There Can Be No Innovation Without Diversity
For society to advance, we need solutions and upgrades that work for everyone without leaving anyone behind.
The various vaccines against the virus that causes COVID-19 could prove to be among the most important medical innovations of this generation, for reasons that extend far beyond the scientific and technological advances underpinning their creation. As they were being developed, the United States was experiencing a new wave of racial reckoning. The confluence of George Floyd’s murder and the recognition that people of color were being disproportionately affected by the pandemic prompted widespread soul-searching to uncover past mistakes and chart a course to do better by these communities in the future.
As a direct result, biomedical companies placed greater emphasis on diversity and representation among participants in the clinical trials for the vaccines than has been seen at practically any other time in US history. Increased attention was also given to ensuring that lower-resourced communities and people of color had access to the vaccines, which remain the best tools available to protect individuals from the novel coronavirus and to empower society to move past this crisis.
To be sure, society floundered on both accounts. The participation of African American people in many COVID-19 vaccine trials still fell short of the almost 13% of Black Americans in the general population, even as many experts advocated for having people of color represent an even higher proportion of participants due to the outsized toll the pandemic had taken on these communities. In addition, many Black men and women, particularly those who lived in predominately African American communities, did not have equal access to vaccination—especially as the vaccines were first being distributed. Philadelphia, for example, reported in April 2021 that its Black and Latinx residents were receiving the vaccine at around half the rate of its white population.
Despite these shortcomings, society has made progress on these fronts. Prior to the pandemic, most clinical trials only included around 5% Black participation on average. Diversity in COVID-19 vaccine trials was dramatically better: 9.8% of the Pfizer trial participants were Black and 9.7% of the Moderna participants were Black. And after initial setbacks, vaccine access improved dramatically for communities of color.
In thinking about the legacy of the COVID-19 vaccine, it is imperative to consider its social impact as much as its scientific ingenuity. Technological advancements will always be governed—either enhanced or restrained—by the context in which they are deployed. Inventing new and improved methods for creating vaccines won’t stop a global pandemic if people can’t or won’t get vaccinated. Improving telehealth capabilities means little if patients do not have reliable internet connections or devices to support remote appointments. And generating new life-saving medications will only ever amount to theoretical benefits if people can’t afford them and insurance won’t cover them.
True innovation requires simultaneous improvements to social infrastructure and societal values. Real innovation cannot be accomplished without an emphasis on equity and justice. Actual innovation requires a diversity of voices and perspectives at all operational levels, including the scientists in the laboratories who develop these new approaches, the physicians who leverage these technological advancements, and, most importantly, the people who benefit from them. Otherwise, studies show, the course of progress is often hampered by groupthink and pursuing only the “safest” avenues of research.
Thus, unfortunately, true innovation is almost impossible in large swaths of American society as it exists today. There is too little diversity and representation in professional ranks and too much segregation in the general population. So often Black and white communities live in separate and unequal worlds, even if they happen to live in close proximity. In Washington, DC, for instance, the life expectancy for Black men living in Ward 7 and Ward 8 is more than 20 years less than for white women living in Ward 3, only a few miles away.
One Pathway to Greater Innovation
Fortunately, as greater emphasis is placed on diversity, science is becoming more diverse. But there is much distance to cover and many milestones to reach before medical advancements can benefit all people equally and amount to real medical innovation.
Although the health care inequities experienced by African American patients are complex and multifactorial, the relative scarcity of Black physicians helps to explain a significant source of the difference. Black Americans represent 13% of the national population, yet only 5% of doctors are Black—a pernicious disparity that has hardly changed in US medicine for over a century.
Unconscious bias is rampant in the medical establishment. Black patients often struggle to receive pain medication because white health care providers discount or dismiss their discomfort. They are frequently blamed for their problems in ways that white patients are not. A missed appointment is perceived to be a sign that they do not take their health care seriously, even if the reality is that they were unable to take off work to make the appointment or did not have adequate transportation to make it on time.
Research shows that Black physicians provide better care for Black patients, focus on researching and solving problems that primarily affect African American communities, and display greater cultural sensitivity in dealing with a diversity of patients. Introducing more Black doctors into the medical ranks would not only enhance the care patients receive but would also help reduce some of the prejudice that has permeated the profession.
The first step to diversifying an industry is to diversify the pipelines that feed into it. Ensuring Black students are better represented at the highest levels of higher education will ensure that Black men and women stand a greater chance of entering into careers in the in-demand fields of science, technology, engineering, and mathematics (STEM). But for many aspiring Black doctors and scientists, medical or graduate school is often unattainable because they cannot afford the long-term salary deferment or the exorbitant cost of a postgraduate education.
Although Black communities and institutions have talked about the importance of diversity in the medical profession for years, the urgency of cultivating Black physicians started receiving more widespread recognition only recently. In September 2020, Bloomberg Philanthropies donated $100 million to the four historically Black medical schools. The gift was intended to help increase the number of Black doctors by reducing the debt burden experienced by Black medical students.
Training more Black doctors is a straightforward process. More Black Americans want to become doctors than end up completing—or even beginning—their schooling. So those Black individuals who have the talent and the drive to become doctors need to be connected with the resources required to bring their aspirations to fruition. With more support from institutions such as Bloomberg that can reduce the debt burden and provide resources as Black students make their way through medical school, this essential profession can become even more diverse.
Greater diversity is needed throughout the medical research enterprise. Society needs more Black scientists, more Black researchers, more Black research administrators. According to a 2019 report, 40% of Black students who start STEM studies switch out at some point in their educational careers. It is imperative that Black students are encouraged and motivated to stick with STEM.
For Black men and women to reach the pinnacle of a STEM professional career, they must be engaged from a young age. At Howard University, we created a middle school right on our campus focused on math and science. From an early age, we are familiarizing students of color with the STEM discipline and encouraging them to continue their STEM education and pursue STEM careers.
Howard accounts for more Black PhD students than any other university in the country. We developed the Karsh STEM Scholars program to cultivate the next generation of Black STEM pioneers. We accept high-performing students into the program their freshman year and support them as they pursue STEM PhDs or MD/PhDs. Members of our first graduating class completed their undergraduate degrees in spring 2021 and are matriculating to some of the most competitive PhD programs in the country.
As the battle with the coronavirus pandemic and the COVID-19 variants continues, the biggest front of the war is taking place between members of society rather than between society and the virus. Vaccine hesitancy has replaced vaccine accessibility as the biggest foe society is facing in inoculating the public against the ravaging forces of the virus.
We spent time, money, and resources developing the vaccine—but not enough time, money, and resources ensuring that people would get it. Technological advancements are doomed to fail if there is not a diversity of people and perspectives at the table where the ideas are generated and the plans are conceived. For our entire society to advance, we need solutions and upgrades that work for everyone without leaving anyone behind. To truly find innovation, we must first realize diversity.
Diversifying the medical establishment, diversifying government, diversifying science and technology will all lead to better outcomes—not just for people of color, but for society as a whole.