy-Krieger Baltimore lead study[19,20,21,22] has led to a strong mistrust of science and medical research[23,24].

Figure 2. Exploitation of Black Bodies in the Medical Field. Left: A doctor draws blood from one of the test subjects in the Tuskegee Study of Untreated Syphilis in the African American Male. From 1932–1972, the United States Public Health Service denied treatment to hundreds of Black male study participants suffering from syphilis. The men were deceived into believing the purpose of the study was to investigate “bad blood” — a vague colloquialism. The true purpose of the study was to determine how syphilis advanced if left untreated.

This Administration’s new response to the pandemic is Operation Warp Speed, its national program “to accelerate the development, manufacturing, and distribution of COVID 19 drugs, vaccines, therapeutics, and diagnostics”[25]. The proposed program fails to highlight how it will address populations such as Black Americans who have one of the highest mortality rates compared to other racial/ethnic groups. Another problem is its leadership. From the top of the leadership team to individuals leading efforts in vaccines, diagnostics, therapeutics, etc, not a single member of the team is a person of color, not a single member of the team is Black. Are Historically Black Colleges and Universities (HBCUs) members of this partnership? Is the Morehouse School of Medicine including in this effort? Is Meharry Medical College including in this partnership? Meharry currently has scientists developing a drug to stop the SARS-2-virus that causes COVID-19. Was Tuskegee’s National Center for Bioethics in Research and Health Care invited to be a part of this effort?[26]

Figure 3. Henrietta Lacks. In 1951, the cancer cells of Henrietta Lacks, an African-American cancer patient at Johns Hopkins Hospital in Baltimore, MD, were cultured to create the HeLA cell line — the first immortalized human cell line and vastly important to medical research to this day. Neither Lacks nor her family were asked for consent to use her biological samples and there was no compensation given for their extraction or use.

The plan for development, manufacturing, and distribution of effective vaccines, drugs, and therapeutics is also inadequate. The operation lacks details on how ethical principles will be integrated into the development, manufacturing, and distribution efforts. There is also no discussion of equity issues or social justice in these processes. Nearly $10 billion dollars has been allotted for this effort through supplemental funding including the CARES Act, but limited funds have gone to HBCUs and Primarily Black Institutions (PBIs) who have a strong track record of working in Black communities on public health issues. Morehouse School of Medicine recently won a $40 million dollar contract to deliver education and information on resources to help fight the pandemic including linking disproportionately burdened and vulnerable communities to COVID-19 testing, healthcare, and social services.[27] This is a great first step, but where is the engagement of these institutions in vaccine and drug development.

Figure 3. Historically Black Medical Institutions (from left to right): Tuskegee University School of Nursing and Allied Health in Tuskegee, Alabama (Source: Skegeepedia); Morehouse School of Medicine in Atlanta, Georgia; Meharry Medical College in Nashville, Tennessee.

Operation Warp Speed or other programs focused on the development of vaccines, antiviral drugs, and therapeutics related to the pandemic should prioritize ethics, equity, community engagement, and social justice. These initiatives must:

1Have strong community engagement and involvement to build trust [28,29,30,31,32, 33,34,35,36,37,38]. There is a deep mistrust among Black populations of science, medical research, and the healthcare system because of racism[39]. There needs to be a strong informed consent process for any trials[40]. This is one way to increase trust and overcome mistrust due to bad actors in previous trials and studies.

2 The team should follow community engagement principles including the establishment of community research advisory boards to build trust in the vaccine and drug development process[40]. Morehouse should lead this effort through its new coordinating center in partnership with other HBCUs and PBIs across the country.

3 When using principles of partnership, these programs should authentically involve Black communities at all stages of the process of developing the vaccines, antiviral drugs, therapeutics, and diagnostics. Institute train the trainer programs and other efforts community coalitions to raise awareness on vaccine and drug trials similar to the work of the Education Network to Advance Cancer Clinical Trials (ENACCT)[41,42].

4Ethical principle of inclusion also means including those institutions and scientists trusted by Black communities such as HBCUs and PBIs are included in the leadership of Operation Warp Speed and development of drugs and vaccines.

5 Operation Warp Speed and related programs should focus on capacity building[40]. How can this project help build local capacity to address the pandemic but other health issues that differentially impact Black populations? How can this program address disparities in access to health care and improve health care infrastructure? It is important that funds available through CARES and other programs are used to invest in local public health infrastructure and improving work conditions for essential workers. The new initiative at Morehouse- the National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities (NIMIC)[27] is a good first step. But instead, HBCUs across the country should be receiving $40 million dollars+ to help improve public health infrastructure and access to health care infrastructure. Our communities need real investments to address Medical Apartheid and long-term health inequities.

6 Trial Design [40] should include equity and social justice principles from the type of randomized trial, to making sure that all participants receive the most effective vaccine or drug, to dissemination and report back.

7 Operation Warp Speed and related programs should adhere to all ethical guidelines to maximize benefit and ensure that the programs are equitable and just. The vaccine and drug trials should follow the ethical principles of Respect (Autonomy), Beneficence, Non-Maleficence, and Justice[40]. Unfortunately, as described, Operation Warp Speed seems to be ignoring these ethical principles. If there is a bioethics plan, it must be shared and reviewed by the public particularly those most impacted by the pandemic.

Implementing ethical principles related to community engagement and social justice will make sure that Black Lives Matter.

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