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Omar Neal had every reason to be skeptical.

Here in Tuskegee, Alabama, where roadways are dotted with signs that read “Vaccinate Me. Stop the Spread”, the history of racist medical abuse weighs heavily.

For four decades, between 1932 and 1972, the US government sponsored a biomedical study coercing 600 Black men, all sharecroppers, into a study on the effects of untreated syphilis. The male subjects were not told they were part of the research, and instead were made to believe they were being examined for “bad blood”. Many died. Others spread the disease to family members, partners and their newborn children. None were offered proper treatment.

Neal’s uncle, Freddie Lee Tyson, was one of those men. He grew up in the house next door to his nephew and would occasionally share how it felt when the study was exposed in the early 70s.

“There was shame. And there was disbelief. Disbelief that the government would do that,” Neal recalled. “How could you? How dare you use my humanity for such an egregious activity.”

Welcome sign on highway approaching Tuskegee, Alabama.Photograph: Andi Rice/The Guardian

In 1997, President Bill Clinton apologized for the Tuskegee study, which he described as “clearly racist”. Two decades on, the legacy of what happened here has been routinely cited as a reason many Black Americans remain distrustful of the country’s medical systems and also the Covid-19 vaccine itself.

It is then, perhaps, against expectation that vaccination rates in Macon county, where this city of 8,000 residents is situated, are substantially higher than the state average in Alabama. In Macon county, 36% of residents have now received their first shot compared with only 32% statewide. In this historic region of Black Belt counties, home to large populations of Black residents, some jurisdictions have completed vaccinations at rates of over 40%.

But Alabama and the neighbouring state of Mississippi have for months had the lowest vaccination rates in the country, with vaccine hesitancy underwritten by different forces in various locations across the state. In some areas, political leaders have retreated from public engagement on the issue, while in others, including Tuskegee, local leadership has played a vital role in pushing rates above the state average.

Neal, a radio host and community leader, took his shot almost as soon as it was available. He weighed the heavy history but set aside what he described as instinctive distrust of public health systems after generations of failures.

“Trust is a calculated risk,” he said, pausing for a moment. “Five hundred and eighty-eight thousand people have died because they didn’t get this vaccine. Nobody died that did take it. That’s pretty good odds for me.”

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