Black communities are not hesitant just for the sake of it. They are hesitant because of memory. Not out of defiance or resistance, but because history has given them every reason to be hesitant. Centuries of racism and institutionalized silencing taught them to be wary.
During COVID-19, that truth was made even more clear: mistrust is not irrational, rather it is logical, in every sense. Still, there is a disconnect in what Black communities know and feel, and what the state is willing to understand and accept.
In my recent research, I have seen the undeniable pattern: Black communities have, often, been treated as secondary, not just during the COVID-19 pandemic but long before. CBC has reported how systemic racism has and continues to shape Canadian medicine and healthcare. Similarly, the Canadian Medical Association Journal has published anti-racism calls, calling for a shift in medicine itself. Through investigating archival curations, public health policies and conducting interviews, one thing is clear – this same truth keeps showing up: Black communities are acknowledged, tentatively and conditionally, and typically only in times of crisis.
The pattern of tentative acknowledgement and conditional recognition is not new. In Canada, Blacks and Indigenous communities have faced state-sanctioned harm including forced sterilization. The Sexual Sterilization Act in Alberta, which remained in effect until 1972, is one example. More recently, there have been documented cases of coerced sterilization in Montreal.
But these events are rarely discussed in relation to Black communities. In fact, Black people are often absent from these discussions and the records themselves. Even in the archives, it is difficult to find materials relating to Black medical experiences. Sometimes they do not exist. Other times, they require official requests to access. The CBC series: Black Life: Untold Stories underscores much of how Black Canadian History has been excluded. This type of erasure and silencing reflects something deeper: a long history of institutional avoidance, generational erasure and socio-political exclusion.
This type of erasure and silencing reflects something deeper: a long history of institutional avoidance, generational erasure and socio-political exclusion.
But we have always known what has been happening to us. We have pushed back through advocacy, counter-archival work and strategic organizing. It was not institutional initiative that prompted responses during the COVID-19 pandemic, it was us – the Black community. The initial approach to addressing vaccine inequity was generic, with little focus on historical legacies of racism and the mistrust it produced. It was not until Black organizers and strategists pushed back that things began to change. Research like the Ontario Science Table vaccine confidence brief demonstrates how racialized communities needed trusted messengers not just the provision of statistical information. Even then, in my own research, I found that many documents referenced “vaccine hesitancy” and “mistrust” without any real unpacking of where it came from. The messaging was vague. Structural and systemic mistrust was rarely acknowledged. And instead of proactive outreach, the public health response was largely reactive, only appearing after disparities in vaccination and death rates were obvious.
While some strategies such as mobile clinics, vaccine ambassadors and community town halls were employed across Canada, they were implemented reactively and under time constraints, and only after the disparities were evident.
Yes, Black leaders and communities were eventually brought to the table during the pandemic. But they should have been there right at the very beginning, before the crisis even began.
Canada needs a holistic, preventative public health approach. One that necessitates partnerships and constant discussions with Black leaders in health equity, community organizers, academics and historians who understand the deep, ongoing legacies of racism in health care. Their insight is invaluable and critical. These voices must be included at every stage and part of policy development, from decision-making to policy evaluation.
Inclusion is not enough on its own. There must be ongoing feedback mechanisms that allow for policy learning and streamlining. Black communities do not need more reactive inclusion. We need structural change built from trust, not just crisis.
