Dear President Biden,

It’s no secret to any of us that Black Americans have carried a disproportionate burden throughout every stage of the pandemic. As you undertake the daunting task of leading the efforts to lift all Americans out of the grips of the COVID-19 pandemic, we are all prayerful for your success in accomplishing your goals.

Knowing that you are surrounded by truly capable people informing you on the impact that COVID-19 has on the Black community, I would like to, respectfully, share perspectives as seen and experienced by those of us “on the ground.”

In addition to the readers of this column in the Black Press, who have used this information to make better and more informed decisions about staying safe, healthy and, most importantly, alive during the past year, my hope is that this modest insight and perspective will find value in informing the policies and guidelines that you put forth.

My motivation for writing this letter resulted from my concern on the current issue of vaccine hesitancy in Black people. This is a far bigger issue than many prefer to acknowledge. Our society, particularly the medical establishment and public health officials, has pigeonholed vaccine hesitancy into a neat little package called “The Tuskegee Syphilis Study.”

First of all, Mr. President, it wasn’t truly The Tuskegee Syphilis Study. It was the United States Public Health Service Study of Untreated Syphilis in the Negro Male at Tuskegee. Big, big difference.

President Biden, PHS was the predecessor to today’s U.S. Department of Health and Human Services. This wasn’t a mad scientist in a basement conducting cruel experiments in the dark of night. This was the United States government.

These are the same Black folks who thought they could trust and depend on the government to protect us all from unscrupulous medical practices or behaviors that rob individual autonomy, allowing people to be in charge of their own lives and to have the freedom to make one’s own choices about how and whether to receive health care. It should be reasonable to expect that there would be hesitancy in this population. After all, it’s not about whether the vaccine is safe. This is about institutional mistrust.

Instead of convincing Black people that this vaccine is safe, maybe we should be looking at medicine’s behavior in the treatment of Black people for more than 400 years. Maybe the medical and public health establishment could benefit in their strategy to address vaccine hesitancy by acknowledging that Black people have not had a single collectively posi-tive experience with the health care system in more than 400 years.

A consideration for you, Mr. President, is that rather than funding and supporting initiatives that always approach this problem from a point of doing community education on how safe the vaccines are and parading respected Black people in front of the media getting their vaccination, why don’t we provide human and financial resources to medical education?

Why can’t we look at medical education curriculum so that we are producing a workforce of medical professionals who are aware of the historical origins of structural racism in medicine in this country?

Do we really understand not having paid time off to receive the vaccine? Most vaccine sites are only open during business hours in the work week. What health care infrastructure is in place for those in marginalized communities — hit disproportionately harder — while they recover from COVID-19 hospitalizations?

The current inequitable internet access across the country to register online for vaccines demonstrates the systemic disadvantage that many Black people and others in marginalized communities are facing to get a vaccine. This same pattern is reflected racially with the unsuccessful attempts at transitioning to online learning for the children and youths in the public schools in these same communities throughout the pandemic.

Currently, with the overwhelming demand for potentially life-saving vaccines, and in light of known, well-documented research that shows disproportionate gaps in internet access, the public health officials are encouraging Americans to register online to receive the vaccines. But how are we going to ensure equitable access for all?

Then, there’s the issue of face masks. According to Nielsen, a retail tracker, medical masks have seen a 319 percent surge innationalsalesduringthelast month compared to the same time last year. How can communities with already existing high rates of poverty afford to maintain an adequate supply of face masks to protect themselves and their families?

No one thought about the cost associated with wearing face masks for those folks in urban and rural areas with high poverty rates, including mine, Philadelphia, the poorest major city in America. We give out condoms, but don’t think about making face masks available to people.

There’s also the hidden issue in the affordability of face masks for the black market that has developed with inferior products that offer little to no protection. Entire communities across the nation, trying to do the right thing, are made vulnerable to becoming infected, all because they are poor and, in most cases, Black. Merchants are profiteering on fear, and higher prices mean only the more affluent can afford face masks, hand sanitizer, cleaning supplies and other essential items necessary to stay safe during this pandemic. Again, we give away condoms for free. Why can’t we make face masks as readily available?

I also worry about the pervasive chronic conditions. What precautions are in place to protect people with chronic conditions as we watch the primary care network in this country? What is the “national strategy” for chronic disease management, while we fight the pandemic?

Is any agency or department responsible for making sure that there’s information or guidance for people to know whether to take their insulin prior to or after a vaccination? Should they eat first? How should they alter, if at all, their medication schedule?

I should also point out that there are almost 2 million Americans who are completely or mostly homebound, while an- other 5 million have limitations in daily functioning that make it hard for them to leave their homes. What about them?

Finally, Mr. President, there’s the escalating suicide rate among our children and young people.

In Black communities, the resulting social isolation and the “vicarious trauma” of police violence bombarding their minds daily leaves us with an estimated 15 million children and adolescents in need of therapy from mental health professionals, according to the American Psychiatric Association.

However, there are just 8,000 to 9,000 psychiatrists treating children and teenagers in the United States. There was more than a 20 percent increase in the demand for mental health services in 2020 alone. This figure is probably much higher because many people are under-reporting and avoiding hospitals because of COVID-19.

In December, the Congressional Black Caucus issued a report showing suicide attempts by Black adolescents rose 73 percent between 1991 and 2017. White youths still die by suicide at higher rates than Black youths, and Black children under 13 are still twice as likely to die by suicide than their white counterparts.

We can do better on all of this, President Biden. We must do better. We’re rooting for you and your leadership.

The writer is a visiting scholar at the National Bioethics Center at Tuskegee University and a Harvard Medical School Fellow in Research Bioethics and Writing.