As a number of promising COVID-19 vaccines have begun to make their way through human trials, researchers have insisted on the importance of ensuring statistically proportionate black and Hispanic participation in vaccine trials. As National Institutes of Health, Dr Francis Collins told the Washington Post recently, “If this is a vaccine trial that enrolls a bunch of 20-somethings or white college graduates, it will not give us the information we need.”
The pharmaceutical industry’s efforts to recruit black and Hispanic subjects for vaccine trials have been hobbled by controversies. Citing the collective memory of the Tuskegee experiments, many African Americans have expressed reluctance to participate in vaccine studies, while some have even expressed circumspection about the vaccinations themselves.
Readers may recall, Melinda Gates triggered a social media uproar, back in June, when she suggested that the high COVID-19 infection and morbidity rates among blacks merited fast-tracking vaccinations for African Americans, once an effective vaccine becomes available. A flood of critics in the Twitterverse condemned Gates’s remarks as racist, accusing her of treating blacks as “guinea pigs” and “crash test dummies.”
While Gates’s well-intentioned remarks certainly reflected a commitment to a racialist understanding of the world, the problem is not that either she or the pharmaceutical industry are calling for something akin to the Tuskegee experiments. The problem is that both Gates and the pharmaceutical industry have identified “race” (a social construct) as causal, leading them to treat the social construct as if it were a meaningful biological category.
The reality is, however, that race is better understood as a proxy (inadequate or otherwise) for other socioeconomic factors.
Indeed, given the trajectories of infection across multiple demographics at this point, it seems that “race” is far less relevant to outcomes than issues like: 1) whether one is an essential worker; 2) whether one depends on public transportation; 3) whether one shares one’s home with several others or lives in an apartment building; 4) whether one lives in a densely populated neighborhood; 5) whether one has health insurance; and, of course, 6) whether one has pre-existing medical conditions (asthma, diabetes, heart disease, hypertension, immunocompromised, etc).
Gates and the pharmaceutical industry are, thus, proceeding from fundamentally “racist” presumptions about human beings.
Part of what’s going on is that we tend to use “race” in the United States as a proxy for a lot of problems rooted in the world of human contrivance — a mystification that scholars Barbara Fields and Karen Fields refer to as “racecraft.” This problematic dynamic is abetted by standard practices among public health officials, the Department of Justice, and the military to compile data on race, but often there is a failure to compile any meaningful data on other socioeconomic factors.
At this moment, to suggest that it is counterproductive to insist that “race” is the cause of health care disparities is to invite the ire of often well-meaning individuals who are passionately and sincerely committed to living in a more fair, and just world. For what it’s worth, I too would like to live in a more just society, one that isn’t just free of racial disparities, but is also free of black poverty. But if the goal is to live in a nation that is comparatively free of deprivation, then applying a racial lens alone to the problems of black inequality will do us little good.
For the past several decades now, liberals and conservatives alike have been disposed to view racial inequality through one of two racialist frames: the ingrained, if not inborn cultural deficiencies of black and brown poor people; or the ingrained, if not inborn racism of whites. The political-economic underpinnings of inequality, however, have been of little interest to either Democrats or Republicans.
At a moment in which liberals and even some conservatives have expressed a burning desire to exorcise the racist demon that allegedly grips the soul of America, it can be easy to overlook the downside of this tendency. But recent American history reveals the potentially devastating consequences of a disparities discourse that centers on “race” at the expense of more tangible issues like the implications of tax, labor, trade, and housing policies on disproportionately black and brown low-wage workers.
For example, Clinton-era New Democrats’ underclass-informed embrace of tough on crime legislation — which would disproportionately impact black and brown poor people — presumed the impact of proximate political-economic trends on racial disparities in crime rates was essentially beside the point.
Indeed, by the 1990s, unabashed conservatives and centrist-Democrats alike tended to attribute high crime rates in minority communities to the alleged cultural pathologies of black and brown people, rather than the real dearth of decent paying jobs in communities that had lost their blue-collar economic base decades earlier.
To be sure, centrist-Democrats, including Bill Clinton, acknowledged — often in passive voice formulations — that deindustrialization had transformed the American economy. Nevertheless, New Democrats’ attachment to racialist explanations — like “underclass” ideology, “black on black crime,” or even more dehumanizing constructs like “super predators” and “crack babies” — for the high rates of black crime and poverty shifted focus away from the disproportionate consequences for African Americans of deindustrialization, public sector retrenchment, and, then, two decades of depressed wages.
Since this discourse centered on race with little regard for class, the policy solutions advanced by both Republicans and centrist-Democrats ultimately came down to: more prisons, more police, harsher punishments for offenders, cuts to social services, and, interestingly enough, trade policies that undercut the kind of unionized jobs that were even more important to blacks than whites.
Like everyone else in the United States and around the globe, I look forward to a COVID-19 vaccine. And once an effective vaccine is finally available, it would seem appropriate to prioritize distribution to high-risk individuals — medical and other essential workers, and, of course, people with pre-existing conditions. But even as I appreciate the good intentions of people like Melinda Gates who presume that “race” is more than just a proxy for other more tangible issues, I fear the broader implications of this disposition.
Again, I am less concerned that the racial discourse on COVID-19 will help pave the way for a twenty-first-century version of Tuskegee experiments — as horrible as they were. I am far more concerned that this discourse might, ironically, help clear the way for a eugenics-state that will ultimately do even more damage to disproportionately poor black and brown people.
Those disposed to dismiss my fears as histrionic need not reflect on the horrors formal-eugenics frameworks inflicted on the “unfit” during the first half of the twentieth century— from California to the Russian Steppe. One only has to consider the damage inflicted on disproportionately black and brown people in the 1990s by centrist-Democrats and Republicans’ rejection of political-economic interpretations of poverty and racial inequality, in favor of racialist frameworks like “underclass ideology” and “super predator.” In the era of neoliberalism, this disposition lent itself not to a war on poverty, but to a racialized war on the poor themselves.
Racism’s historic legacy — in the form of racially tiered housing and labor markets — has certainly contributed to the material precarity that has made blacks and Hispanics more susceptible to the novel coronavirus, even as more proximate issues such as public sector retrenchment, decline of the union movement, wage stagnation, and absence of universal health care are not just more relevant, but they can actually be redressed. But to suggest that racism is one of many contributors to health care disparities is not to suggest that race — a fictitious biological population — is.
If we are not clear on this distinction now, then we may pay a horrific price for it down the road.