Structural Racism as a Barrier to Influenza Vaccination Uptake during Pregnancy in the Americas; The Extent to which Physician Mistrust caused by the US Healthcare System and held by Minority Patients Exacerbates Racial Health Disparities

The aim of this portfolio’s technical project was two-fold: 1) to elucidate the effects of racial health disparities pertaining to inactivated influenza vaccination (IIV) uptake during pregnancy in Brazil on adverse birth outcomes, and 2) to construct an effective IIV schedule that can mitigate the spatiotemporal spread of influenza in Brazil’s semi-arid state of Ceará. Physiological changes during pregnancy place pregnant women at a higher risk for infection, morbidity, and mortality from influenza relative to other nonpregnant adults. However, current IIV campaigns are largely ineffective due to not only the lack of vaccination coverage among the pregnant population, but also the racial health disparities permeating these campaigns. The technical team hypothesized that racial health disparities pertaining to IIV coverage during pregnancy in Brazil result in a higher quantity of adverse birth outcomes for minority patients. The team also hypothesized that an experimental metapopulation-based IIV schedule for the semi-arid state of Ceará will effectively limit the spatiotemporal spread of the virus. The notion that influenza infection during pregnancy may lead to a higher quantity of adverse birth outcomes due to racial health disparities that continue to ravage Brazil’s healthcare system is alarming. Thus, a timely IIV schedule that effectively addresses these shortcomings and disparities may prove invaluable for public health campaigns in reducing the morbidity associated with the viral disease.

The aim of the sociotechnical paper is to not only explain the origins of minority medical mistrust of physicians in the United States, but also elucidate this population-level mistrust’s exacerbating effects on the nation’s racial health disparities. Through application of the Wicked Problem Framing methodology, it was determined that the nation’s longstanding and ongoing history of unethical medical investigations and clinical atrocities formed the origins of minority medical mistrust, and the lack of diversity and inclusion within the nation’s physician workforce continually perpetuates it. Furthermore, through leveraging a combined Historical Case Studies and Documentary Research Analysis methodology, it was found that mistrust of physicians held by minorities exacerbates the nation’s racial health disparities primarily via deteriorating the patient-provider relationship. Overall, the sociotechnical project elucidated the need for further analysis to be conducted in this area. Racial health disparities pervade the United States healthcare system at every level; ignoring these disparities—as well as the factors that perpetuate and exacerbate them—may leave the system vulnerable to continue straying further and further away from the key tenets of medicine.

School of Engineering and Applied Sciences
Bachelor of Science in Biomedical Engineering
Technical Advisor: Sean R. Moore, MD, MS
STS Advisor: Hannah Star Rogers, PhD
Technical Team Members: Simone Herron and Hunter Newland