Medical Examiner

Why Flint Residents Turn Down Help

After the water crisis, it’s no wonder that vaccine hesitancy is high.

Four bottles of cloudy, dirty water
Photo illustration by Slate. Photo by Nastco/Getty Images Plus.

The city of Flint, Michigan, is still hurting.

Several residents claim they’re still receiving poisoned drinking water in their homes, and that the local and national media that once covered their plight has now abandoned them. New revelations about what the state knew about the water troubles keep coming; a recent multimillion-dollar settlement granted to 85,000 Michigan residents has been denounced by its recipients as insufficient for compensating victims and repairing the damages. Residents see recent attempts at long-term fixes to the structural problems responsible for the crisis as too little, too late. And pollution issues similar to what Flint faced have not only popped up in other cities within Michigan, but outward to the broader Midwest as well.

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This was all happening before the coronavirus came to town; once it arrived, things got worse. Work to replace lead-corroded water service lines was paused. Flint residents already experiencing PTSD from the water crisis suffered further from lockdown isolation. COVID deaths rapidly escalated in the majority-Black city; Genesee County, where Flint is located, has one of the highest total disease case and death counts in the entire state.

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Now, Genesee County is facing another challenge: It has lagged far behind many other Michigan regions when it comes to vaccinating its population, with a “fully vaccinated” rate of only 47 percent as of last week. This might sound counterintuitive—after all, vaccinations are the very thing that would best help ease the burden of COVID. Yet Genesee’s citizens are not taking them.

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This is not misfortune befalling a city twice. There is a reason Genesee is having trouble with vaccines. The two crises—the water crisis and the COVID crisis—are intertwined, each making the other worse. Moreover, as Americans continue to lose trust in experts and the government as a result of the pandemic, the spiraling tragedies in Genesee are a warning for the rest of us.

Longtime residents of Flint knew the water in the local river was polluted and corrosive. Flint rapper Jon Connor once said: “I remember all of us joking at 10 and 11 years old. All of us knew, You don’t drink from the Flint River! You don’t get water from the Flint River!” But in early 2014, the city nonetheless switched its source of drinking water from a treated Detroit utility to a cheaper plant that sourced from the polluted Flint River. The decision was made by a state-appointed “emergency manager” looking to reduce Flint’s expenses. The problems began almost immediately after: outbreaks of E. coli and Legionnaires’ disease, body rashes, foul-smelling and -looking and -tasting tap water.

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Experts downplayed or dismissed Flint residents’ concerns about the water even as it sickened them, as is perhaps best detailed in a book by local journalists, Poison on Tap. Leaders and core operators from state and federal health and environment departments conducted inaccurate tests, suppressed their colleagues’ findings of water issues, and shrugged off reports of high lead levels. It was an experience of going through something obviously wrong, and then “having all levels of government tell us it’s OK.” says E. Yvonne Lewis, a lifelong Flint resident and director of outreach for the nonprofit Genesee Health Plan. After the story was made public, multiple decision-makers resigned, and some were charged with involuntary manslaughter.

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The damage to the Genesee citizens’ trust in authority was understandably thorough. Environmental engineer Siddhartha Roy, one of the researchers who helped expose Flint’s crisis in 2015, told Stat News this November that to this day, many Flint residents “have said they would never touch tap water again.” As documented in Poison on Tap, when the National Guard was dispatched to hand out bottled water to Flint citizens, many turned them down.

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The coronavirus hit Flint especially hard early on: By June 2020, Genesee County had more recorded COVID deaths than 16 states. When the vaccine rolled out, white Michiganders were twice as likely to receive the vaccine as Black Michiganders were (a disparity that far surpassed the nation’s at the time). Lack of vaccination, along with a freak coronavirus surge in the spring, plunged Flint and Genesee County into new public health nightmares: In April of 2021, the county was recording the third-highest number of new cases in the entire country.

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We well know by now the archetypes of the COVID-era anti-vaxxers: pandemic deniers, Trump supporters, microchip truthers. Yet none of these applied to the vast majority of Flint residents, overwhelmingly Democratic voters who practiced social distancing. There was the fatal scuffle over a mask dispute in a city Family Dollar. But for the most part Flint residents have favored mask mandates in various indoor settings.

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Flint’s vaccine reluctance was perhaps born of the chronic health care issues that have plagued many other Black Americans: They have historically been neglected or misled by their health care providers, as Julia Craven wrote in Slate back in January. In the Atlantic, a Black doctor wrote of her vaccine-refusing mom that “she doesn’t trust the medical system. And if you don’t trust a system, you don’t trust what the system is trying to do.” Many of these Americans know and understand the severity of COVID; they’ve seen it rip through their communities. Nonetheless, they are skeptical. As the polling group the COVID States Project told the New York Times, research showed that “unvaccinated people who nonetheless wore masks were, indeed, more likely to be Black women.”

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But in the case of Flint, there was also a very recent and straightforward reason for the mistrust: Residents had gone to their health officials with reports of bad water and illnesses, and had been turned away. Debra Furr-Holden, an epidemiology professor at Michigan State University, told me that her institution’s annual surveys of Flint residents’ opinion of their government have “data that clearly demonstrates that during and following the Flint water crisis, mistrust continued to grow.” A rap hit from the metropolis summed up the prevailing feeling in 2020: “Fuck a pandemic, Flint water been fucked up/ Ain’t nobody send nobody there to help us.”

The link between the water crisis and vaccine hesitancy has data to back it up. Cedric Taylor, a sociology professor at Central Michigan University, has examined it. “It was a no-brainer that the most significant public health crisis in the state had to be considered when investigating vaccine hesitancy in Flint and Genesee County,” he wrote me in an email. “We felt it was important to assess how endemic distrust could extend to the very institutions and organizations that play a critical role in controlling the COVID-19 pandemic.”

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Along with CMU student Margaret Kessler and University of Idaho sociology professor Dilshani Sarathchandra, Taylor talked to more than 1,000 residents of Flint, Genesee County, and Detroit from mid-March through mid-April. At the time, only 21 percent of residents in all of Genesee County had received at least one dose, while more than half of American adults had already gotten one. The three researchers asked the respondents about the Flint water crisis and whether it caused them to distrust public health messaging on the vaccine. The results: 33 percent of Detroit and Flint respondents claimed they would never get the vaccine, 60 percent of the sample group said they didn’t think the vaccine was safe, and nearly 50 percent believed they could get infected from the vaccine itself.

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“Our research found that many of the unvaccinated in Flint found it hard to ‘trust what public health officials say about the vaccine because of what happened with Flint water’ and had the opinion that ‘public health officials lied during the Flint Water Crisis and are likely to lie again about the vaccine,’ ” Taylor told me. This wasn’t just in Flint: “The water crisis was of significant concern … for people beyond Genesee County and throughout Southeast Michigan,” as he wrote to me. And the fear and reluctance were higher among Black residents—who were disproportionately affected by the water poisoning—than among white Michiganders.

There is warranted frustration with the vaccine-hesitant, considering that such reluctance has prolonged a deadly pandemic. But at the same time, can you blame the people of Flint? “We were asking people to trust the same institutions that they know failed them miserably during the Flint water crisis,” says Furr-Holden. “So it stands to reason that there is this perpetual fallout and lingering mistrust that was … I won’t even say birthed during the Flint water crisis. I think it actually just grew.” Flint’s was a crisis that affected a whole city, gained national attention through dogged reporting, and had a clear villain. Many eagerly vaccinated Americans are simply unaware of the smaller but incredibly damaging breaches of trust that happen to other Americans routinely.

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It’s also worth noting that this isn’t even a cut-and-dried story of immutable mistrust: When the vaccines first rolled out, Flint’s demand for them outpaced the supply and ease of availability; however, once there were enough vaccines in enough locations to satisfy this demand, it fell sharply. “There were a lot of people who wanted it, couldn’t get it, and then they said, ‘Why bother?’ ” Furr-Holden says. The hiccups of both the local and national vaccine rollout only made the situation worse.

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There have been achievements in vaccinating Flint’s population since Cedric Taylor’s study. E. Yvonne Lewis and Furr-Holden, in their respective positions, have worked to improve and target messaging to persuade residents to receive the vaccine. Lewis’ organization has aided underresourced city communities by helping provide meals and water in public spaces along with vaccines—not just for COVID, but also for the flu. The University of Michigan–Flint has mandated vaccines for its students and faculty (with limited exemptions) and is enforcing this policy. Currently, a significant portion of the unvaccinated consists of children, for whom the vaccine has only recently been federally approved. And in response to a recent case surge, the city has converted some small police stations into accessible pop-up vaccination clinics.

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Still, it’s hard to avoid the conclusion that a local public health failure that began seven years ago has directly worsened a new public health crisis, one of a completely different nature. And as one Flint doctor warned, COVID rates in the city will stay high unless vaccination rates drastically improve.

“Everybody’s got Tuskegee as a frame of reference” when it comes to distrust in medicine, says Connor Coyne, a novelist and longtime Flint resident. “But we’ve also now got the water crisis as a frame of reference.” Tragedies compound on tragedies: As Black Americans die in high proportions compared with white Americans during the COVID-19 pandemic, the coronavirus crisis may well become its own tragic frame of reference too.

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