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World: How a Black bioethicist makes the case for vaccination to people of color

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Covid-19 vaccines are becoming available, but not everyone wants to get a shot. Which raises a fraught question: Should it be up to each individual to decide whether or not to get vaccinated against a disease that poses a real threat to public health? Or do we all have a moral obligation to get vaccinated?

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This has been a long-running debate among ethicists since well before the coronavirus pandemic. Some philosophers argue that everyone has a moral obligation to be vaccinated against infectious diseases like measles, while others say it’s not so simple. It’s a debate that gets at fundamental questions about individual liberty, bodily autonomy, and communal obligation.

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I was curious about how these arguments have played out during the Covid-19 pandemic, and I’ve been speaking to bioethicists, epidemiologists, and thinkers to sort through these questions. One conversation I had was with Keisha Ray, a bioethicist and professor at the McGovern Medical School at the University of Texas. Armed with a PhD in philosophy as well as her own experience as a Black woman in America, she’s become an unofficial ambassador during the pandemic, trying to convince people of color to get vaccinated against Covid-19.

I talked to Ray about the arguments she makes and which ones are most effective at swaying people. A transcript of our conversation, edited for length and clarity, follows.

a person standing posing for the camera © Courtesy of Keisha Ray

Sigal Samuel

Once vaccines are widely accessible, do you think we’re all morally obligated to get vaccinated against Covid-19?

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Keisha Ray

Yes, I do think it’s a moral obligation. When our actions can have devastating consequences for people globally, near and far from us, then the moral obligation to protect everyone is something we have to take very seriously. And it’s a mutual obligation. Things like vaccines can only work if we all take this obligation to each other seriously.

Sigal Samuel

Black, Indigenous, and Latinx people have been dying of Covid-19 at higher rates than white people. But some people of color are more hesitant to get the vaccine. That has to do with a history of exploitative medical experimentation (the Tuskegee experiment, for example). So when you say there’s a moral obligation to be vaccinated, what about those people of color who are understandably hesitant to trust the medical establishment?

Keisha Ray

In general, obligation should be mutual, but medicine hasn’t always held up its side of the mutual obligation to Black people or Indigenous people or Latinx people. That’s part of why we see this hesitancy. It’s not that people of color just don’t trust medicine. It’s that medicine hasn’t shown itself to be trustworthy to people of color.

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So honestly, even as someone who works in medicine, I’d say the hesitancy is justified. I never judge a person of color when they say, “I don’t want the Covid-19 vaccine.” I try to talk to them, but I never say, “How dare you.” As much as I believe in vaccines and science, I know the history all too well for me to judge a Black or Indigenous person who says, “I’m going to wait and see what happens to other people who get the vaccine.”

Sigal Samuel

There’s always a spectrum in ethics. There are things we can say are morally obligatory, things that are morally praiseworthy (but not obligatory), things that are morally permissible, and then things that are morally blameworthy. What I’m hearing is that you think for people in general it’s morally obligatory to get the vaccine, but for people who have legitimate reasons to be hesitant, like communities of color, it may be praiseworthy to get it but it’s certainly not blameworthy if someone doesn’t get it at this stage. Is that accurate?

Keisha Ray

Yeah, I would agree with that. I want to do my best to encourage people of color to get the vaccine. But I think if they don’t, they should not be blamed.

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On the other hand, I still think there’s an obligation to educate themselves. Obviously this is if you have access to [education]; not everyone has that privilege. But I think there’s some obligation to consider, and not to just say, “I’m not getting that thing and that’s the end of the story.”

And in the Black community, if we’re just thinking about ourselves, I do think there’s some obligation there to not infect fellow members of your Black population. Black people on average tend to have housing situations with more people, so there’s more chance for more infection. Black people are more likely to be essential workers, working in grocery stores and places where they’re interacting. If they’re not vaccinating themselves, they have an effect on the Black community that they come into contact with daily.

Even if you can’t think about your moral obligation to the general public because of what medicine has done to Black people in the past and currently, I would encourage you to think about what not being vaccinated means for your family, your friends, your community.

Sigal Samuel

What else do you say to people in the Black community to try to convince them?

Keisha Ray

One argument is the family argument — that family members have to be alive to take care of family members who are more vulnerable. It’s this very practical attitude: Who’s going to be left to take care of grandma if we all don’t get vaccinated and we’re all dead?

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And I say that in this case, it’s slightly different from the history. What would be more aligned with history is if the vaccine for Covid-19 was withheld from people of color, or if it was tested on people of color and then given to the general population. These things did not happen with the Covid-19 vaccine. If anything, there weren’t enough Black people in the clinical trials. So you can isolate the Covid-19 vaccine case and say, we aren’t seeing a whole lot of racism here yet.

Sigal Samuel

When you tell people the Covid-19 vaccine case is different from other cases in history, are they convinced?

Keisha Ray

Yes and no. It’s still hard to separate Covid-19 from the greater history of medicine.

I received a message from a Black friend — she’s a college professor with a PhD, so she’s very well educated — and she asked me: “I’m sure you know that medicine hasn’t always treated people who look like us the best, so why did you feel comfortable getting the vaccine?”

I shared with her that although I know all too well medicine’s history with Black people, and the current abuses that happen every day, I still believe in science’s ability to give us the opportunity to fight injustice. I can’t continue my work in Black health if I’m dead of Covid-19.

There’s a lot of mistrust among Black people toward health care now because we aren’t getting equitable access to Covid-19 testing and interventions. But one way for Black people to think about this is to say, “Fine, if you’re going to treat us like that, we’re going to take care of ourselves by taking the vaccine. If we’re going to make sure people in our communities are not dying off, if we want to have a can-do and self-care attitude, then one way to do that is to get the vaccine.” We shouldn’t have to have this mindset, but oftentimes we do.

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We can’t fight for equity and fight for justice if we’re dead. We have to get the vaccine so that we can continue to fight.

Sigal Samuel

Since you said that you think there’s a moral obligation to get vaccinated, do you think vaccination should be mandatory in a legal sense?

Keisha Ray

I think it’s ethically viable to think about the Covid-19 vaccine in the same way we think about, say, the smallpox vaccine or polio vaccine. Before I took my current job, I had to give a vaccination record showing that I’ve had certain vaccines, or I would not have been hired. When we put kids in school, they say, “Show your vaccination record or you can’t come to school.”

I think it should be something similar to that. Sometimes we have to put personal liberties aside for the greater good, for the protection of public health. I think this is one of those instances.

And if we think too much about personal liberties, we will actually end up forgoing other personal liberties, because we won’t be able to freely sit in a restaurant, and we’ll still have mask mandates. So if you’re concerned about personal liberties, think about public health as actually ensuring personal liberties.

Sigal Samuel

I like that you’re highlighting that there are multiple values at stake here: There’s a value of personal liberty, there’s a right to bodily integrity (deciding what does or doesn’t happen to your own body), but there’s also a value of protecting the collective good. We can have a value pluralism where we recognize there’s not just one good at stake here. There are competing values.

But one concern I might have about a system where the vaccine is mandatory and unvaccinated people get barred from entering workplaces is this: If some people of color continue to be hesitant about getting vaccinated, does that policy risk locking them out of jobs and educational opportunities and exacerbating racial inequality? Do you worry about that and think it’s best to try smaller nudges first, like financial incentives to get vaccinated?

Keisha Ray

I do worry about that. And I do think we should start off small. But I still worry that if we don’t go in aggressively, how many deaths will we have from Covid-19? And again, most of those deaths will be people of color. The longer we’re not being more aggressive, the more deaths we’ll have.

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