COVID-19 vaccines and the impact of historic race-based experiments

This story was originally posted in February 2021. Some edits have been made to reflect updated information.

Janel Smith, BSN, RN, knew the idea of vaccination from COVID-19 was going to be challenging in the Black community.

“My mind couldn’t help but reflect on the Tuskegee experiment with the infamous syphilis study,” she told a group of Catholic Charities colleagues during a Zoom conversation in the organization’s People of Color interest group – a group created to foster free conversation about issues around issues facing Black, Indigenous, and people of color. 

Smith, who is a nurse at a veterans’ facility in North Carolina, has diabetes and hypertension. She is not a COVID-19 expert, but she knows those underlying conditions make her more vulnerable to significant disease if she is infected. 

Leia Medlock, MD, a Maryland OBGYN, has been fully vaccinated. She’s not an infectious disease expert, either, but early in the pandemic, her father was very sick with COVID-19, and her uncle died from it, which impacted her decision.

“Of course I had hesitations. Of course I had concerns, and in some ways was even scared,” she said. “Just looking at my father’s course and looking at the fact that my uncle also then passed away from COVID-19 and his death was surprising – he was at home and his wife found him dead from COVID – they knew he had it, but he  kept putting off going to the doctor [when his symptoms worsened]. Those two experiences put in perspective to me that if I get the vaccine, I won’t get that sick. I won’t die.”

Dr. Medlock highlighted the vulnerabilities in minority communities as additional reasons to get the vaccine.

“People of color, black and brown people, we tend to be sicker. We tend to be the majority of the essential workforce, meaning we can’t work from home. We tend to live in multigenerational households [which contributes to spread]. It’s not just a disease of the lungs. It’s systemic… If you already have a disease that’s compromising systems, COVID is going to make them worse.”

Dr. Medlock and Ms. Smith joined the Catholic Charities People of Color group call because they understood – and wanted to share their insights on – the reasons that Black people in particular might feel uneasy about getting the COVID-19 vaccine. Along with Catholic Charities’ chief medical officer, Ron Means, MD, they wanted to help colleagues—and the neighbors those colleagues serve, by extension—feel more comfortable about their sources of information on the vaccine. For more than 90 minutes, they answered questions, busted myths, and addressed issues that are often hard to bring up in other environments.

 The myths vs. the facts

MYTH: We can achieve herd immunity if we let the virus spread through the community.
FACT from Dr. Medlock: It’s true, but let’s do the history on the background of massive plagues and death due to no vaccine. Bubonic plague: 200 million deaths. Spanish flu: 40-50 million deaths. HIV/AIDS: 30 million deaths. [There is no vaccine for HIV or the plague; those rates of infection are dramatically reduced because of broad public sanitation and health initiatives, including protective actions, and AIDS deaths have been reduced due to decades of heavy research investment resulting in effective medications and treatments for the sets of diseases AIDS patients develop.]

Vaccines prevent death. In order for us to achieve herd immunity from COVID-19, 200 million Americans would have to have had it. We’re at about 27.6 million, and about half a million have already died. How much do we want to sacrifice to achieve herd immunity? How many of your friends, your family, your patients, do you want to see die?

MYTH: The number of COVID deaths is lower than reported, and the severity is overblown.
FACT from Janel Smith: While deaths often do have other or underlying conditions, it doesn’t change the fact that COVID-19 is the reason they died. The vast majority could have lived much longer if they had not contracted COVID-19.

MYTH: COVID-19 is no worse than the seasonal flu.
FACT from Janel Smith: They’re both contagious respiratory diseases caused by a virus, and people with COVID-19 and the flu may share some common symptoms. But the viruses affect people differently. Symptoms appear at different times. COVID-19 symptoms appear 2-14 days after exposure, and flu symptoms show up 2-4 days after exposure. COVID-19 is more contagious. Lung injury and other severe illness is more frequent and the death rate appears to be higher with COVID-19. COVID can cause different complications including blood clots and a multi-system inflammatory syndrome in children.

MYTH: There are no long-term effects of COVID-19.
FACT from Dr. Medlock: The majority of people who have COVID-19 will survive and recover within a couple of months, but there are some who have a systemic reaction with a long-term symptomatic period. Lungs and other organs can be affected. The reaction caused by COVID-19 is an extreme inflammatory reaction. We don’t know why some people’s systems react more strongly than others. As fluid in lungs resolves, some patients sustain lung scarring. That can lead to long-term effects like breathing difficulties, cough, fatigue and other things. Brain fog can also persist.

MYTH: The COVID-19 vaccine is not safe because it was developed too fast.
FACT from Dr. Medlock: Because of unethical research like the Tuskegee experiment, there are laws and regulations now about how testing is allowed to be done. Any time there’s a study, it has to go through an institutional review board that says yes, this study is legitimate, has a purpose, is safe, and is ethical. Every institution has its own IRB made up of people from a variety of backgrounds. COVID vaccines had to go through that process. Then they had to go through the FDA’s three phases: testing on healthy people to ensure dosing and safety; testing in an expanded cohort for verification of safety; and waiting one year to make sure all study participants are still safe and have not suffered long-term effects. The approval for COVID vaccine was under what’s called emergency use authorization, and that’s why there wasn’t a full-year wait. The emergency use authorization was to decrease deaths. It means the doses were produced while the study was going rather than waiting until the year was up to produce the doses. It does not mean the safety was not tested. By the way, the fundamental medical technology for this vaccine began 10 years ago when SARS hit Asia.

MYTH: I already had COVID so I don’t need the vaccine.
FACT from Janel Smith: There isn’t enough information to say whether or for how long after infection a person is protected from getting COVID-19. Early evidence suggests natural immunity may not last very long. The Mayo Clinic recommends getting the vaccine regardless, but if you’ve had it, you should wait about 90 days from your diagnosis, and you shouldn’t get it if you have symptoms right now.

MYTH: Avoid the hospital if you want to stay healthy.
FACT from Janel Smith: It can be dangerous to avoid the hospital when you need medical help. For non-emergencies, call a doctor or health care provider to ask if a hospital visit is necessary. A lot of doctors have set up telehealth so people can reach out.

MYTH: COVID-19 is an invented pandemic to cover up the effects of 5G radiation.
FACT from Dr. Medlock: 5G is available in some places but not everywhere COVID is. (Additional information from the National Institutes of Health: This is a conspiracy theory for which there is no evidence of truth. Learn more from the National Institutes of Health.)

MYTH: COVID-19 tests are expensive.
FACT from Dr. Medlock: COVID testing and treatment is covered, even if you don’t have insurance. (This applies to PCR, which takes 72 hours, rather than rapid tests. Most community-based testing has been free to this point. Your doctor’s office may charge for an office visit.)

MYTH: Wearing a mask will increase the amount of carbon dioxide I breathe and will make me sick.
FACT from Dr. Medlock: There are lots of professions that require people to wear masks for long periods, and they are perfectly healthy. You already breathe in carbon dioxide; wearing masks will not compromise your blood oxygen.

MYTH: We don’t need to wear masks after we get the vaccine.
FACT from Dr. Medlock: We will have to continue wearing masks. I myself am tired of wearing masks as well, but I do it to protect myself and others. The vaccine doesn’t make us invisible to COVID-19. It means you won’t get at seriously ill. The vaccine means your full immunity is achieved about two weeks after the second dose. There are questions about whether you can accumulate a viral load that is transmissible to others even if you’ve had the vaccine, which is why it’s still important to use PPE.

Editor’s note, July 8, 2021: The state of emergency in Maryland and Baltimore City no longer requires masks for vaccinated individuals; however, any individual is free to wear a mask or to request that others wear a mask in their presence, and some private establishments may still request or require masks.

MYTH: COVID 19 will alter my DNA.
FACT from Dr. Medlock: This vaccine does not do that. A vaccine uses a [deactivated] piece of a virus to trigger your body’s immune response in ways that create immunity without creating disease. The part of the virus that’s introduced to your virus is mRNA – the “spikes” on the “ball” of a coronavirus. Your body reacts to the virus mRNA, but it doesn’t alter your DNA.

Editor’s note, February 22, 2021: There’s a difference between infection and disease. Infection happens first. Disease is your reaction to the infection – what makes you sick.

Other Q&A with Dr. Medlock

Q:Does COVID break down your immune system like HIV does?
Dr. Medlock: HIV has found a way to enter into the body and attack immune cells. COVID-19 does not attack immune cells. Your immune system overreacts to COVID because it’s never seen it before, whereas HIV weakens your immune system as a matter of its basic viral function.

Q: Can you defeat the coronavirus symptoms by consuming more alkaline foods?
Dr. Medlock: If you have a better diet overall, you are healthier and your immune system is stronger. It never hurts to eat well, but it does not necessarily prevent you from getting COVID-19.

Q: Are kids as at-risk as adults?
Dr. Medlock: Kids are more exposed to varying types of coronavirus [the family of viruses to which COVID-19 belongs]. But we should still take measures to protect them and others.

Editor’s note, February 22, 2021: The latest CDC information is that, compared to adults, children likely have similar viral loads in their nasopharynx (nasal and throat passages), similar secondary infections rates, and can spread the virus to others.

Q: Can you get COVID-19 more than once?
Dr. Medlock: Yes. Either you didn’t build up enough immunity when you had it the first time or your immunity wanes. It’s like the common cold in that regard.

Q: Why isn’t the vaccine accessible at our doctors’ offices?
Dr. Medlock: There just isn’t enough vaccine yet.

Editor’s note, July 8, 2021: Consult your doctor’s office for availability.

Q: Why do we have to get two shots?
Dr. Medlock: It’s like booster shots or flu shots. Your immune system recognizes some viruses more readily than others. [With the Pfizer and Moderna vaccines,] the first shot introduces the virus to your system without infecting you. The second shot is for your immune system to say, “I’ve seen this before. Let me really attack it.”

Q: How long does the vaccine last?
Dr. Medlock: We don’t know yet. The people in the original trials will be followed and their immunity will be tested for years to come.

Q: Should I quarantine if I received the vaccine but then was exposed?
Dr. Medlock: Depends on how long after your vaccination you were exposed. If it’s been two weeks since your second dose, the CDC says you do not need to quarantine.

Q: Can I get COVID after I get the vaccine?
Dr. Medlock: Yes, but you will either be asymptomatic or you won’t get very sick. Hopefully you won’t be able to transmit, though we aren’t sure about that yet.

Q: For people with autoimmune conditions that makes your body unable to produce antibodies, can the vaccine protect you from COVID-19?
Dr. Medlock: The hope is that your body will be able to mount some level of immune response even if you are immunocompromised and reduce your degree of disease.

Q: If you have prostate cancer, diabetes, or another condition, can the vaccine make those conditions worse?
Dr. Medlock: It may have some impacts, but they can be managed. Talk to your doctor.

Editor’s note: Any impact that the vaccine would have on these conditions afterwards would be solely based on a building immune response following vaccination, not because the vaccine actually made the condition worse. The only exception might be immunocompromised states (having prostate cancer and getting chemo treatment) but even that is unclear at this time.  

Q: Why aren’t minority groups eligible earlier if the impacts to these communities are disproportionate?
Dr. Medlock: Age trumps race. That was the primary focus. If you’re 25 and you’re healthy, regardless of your race, the risk of you getting symptomatic COVID-19 to the point you have to be in the hospital is lower.

Q: What would you say to someone who is worried about the vaccine to encourage them to get it?
Dr. Medlock: It’s natural to be nervous. We want to make decisions based on evidence, education and facts rather than false information. The society we live in today can put out anything on the internet or some other way. Make sure you use reliable sources if you’re going to do research. Use cdc.gov, call your doctor, reach out to the Medical Society of Maryland, which is the governing board for the state’s physicians, and they can provide resources. Ask yourself, “What is my Why?” Why are you anxious? If it’s reliable fact and evidence-based, that’s one thing. If it’s not reliable fact and evidence-based, it may not be the right way to decide on vaccination.