David Graham is a nurse practitioner who spends his days and nights treating coronavirus patients. He's a 41-year-old black man who learned in high school how doctors failed to treat hundreds of black men in a federal study for their syphilis, so he isn't inclined to trust the government to get a vaccine for the pandemic right.

African Americans, who are being infected and killed by COVID-19 at a much higher rate than whites, are 40% less likely to get flu shots,a study out last year showed, and some fear they will be reluctant to get the coronavirus vaccine when one is released. A historical distrust of the health care system, which has far fewer physicians of color and a record of discrimination and mistreatment, gets much of the blame, experts said.

"For African Americans of a certain age group, Tuskegee always looms in our minds," Graham said.

In 1997, President Bill Clinton issued a formal apology for the U.S. Public Health Service study that started in 1932. Men who were mostly poor and illiterate sharecroppers were enrolled in a study of syphilis, and hundreds were not given penicillin when it was found to be a cure. Dozens of men died, and countless others were infected.

Black Americans are dying of COVID-19, the disease caused by the coronavirus, at much higher rates compared with other Americans in some major cities. Of the 512 coronavirus-related deaths In Louisiana for example, about 360, or 70%, were African American even though blacks comprise less than a third of the state's population.

Most federal officials and states are not keeping track or releasing racial data on COVID-19 victims. The reasons cited for the higher death toll include higher rates of chronic illness, especially heart disease and diabetes, and higher rate of exposure to infected people in jobs that require face-to-face contact.

Racial disparities persist: Black people dying from coronavirus at much higher rates in cities across the USA

Fighting fear with vaccine facts

The resistance to vaccines is unwarranted, said Dr. Garth Graham, vice president of community health and impact at CVS Health. Citing Centers for Disease Control and Prevention data, he noted the flu vaccine prevents millions of illnesses and flu-related doctors visits and complications each year.

Another major study, he said, showed the flu vaccine can significantly reduce a child’s risk of dying from flu. Children with underlying high-risk medical conditions saw their risk reduced by half, and the risk of death dropped by nearly two-thirds for healthy children.

Given such strong arguments for vaccination, Graham said, racial disparities in flu vaccines can be lessened if not eliminated.

"The history of Tuskegee notwithstanding, you should not assume resistance to vaccines because it could be a lack of appropriate outreach," Graham said. "Are we designing and pushing the campaign enough so we're reaching all communities?"

When he was an investigator and chief of health services research at the University of Florida, Graham said, he didn't find much resistance to vaccines when he explained "the risks and benefits."

Disparities are often due to “inappropriate and ineffective outreach,” said Graham, a former deputy assistant secretary at the Department of Health and Human Services,

Nurse practitioner David Graham, who is unrelated to Garth Graham, still worries.

He said flu vaccines have taken "decades of trial and error," and many people still get the flu. The speed and financial interests involved in the race for a coronavirus vaccine concern him. He hopes it isn't "made mandatory when kids get back to school."

Building trust

Epidemiologist Suma Vupputuri, a research scientist for Kaiser Permanente's Mid-Atlantic region, studied what factors lead to the disparity between African Americans and whites getting flu shots.

Her study last year in the medical journal Plos One found African Americans in the health system were 40% less likely to receive a flu shot than white members, despite having access to health care and no out-of-pocket costs.

That's for a health systemwith more doctors of color than many others and a study population of higher socioeconomic levels indicating “there may not be as much of a problem with distrust.”

Vupputuri said she expects the same disparity would not exist with coronavirus vaccinations because of media attention and the seriousness of the pandemic.

"I suspect that if the vaccination is offered equitably, the disparity would not be as great,” she said.

More African Americans are likely to get the coronavirus vaccine if adverse effects are reduced, said Dr. Georges Benjamin, executive director of the American Public Health Association and a former Maryland and D.C. health commissioner.That will be aided if African Americans participate in the research for drugs and vaccines, he said.

Less than 5% of National Institutes of Health funded respiratory research included racial or ethnic minorities, according to a study in 2015 in the American Journal of Respiratory Critical Care Medicine. Similar disparities exist for cancer, heart disease and diabetes research, even though these diseases affect people of color at far higher rates.

Vaccines are "overall safe and effective," Benjamin said. Even though a vaccine for coronavirus will be new, he hopes research protocols for clinical trials will have enough women, Hispanics and African Americans, "so there are no untoward effects in those populations."

"We always have to be on the watch for research misconduct, but there's much less chance today of the significant abuses that occurred with Tuskegee," Benjamin said.

The United States has higher standards for vaccine approval and oversight, he said.

“What is most important is for people of all races to have equal access to vaccines since we're not going to go back to normality until we have an effective vaccine," Benjamin said.

Follow O'Donnell on Facebook and Twitter at @JayneODonnell or email at jodonnell@usatoday.com

Black medical leaders:Coronavirus magnifies racial inequities, with deadly consequences