The Brothers Grimm told us the story of “The Wolf and the Seven Young Goats.” In response to the wolf’s progressive deceptions, the little goats react with fear, mistrust, and anger. As the mother of young children, I know from many a bedtime story that quite a few tales across cultures, continents, and centuries explore similar themes: “Little Red Riding Hood,” “The Three Little Pigs,” “Pinocchio.”
While the story of racism in United States healthcare is no fairy tale, the deception and discrimination of people on the basis of race or ethnicity have resulted in very real reactions of fear, mistrust, and anger.
This is the experience of millions of Black and Brown people who have been repeatedly subjected to mistreatment, often at the hands of people who were supposed to protect them. Take, for example, the experimental treatments on enslaved African American women given without consent or anesthesia in the 1840s, denial of lifesaving treatment to Black patients with syphilis at the Tuskegee Institute starting in the 1930s, the involuntary sterilization of Puerto Rican women in the 1930s-40s and as recently as 2020 in U.S. Immigration and Customs Enforcement detention centers.
These stories are real, and when they are ignored they take on the aura of a myth — “that could never really happen.” Yet, the falsehoods are not the stories themselves but rather the false beliefs that individuals in positions of power or privilege (knowingly or unknowingly) use to “justify” unethical behavior or unequal treatment.
What’s more, trauma related to racism may be transmitted socially and possibly inherited genetically across generations. Some of these falsehoods persist today and continue to result in discriminatory healthcare, including the tragic story of Susan Moore, MD.
Now that a vaccine against COVID-19 is available, we are asking nonwhite racial minorities no less than to suspend their justified disbelief. To their eyes and ears — rightly skeptical after decades of mistreatment — do the people urging vaccinations not appear eerily similar to the wolf who swallowed egg yolks to sound like the mother goat?
It is not enough to simply ask marginalized communities to trust the system that has let them down for generations without doing anything to change the system. In fact, it is insulting.
Ironically, the communities who now may be more likely to refuse the vaccine due to longstanding mistrust are the ones who have the most to lose by not being vaccinated. Black and Hispanic/Latinx people continue to experience higher COVID-19 infection rates, death rates, and younger age of mortality.
This is precisely why it is critical that we give visibility to the scientists, doctors, and leaders who come from the communities who have been harmed. If we truly want to reach those communities in greatest need, it is their own voices that must be heard and amplified. They understand their fears; they speak their languages.
It is not only fairy tales we must tell our children. We must tell them the truth — good and bad — of our history in an age-appropriate way. We will not be able to suddenly undo centuries of discrimination with a single bedtime story, a single public health information campaign, a single lecture to teach doctors about cultural diversity, a single research study, or a single vaccination syringe, but it is a start.
When I was a little girl, it took all the imagination one could muster to envision a Black or Brown doctor. Now, when I talk to my children about their dreams, I can share some authentic stories of hope, thanks to the leadership of a growing group of Black and Brown leaders. I can tell them about Kizzmekia Corbett, PhD, one of the lead scientists who developed the COVID-19 vaccine; Marcella Núñez-Smith, MD, MHS, co-chair of President-elect Biden’s COVID-19 Task Force and chair of Biden’s COVID-19 Equity Task Force; and Carlos del Río, MD, an infectious disease expert and medical school dean who has authored numerous key publications throughout the COVID-19 pandemic.
Authenticity may, in fact, be the only thing that can combat the centuries of lies and mistreatment to marginalized communities. For years, many of us have imagined better, and now, as we look to safely and equitably distribute the COVID-19 vaccine, we have a new opportunity to actually do better, together.
Pilar Ortega, MD, is an emergency physician and clinical assistant professor of emergency medicine and medical education at the University of Illinois College of Medicine in Chicago, founding president of the National Association of Medical Spanish, and founder and immediate past president of the Medical Organization for Latino Advancement.