Vaccine Distrust: A Predictable Response to Structural Racism and an Inadequate Public Health Infrastructure

Black Americans have higher mortality rates from COVID-19 than the general population and also stand out as less inclined to accept COVID-19 vaccination. As of January 5, 2021,1 in 735 Black Americans and 1 in 1000 Latino Americans Has Died From Covid-19, In Comparison With 1 In 1030 White Americans.1 As These Statistics illustrate, the public health infrastructure has visibly failed to protect Black and Brown communities from disproportionate rates of death from COVID-19. Also, according to Khubchandani et al., only 66% of Black adults and 71% of Hispanic adults say that they would get vaccinated compared with 78% of White adults.2 The Public Health 3.0 framework introduced by DeSalvo et al. in 2016 committed to creating adequate public health systems that would be able to respond to community needs in times of crises.3 The evidence of racial inequity in access to COVID-19 prevention and treatment and in the distribution of the social and economic burden of the pandemic calls into question the capacity of the Public Health 3.0 framework to meaningfully address structural racism. Vaccine hesitancy, as defined by the World Health Organization, is a refusal or a delay in the acceptance of vaccines despite availability.2 We posit that the term "vaccine distrust" is preferred over the term "vaccine hesitancy" because of the negative connotations of the latter, which in effect faults the individual for their lack of confidence in a system that has historically failed and continues to fail them. We examine the shortcomings ofthe Public Health 3.0 framework through the instructive case of vaccine distrust, which is both a barrier to health care and a predictable response to the public health infrastructure's failure to respond to structural racism.