Editorial: Structural Barriers to Healthcare, Vaccine Hesitancy, and Racialized Communities, by Sarah Whitwell 

By Sarah Whitwell

Life seemingly changed overnight in March 2020 as Covid-19 swept across the globe. For many, life fundamentally changed. We entered a period of lockdowns, quarantines, social distancing, mask mandates, and vaccination requirements that are only now, for better or worse, beginning to ease. Many of us struggled to face this new reality. We stopped attending social gatherings, began working remotely, and even engaged in panic buying as supply chain concerns turned toilet paper into a hot commodity. We also watched and waited as pharmaceutical companies raced to develop a safe and effective vaccine.

Of all the changes that weary North Americans have endured over the course of the pandemic, vaccination mandates have been among the most divisive. Spaces that had previously been unregulated – restaurants, office buildings, hospitals – now faced a new layer of scrutiny, which prompted widespread outrage.

Opponents of vaccination mandates have raised concerns about bodily autonomy and government intervention in the lives of ordinary people. In liberal societies, individuals enjoy ownership over their own bodies, and have the right to make decisions about the medical procedures they receive. The problem is that individuals who delay in receiving vaccines because they lack confidence in the efficacy or safety of the vaccine, or who do not have convenient access to vaccines due to location, timing, and/or cultural contexts, are being framed as villains in the Covid-19 narrative. CDC Director Rochelle Walensky described Covid-19 as “a pandemic of the unvaccinated.”^[1] Prime Minister Trudeau similarly expressed frustration at those who refused to be vaccinated, calling on them “to do the right thing.”^[2]

The rhetoric of Covid-19 vaccines and vaccination mandates has turned those who are unvaccinated into a monolith: anti-vaxxers, reckless deniers of science, heedless menaces to the social order. Yes, some opponents of vaccines are, in essence, against any scientific findings that might limit their ‘freedom’ to behave in ways that put others lives in dangers. But there are others who remain unvaccinated due to structural barriers, including racism in healthcare systems, lack of access to medical professionals, limited transportation options, and long wait times.

Covid-19 has disproportionately affected racialized individuals who are more likely to face structural barriers to access healthcare and who are more likely to express vaccine hesitancy due to mistrust of the medical community and the policymakers who mandate vaccinations.

In Canada and the United States, racialized populations face disproportionately high rates of infection and death. It is not that Covid-19 discriminates. Rather, racial inequalities that are deeply ingrained in our society leave racialized populations “more exposed and less protected.”^[3]

In Canada, Indigenous communities often have fewer doctors, as well as inadequate housing and access to clean water. Federal neglect has allowed COVID-19 to spread quickly, and a long history of abuse and marginalization stemming from the Indian Act has created mistrust. We see similar trends in the United States where Indigenous peoples have long been marginalized. As a result, many Indigenous people have expressed concerns about the COVID-19 vaccine even as the vaccine has become readily available.

In the United States, a long history of medical abuses against Black people has led to widespread vaccine hesitancy. In the Tuskegee Experiment, for example, hundreds of Black men were promised treatment for syphilis in exchange for participation in a study of the disease. Even when penicillin was available, none of the men received treatment in order to observe how syphilis progressed when left untreated. Events such as this have fostered longstanding mistrust of both the medical community and the government, and fears of medical abuses have again come to the surface with the COVID-19 vaccine. As a result, many Black people in both Canada and the United States have expressed vaccine hesitancy even in the face of restrictive vaccination mandates.

When we talk about those who refuse vaccination or who do not support vaccination mandates, it is important that we consider our privilege in doing so. Yes, there are those anti-vaxxers who speak out of ignorance and a lack of understanding of science.

But there are many who, for practical reasons, cannot access vaccines. And there are others still from racialized groups that have historically been abused by the medical community and the government, who have well-founded reasons to express vaccine hesitancy.

Systemic racism has skewed policies and interpretations during this pandemic. Before we condemn racialized individuals making difficult choices about vaccines, we should remember the manifold structures – economic, political, cultural – that mean racialized individuals’ decisions about their bodies are not made in a void. They are made in the context of a hierarchal social order in which “race” often determines how an individual moves through society.

We are frequently being told to “do the right thing” by pundits and politicians. Once the pandemic has passed, and it is time to assess its lesson, the ‘right thing’ must surely include a reappraisal of the logics of race and racialization that left so many people vulnerable to the ravages of this pandemic, and equally susceptible to the next one.

[1] Emily Anthes and Alexandra E. Petri, “C.D.C. Director Warns of a ‘Pandemic of the Unvaccinated,” New York Times, 16 July 2021, Link to source.

[2] Ryan Tumilty, “Prime minister encourages the unvaccinated ‘to do the right thing’,” National Post, 5 January 2022, Link to source.

[3] VAW Learning Network, “More Exposed and Less Protect” in Canada: Systemic Racism and COVID-19,” Centre for Research & Education on Violence Against Women & Children Learning Network, Link to source.