Abstract
Widespread exclusion of ethnic and racial minorities in medical research has contributed to healthcare disparities among these populations. In the United States, this oversight is particularly evident among the African American community. Centuries of systemic racism have left this population with limited access to proper healthcare. In particular, African Americans are disproportionately affected by breast cancer and Alzheimer’s disease in the United States. Yet, this demographic is often left out of clinical studies for these conditions and thereby continues to be at increased risk. These disparities in minority inclusion are evident globally as well. Although genome sequencing is critical to future medical advancements, genomic studies are often biased toward Caucasian populations. This leaves healthcare professionals globally with less knowledge of gene-disease relationships in other ethnic groups. Moreover, the majority of COVID-19 vaccine trials have taken place in regions with predominantly Caucasian populations, and vaccine distribution has been heavily skewed towards high-income countries. This has left those populations that are most affected by COVID-19 with less understanding of, and access to, the vaccine. Ending ignorance of these disparities is crucial to improving minorities’ access to quality healthcare.

Historical Context of Access to Medical Care Among African Americans
African Americans have historically lacked access to proper medical care in the United States. Although the system has improved over the past century, significant disparities still exist that impact the quality of care that these racial minorities receive. “African Americans are more likely to require health care services, but are least likely to receive appropriate care” (Kennedy et al. 58). One reason for this disparity stems from the United States’ history of oppression and mistreatment of African Americans. During the period of legalized enslavement in American history, African Americans predominantly relied on home remedies to treat ailments since they were generally not given access to doctors (Kennedy et al. 57). After the ban of slavery, African Americans tried to integrate into society and racial violence became normalized and widespread. This was especially true within the United States healthcare system. 

From 1932 to 1972, the United States Public Health Service (PHS) and the Centers for Disease Control and Prevention (CDC) conducted the infamous Tuskegee Syphilis Study. Researchers enrolled 600 African American sharecroppers from Macon County, Alabama into this initiative. Unbeknownst to these participants, the study was intended to observe the effects of untreated syphilis on the human body. Yet the test subjects were told that they were receiving free health care from the federal government, when they were not (Reverby 47). “The study initially involved 600 Black men – 399 with syphilis [and] 201 who did not have the disease...By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, but the participants in the study were not offered treatment” (Centers for Disease Control and Prevention). Furthermore, researchers disguised placebos and ineffective medical procedures as treatment (Gray 76) and PHS physicians did not educate subjects with life-saving information about the disease (i.e., that it was contagious, transmitted through sexual intercourse, and could be transferred from mother to fetus) (Thomas and Quinn 1501). In addition, researchers undertook proactive, extreme measures to ensure that test subjects would not receive effective treatment. “During World War II, approximately 50 of the syphilitic cases received letters from the local draft board ordering them to take treatment. At the request of the PHS, the draft board agreed to exclude the men in the study from its list of draftees needing treatment” (Thomas and Quinn 1501).

The study was initially intended to last for six to nine months. However, the drive to satisfy scientific curiosity resulted in a 40-year experiment that followed many of these men to their death (Thomas and Quinn 1500). Over the course of the study’s duration, 28 patients died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients' wives were infected with syphilis, and 19 children were born with congenital syphilis (Kim and Magner). The Tuskegee study remains the “...longest nontherapeutic experiment on human beings in medical history” (Thomas and Quinn 1501). 

The horrendous conduct of Tuskegee Syphilis Study researchers and the study’s deadly consequences have negatively impacted how many African Americans perceive the United States medical establishment. The study “...is one major reason why so many African Americans' distrust the health care system”  (Kennedy et al. 56). Dallas Urban League health educator Alpha Thomas reflected this sentiment during a testimony delivered before the National Commission on AIDS. Thomas said, "So many African American people that I work with do not trust hospitals or any of the other community health care service providers because of that Tuskegee Experiment” (Gilbert et al. 312). Thomas’ insight can be observed on a much wider scale as well. “The continuing legacy of the Tuskegee Syphilis Study has contributed to Blacks' belief that genocide is possible and that public health authorities cannot be trusted” (Thomas and Quinn 1499).  

Recommendations Regarding African American Mistreatment Within the United States Healthcare System
In light of such pervasive mistrust among African Americans toward the United States healthcare system, various recommendations for improvement can be undertaken. First, public health authorities “...must be willing to listen respectfully to community fears, share the facts of the Tuskegee study when it arises as a justification of those fears, and admit to the limitations of science when they do not have all the answers. This approach may help to regain the credibility and the public trust…” (Thomas and Quinn 1503). In addition to transparency, future studies that involve African American communities must abide by stringent medical and ethical standards. To this end, the Office for Human Research Protections (OHRP) was established in the aftermath of the Tuskegee Syphilis Study to ensure that such an abuse of power does not occur again. “OHRP provides clarification and guidance, develops educational programs and materials, maintains regulatory oversight, and provides advice on ethical and regulatory issues in biomedical and behavioral research” (United States Department of Health and Human Services). In tandem with OHRP, researchers can notify potential test subjects about their strict adherence to regulations that protect research participants. 

Racial and Ethnic Disparities in Genome Sequencing 
With the historical backdrop of limited healthcare access among African Americans established, the next segment of this paper explores a contemporary expression of this disparity in the field of genome sequencing. Progress in the field of human genomics has advanced rapidly over the past 30 years as new technologies have developed. Knowledge of genomics is critical to improving preventative treatments, medicine, and healthcare professionals’ overall understanding of genetic differences and their impact on human health. However, genomic studies are “...heavily skewed toward people of European descent,” leaving healthcare professionals globally with less knowledge of gene-disease relationships in other ethnic groups (Korlach).
 

The National Human Genome Research Institute (NHGRI)-European Bioinformatics Institute (EBI) genome-wide association studies (GWAS) Catalog “...is the most complete record of published genome-wide association studies” yet evaluations of its data collection show a clear White majority among the study subjects (Bentley, et al.). Within the United States’ GWAS publications, 79 percent of the initial study populations and 75 percent of the replication sample populations were all White (Haga), and overall, “92 percent of US GWAS participants were White, followed by African-Americans (3%)” (Haga). This issue is not limited to general genomic sequencing projects. In fact, it also extends into genomic studies that focus on specific fields and diseases in medicine. The Cancer Genome Atlas repository, for example, includes studies aimed to increase understanding of the interplay between cancer and genes, but a “2016 study of data in the Cancer Genome Atlas repository found that of 5,729 tumor samples, 77 percent were from whites, 12 percent from blacks, and 3 percent from Asians,” once again demonstrating a lack of representation for non-white populations (Landry, et al.)

Overall, a 2009 study by Anna Need and David Goldstein reported that “96 percent of all genomewide association studies were of people of European descent,” yet “fewer than 16 percent of the world’s population is of European descent,” exhibiting a substantial disparity between representation of people of European descent and those of other ethnicities (Landry, et al.). More recently, in 2016, “Alice Popejoy and Stephanie Fullerton reported that 81 percent of genomewide association studies were of people of European descent,” demonstrating a decrease since 2009 (Landry, et al.). However, “[o]f the 19 percent of the studies that focused on non-Europeans, 14 percent focused on populations of Asian descent, indicating clear improvements for those populations, but very little progress for other non-European groups” (Landry, et al.). Genetic research in African American and other non-European populations is still severely lacking. In turn, this disparity can stall healthcare advancements on their behalf.

The central impact of the lack of diversity in genomic databases is the “...inequity in the usefulness of the information they contain, which informs everything from genetic test results to clinical trial outcomes” (Korlach). Study samples composed of mostly European participants will reveal gene-disease relationships for diseases impacting European populations, while diseases that are more prevalent in non-European populations will have less data. This further “...limits the generalizability of findings from genomic research, and it limits the evidence base for translating these findings into clinical care in diverse populations” (Landry, et al.). Consequently, less genetic testing is available for non-European populations. A review was conducted on the genetic testing offered for 22 diseases by two major companies, 23andMe and deCODEme. The review revealed that “...testing for 16 and 11 of the 22 diseases reviewed are applicable only for individuals of European ancestry, respectively,” (Haga). Further, “...for African Americans, testing is only offered for 1 of 15 variants for Type 2 diabetes and 2 of 13 variants for prostate cancer,” illustrating how the underrepresentation of non-Europeans in genome studies limits their access to preventative care (Haga).

The lack of inclusion of participants with African ancestry in particular is detrimental not only to those of African descent, but to humanity as a whole “...as Africa is the birthplace of modern humans and harbors the greatest genetic diversity” (Bentley, et al.). In the NHGRI-EBI GWAS Catalog, for example, although only 2.4 percent of the cataloged individuals were of African descent, they contributed 7 percent of the associations in the catalog (Bentley, et al.). Hence, greater inclusion of individuals with African ancestry in genomic research will likely “...bring novel insights into human biology, and lead to improvements in clinical care and improved understanding of health disparities” (Bentley, et al.).

One barrier to the inclusion of non-European populations in genomic studies is “...the distribution of biomedical funding” (Need and Goldstein 489). When genome sequencing projects launched, funding “...was often highest among predominantly white countries...” which led to predominantly Caucasian study samples. These existing samples were commonly used in subsequent studies, with “76% (51 of 67) of US GWA studies [using] existing cohorts as their initial sample population” (Haga). Of these 51 cohorts, 47 included a single population, “....limiting the generalization of the study findings” (Haga). A second significant barrier is African Americans’ distrust of clinical studies, especially in the field of genetics where additional concerns include “...the collection, storage, and use of DNA samples” (Haga). Although the United States federal government began encouraging participation of ethnic minorities in medical studies after the establishment of early genomic studies, European populations still account for most of the data in genome databases, showing that more steps must be taken to spur change.

Recommendations for Fostering Greater Inclusivity in Genome Sequencing 
An initial pathway toward increased inclusion in the field of genomics entails implementing “...targeted efforts to recruit representative patient populations into studies involving genomic sequencing” (Kim and Sarkar). The Clinical Sequencing Exploratory Research (CSER) program launched a project for Clinical Sites with Enhanced Diversity that “...aims to recruit a minimum of 60 percent of patients who come from racial or ethnic minority populations, underserved populations, or populations who experience poorer medical outcomes” (Genome.gov). Similarly, the National Institutes of Health started the All of Us Precision Medicine Initiative with the goal of sequencing “...a diverse sampling of Americans across gender, sexual orientation, ethnicity and race” (Korlach). The initiative estimates recruitment of “...up to 75% from groups who are underrepresented in health research” of its 1 million recruits (Bentley et al.). Along with diverse recruitment, genomic research technologies must become more universally accessible as this would allow for studies to take place in regions with non-Caucasian majorities and increase the likelihood of diverse research samples (Bentley, et al.). Taking these direct steps to combat underrepresentation in research will both improve minority healthcare and lead to crucial new discoveries about the human genome.

Alzheimer’s Disease Disparities Among African Americans
One manifestation of limited healthcare access Among African Americans is evident through the incidence of Alzheimer’s disease among this population. Alzheimer’s disease is a medical condition that adversely affects memory and thinking. It is important to note that this condition is not a part of the normal aging process and is the most common type of dementia in older people (University of Pittsburgh). Although nearly six million Americans are suffering from Alzheimer’s disease, African Americans “...may be at increased risk of the disease and...differ from the non-Hispanic white population in risk factors and disease manifestation” (Barnes and Bennett). 

The exact reasons for this disease’s prevalence among African Americans is currently unknown. This lack of information may be partly due to the fact that “[k]nowledge about diagnosis, mechanisms, management, and treatment of the disease is based almost exclusively on studies of non-Hispanic whites'' (Barnes and Bennett). This can result in a disproportionate amount of research regarding the specific mechanisms that contribute to this disease among African Americans. Another possible reason for this phenomenon may be linked to biased screening tools. “The discrepancy in the literature may stem from the fact that substantial racial disparities exist for cognitive test performance, with older African Americans tending to perform more poorly, on average, than older non-Hispanic whites” (Barnes and Bennett). Often, these tests may yield an inaccurate Alzheimer’s Diagnosis because they do not account for differences in access to quality education among minority communities versus that of non-Hispanic whites. Lastly, there is a widespread unwillingness within the African American community to participate in Alzheimer’s Disease Biomarker Research -- especially in the aftermath of the Tuskegee Syphilis Study. “These factors include mistrust, insufficient information dissemination in the African American community, inconvenience, and reputation of the researcher and research institution” (Williams et al.).

African American communities nationwide are also plagued by disparities in diagnosis and treatment of Alzheimer’s Disease. Delays among African American populations between symptom identification and physician consultation could be as long as seven years (Clark, et al.). There are a number of factors that account for this prolonged gap. One possibility stems from a lack of health-related education among African Americans to inform them about the specific, memory-related symptoms that constitute an accurate Alzheimer’s Disease diagnosis. Other contributing factors include an overall “...lack of adequate access to medical care, and issues of trust between minority groups and the medical establishment” (Chin et al.). As a result of these factors, African Americans often exhibit greater severity of symptoms at the time of presentation and may therefore not be able to receive timely treatment.

Recommendations For Limiting Alzheimer’s Disease Disparities Among African Americans
There are a number of recommendations that can begin to address this prevailing issue. One possibility is for medical establishments to actively engage with African American communities that are beset with high levels of mistrust. This can be achieved by employing African American health care team members who have strong, long-lasting bonds with the wider African American community. In turn, these individuals can offer “...culturally sensitive community education or ancillary services, such as health screenings or educational presentations...” (Barnes and Bennett). As part of these screenings and educational outreach initiatives, a concerted effort can be taken to encourage African Americans to participate in medical research that advances knowledge of this disease. This is because there is evidence that personalized biomarker-based diagnostic tools “...may be useful in further characterizing diverse populations with AD [Alzheimer’s Disease]” (Chin et al.). 

In addition, community-outreach educational efforts among African Americans must ensure that the people of this community understand the symptoms of Alzheimer’s Disease as distinct from the normal aging process. In addition, they should also be given tools “...to understand the illness, plan for patient safety, and make long-term plans” (Clark et al.). These efforts can result in a more timely diagnosis and expedient treatment plan implementation. Furthermore, “[c]ontrolling for literacy level or using savings scores in psychometric analyses can lower racial biases inherent in cognitive screening tools” (Chin et al.). This endeavor may yield more accurate Alzheimer’s Disease diagnoses for African American populations. When implemented, the aforementioned recommendations can lead to improved outcomes for this disenfranchised population. 

Breast Cancer Disparities Among African Americans
Breast cancer is the second most common and lethal cancer among women in the United States, affecting “...more than one in ten women worldwide” (Yedjou et al.). “Although white women have the highest incidence of breast cancer, African American women have the highest death rates from the disease” (Gorin et al.). This difference stems from the fact that African American women are more likely to face delay in breast cancer diagnosis, which impedes treatment and reduces survival rates.

Black women had a 6.2 percent risk of death from stage I breast cancer at 7 years versus non-Hispanic white women with a 3.0 percent risk (Iqbal et al.). For breast cancer with small-sized tumors, Black women were also more likely to die (9.0%) than non-Hispanic white women (4.6%), and “...the difference remained after adjustment for income and estrogen receptor status” (Iqbal et al.). Part of this disparity may be attributed to diagnostic time, as African American women, in reference to white women, are 61% more likely to experience diagnostic delay past one month and 40% more likely to experience delay past two months (Gorin et al.). Further, after adjustment for age, income, estrogen receptor status, and race/ethnicity, “[c]ompared with non-Hispanic white women diagnosed with stage I cancer (50.8%), black women (37.0%) were significantly less likely to be diagnosed” (Iqbal et al.). Diagnostic time is critical to a patient’s chance of survival as “...patients with a delay of 3 months or more had a 12% lower 5-year survival than those without delay” (Gorin et al.). It is necessary to address the causes of diagnostic delay among African American women in order to raise their chances of survival.

A central cause of diagnostic delay among African American women is poverty. Since a greater percentage of African Americans live in poverty than their Caucasian counterparts, African American women are more likely to lack access to primary healthcare providers. This results in “...lower rates of mammography screening and greater probability for late-stage diagnosis,” or living in areas where healthcare providers are not well-equipped to treat or inform patients (Yedjou et al.). Financial instability may also prevent African American women from seeking out preventative or follow-up care as they cannot take time off from work (Yedjou et al.). Poverty may also contribute to increased comorbidities, less education, and lack of proper nutrition, all of which may delay diagnosis, limit treatment options, and reduce survival rates (Yedjou, et al.).

Other major factors that contribute to delay in breast cancer diagnosis in African American women include culture and racial bias (Yedjou et al.). “Cultural factors such as spirituality, misconception on the susceptibility of breast cancer, cultural beliefs and views as well as medical mistrust are more prominent in Black women when deciding about breast cancer screening, diagnosis, and treatment options” (Yedjou, et al.). Black women are more likely to “...rely on divine intervention alone for treatment...” and be less concerned by signs or risk of breast cancer, which may account for some diagnostic delay (Yedjou et al.). Finally, Black women are less likely than White women to receive mammography referrals from their physicians. “41% of Black women versus 28% of White women stated that their doctor had never suggested mammography,” implying that some physicians may be racially biased, hence lessening the quality of care that Black women receive (Yedjou, et al.).

Recommendations For Limiting Breast Cancer Disparities Among African Americans
There are numerous steps that can be implemented to ameliorate the aforementioned disparities among African American breast cancer patients. One foundational component of this process entails proactive, widespread involvement of medical professionals from minority populations in breast cancer research studies. Their insights are crucial to ensure that breast cancer can be “...well-studied, fully addressed, and ultimately eliminated” (Yedjou et al.). This is partly because of findings uncovered by University of North Carolina Lineberger Breast Cancer Research Program Co-Director Dr. Charles Perou. Dr. Perou has discovered “...differences in biology in breast tumors of Black women compared to those in white women that may be targetable to decrease the disparities in breast cancer outcomes” (Breast Cancer Research Foundation). 

Dr. Perou’s revelation necessitates a minority patient-driven course of action. “Expanding Black women’s participation in research is critical…[to] ultimately inform personalized therapies and improve outcomes… (Breast Cancer Research Foundation). To this end, Dana-Farber Cancer Institute oncologist Dr. Nikhil Wagle’s Metastatic Breast Cancer Project recruits African-American patients to “...share their tumor and medical history data in an online registry to accelerate research on metastatic disease” (Breast Cancer Research Foundation). Given the success of Dr. Wagle’s Breast Cancer Project to date, it should be enacted on a broader scale across the nation and globe. 

In addition to augmented research among minorities, breast cancer prevention and screening programs that are accessible to underserved populations are also critical to addressing this issue. One important component of this initiative should include offering all women (especially minorities) subsidies to consume vitamin D supplements. Alongside this approach, “[c]ities that have confronted this problem by increasing access to state-of-the art mammography facilities made significant progress in narrowing the breast cancer mortality gap between Black and white women” (Breast Cancer Research Foundation). As a result of such positive outcomes, it would be beneficial for local, state, federal, and international government officials to create ongoing cancer screening programs within their respective jurisdictions for this demographic. 

COVID Vaccine Racial and Ethnic Disparities
Racial inequality in medicine is not limited to the US; the COVID-19 pandemic has revealed disparities at a global scale as vaccine research and distribution have been based in nations with predominantly Caucasian populations.

Black, Hispanic, and other minority populations are disproportionately and more severely affected by COVID-19. While African Americans and Latinx comprise only about 30% of the US population, these populations account for about 52% of COVID-19 cases in the US (Newman, et al.). The severity of the cases is greater than that of Caucasian individuals as well. Based on data in the US, the mortality rate of Black people is nearly 2.5 times the mortality rate of White people, and the mortality rate of Hispanic, American Indian, and Alaska Native individuals is 1.3 times the rate of White people (Jaklevic). Further, the hospitalization rate of individuals with COVID-19 in these populations, with respect to the rate in White populations, is 5.3 times greater for American Indian and Alaska Native individuals and 4.7 times greater for Hispanic and Black individuals (Jaklevic). This pattern is not only exhibited in the US: “Reflecting a trend seen globally, the mortality rate from COVID-19 in the UK is over twice as high in the most deprived areas (3.1 compared to 1.4 per 100,000), with Black people four times more likely to die from coronavirus infection than White” (Pepperrell, et al.).

One root of this disparity is socioeconomic deprivation along racial lines (Pepperrell, et al.). Decreased financial stability accentuates the difference in infection rates of racial minorities as Black and Latino individuals “...more frequently live in crowded, multigenerational homes and hold jobs they can’t do remotely” (Jaklevic). In turn, insecure housing and jobs “[cause] overcrowding, difficulty isolating, or inability to discontinue the use of public transport,” increasing risk of infection (Pepperrell, et al.). Additional problems include language and cultural barriers in health education, limiting understanding and compliance with preventive behaviors (Pepperrell, et al.).

Despite the greater prevalence of COVID-19 among racial minority populations, medical research has been primarily focused on people of European descent. A series of eight trials for COVID-19 vaccinations took place in Brazil, South Africa, the US, and the UK: “[o]f a total of 46,082 trial participants across these 8 trials, 36,857 (80.0%) were White, 4,495 (9.8%) were Black, 1,897 (4.1%) were Asian and 2,883 (6.1%) were registered under another ethnicity” (Pepperrell, et al.). The percentage of trial participants who belong to racial minorities is significantly different from the percentage of affected individuals, and thus, the trial samples “...do not represent demographics most affected by COVID-19 globally” (Pepperrell, et al.).

A major factor that affects representation in vaccine trials is where the trials take place. “Clinical trials were disproportionately lacking in parts of Asia and the Pacific, and all of Africa and South America” (Pepperrell, et al.). About 88.6% of COVID-19 vaccine trials took place in upper-middle income countries, while 10.5% took place in lower-middle income countries and only 2 of 194 trials (0.9%) were conducted in low-income countries (Pepperrell, et al.). Although the devastating impact of COVID-19 has been shown to increase with socioeconomic deprivation, the vaccine trials are more likely to take place in regions with higher socioeconomic status, hence limiting the number of low-income participants (Pepperrell, et al.). This ties into the limited diversity of trial participants as the majority of clinical trials have been “...set in Global North countries with largely affluent populations of European descent” (Pepperrell, et al.). Many of the high-income countries participating in vaccine research have large Caucasian populations, which further limits the inclusion of racial minorities in COVID-19 research.

Hesitancy among racial minorities is another significant barrier to diversity in medical research regarding COVID-19. A 2020 study in the UK demonstrated that “...vaccine hesitancy was associated with lower education, lower-income and minority ethnic grouping” (Pepperrell, et al.). Logically, populations with lower education are likely to have less of an understanding of how vaccines work, and systemic racism has prevented racial minorities from accessing proper education for centuries. Systemic racism has also made it difficult for racial minorities to achieve financial stability, further affecting their access to healthcare and education. The prevailing cause of hesitancy, however, is racial minorities’ distrust of the medical field. “This distrust stems from the long history of unethical medical research conducted amongst minority groups, whilst continuing unequal and delayed access to healthcare reinforces this tendency today” (Pepperrell, et al.). The Tuskegee Syphilis Study and the general mistreatment of racial minorities by the healthcare system have understandably evoked long-lasting fear in these communities.

Recommendations For Limiting COVID-19 Vaccine Racial and Ethnic Disparities
There are steps that COVID-19-related trials can take to improve representation, and consequently trust, of racial minorities in medicine. First, studies should aim to include minorities most affected by the disease in proportion to the population’s demographics (Jaklevic). Taking this one step further, minorities should be included in proportion to their infection rates within the population. In order to prove these changes to the public, clinical trial registries must report the demographics of trials. However, clinicaltrials.gov, the largest trial registry in the U.S., does not require or encourage reports of demographics, nor do many other trial registries (Pepperrell, et al.). This demonstrates a “...dangerous disregard of ethnicity and social circumstances when testing novel health technologies” (Pepperrell, et al.). Making demographic reports a requirement would both keep the public informed and encourage diversity, as vaccine hesitancy may likely decrease if minorities knew how the vaccine worked in their populations.

COVID-19 Vaccine Distribution in Low-Income Countries
COVID-19 vaccine distribution has generally been lacking in low-income countries, despite the increased risk of infection in such regions. Israel and Gibraltar, for example, had administered over 78 cumulative vaccine doses per 100 people by February 19, 2021 (Archarya, et al.). By the same date, Cambodia, Pakistan, Mauritius, Albania, Ecuador, Guyana, and Bolivia had administered less than 0.1 doses per 100 people, exhibiting a massive disparity in vaccine distribution to these countries (Archarya, et al.). More generally, by February 19, 2021, “...ten countries that account for 60% of the global gross domestic product had administered 75% of all COVID-19 vaccines” (Acharya, et al.). Meanwhile, there remained 130 countries that had not yet administered a single dose (Archarya, et al.).

There are several factors that make vaccine distribution more difficult in low-income countries. Transportation to mountainous and desert regions is limited and traveling through war-torn regions is risky as the vaccines must be handled with care. For example, “...more than 160 million people have been estimated to be at risk of inaccessibility of the COVID-19 vaccine in Yemen, Syria, South Sudan, and Ethiopia” due to conflicts within those nations (Acharya, et al.). The COVID-19 vaccines also have strict requirements for storage and low-income countries are likely to lack the technology needed to properly preserve them. These challenges stem from an overall dearth of resources in low-income countries.

The prevailing issue, however, is that wealthy countries purchased vaccine supplies months in advance. This limited the supply available to developing countries, even if such countries had the means to purchase them. Before COVID-19 was declared a pandemic, the US entered an agreement with Sanofi, a pharmaceutical company, “...to secure preferential and priority access to a future vaccine” (Nhamo, et al.). The UK and US both entered into an agreement with Oxford University to secure preferential treatment for vaccines as well (Nhamo, et al.). By July 26, 2020, the UK had secured 230 million doses of vaccines from several candidates, prior to their approval (Nhamo, et al.). By August 2020, the USA, UK, EU, and Japan had purchased a total of 1.3 billion doses, and the available supply was depleted before the vaccines had even been approved for use (Nhamo, et al.). Since low-income countries lack the budgets to purchase large quantities in advance, such nations “...are likely to suffer the most from COVID-19” (Nhamo, et al.).

This disparity has also exists with respect to a variety of other medications and vaccines throughout the COVID-19 pandemic. For example, hydroxychloroquine is a drug used to treat malaria, which is a disease prevalent in many low-income countries. Early on, hydroxychloroquine was granted emergency approval in the US as a treatment for COVID-19. By the time the US revoked its approval, it “had stockpiled about 29 million doses of hydroxychloroquine,” meaning these doses were not being used by the US, yet they could not be accessed by other countries (Nhamo, et al.). “The World Health Organisation (WHO) estimated that up to 769,000 people in sub-Saharan Africa (SSA) could succumb to malaria as a result of the shortage, thus, double the number estimated under normal supplies of the drugs” (Nhamo, et al.). Access to COVID-19 testing supplies was a challenge for impoverished countries as well. Citizens of Brazil and South Africa had to wait up to two months to procure chemical reagents crucial for testing for COVID-19 because wealthier countries “...had already purchased these supplies blocking out months of production for their benefit” (Nhamo, et al.). The U.S. “...went further to procure all the world’s remdesivir stock, a drug that has been proved to be effective in reducing COVID-19 mortality” (Nhamo, et al.). 

Disparities in global healthcare will continue to devolve as long as wealthier countries can exert their privilege in ways that prevent low-income countries from accessing crucial medical supplies and treatments. Nevertheless, there are several steps that wealthier nations can implement to support low-income countries and promote global solidarity. These remedies include a resolve to prepare in advance for mass production and distribution of anticipated vaccines across the world. In addition, wealthy countries must “...assist the most vulnerable nations and territories in fighting the pandemic; manage debt crises and combat famines in developing countries that would have emerged from COVID-19, and preserve global trade by privileging diversification of supply chains…over economic nationalism” (Nhamo, et al.). The contracts made to purchase treatments in advance should also be revamped in ways that consider the best interests of the world as a whole, especially with respect to the needs of people living in poverty.

Conclusion
  A history of systemic racism across the U.S. and the globe has led to socioeconomic healthcare gaps along ethnic and socioeconomic lines. On a national scale, wealth disparities have limited minorities’ healthcare access and education. This resulted in glaring breast cancer and Alzheimer’s disease diagnosis and outcomes disparities among African Americans. Steps to reduce these disparities include implementing community-outreach programs to better inform African Americans about these diseases and funding screening programs to prevent delayed diagnoses. Furthermore, past mistreatment by the U.S. government has caused minorities’ distrust of clinical trials, particularly among African Americans. Researchers may rebuild trust by providing targeted educational programs to minority populations, and “...efforts to increase training of minority physicians and scientists should also be continued and expanded” (Haga).

On a global scale, wealthier countries’ advanced purchases of necessary medical supplies regarding the COVID-19 pandemic prevent low-income countries from accessing such resources for their underserved populations. Fairer distribution of medical funding and supplies, especially to more vulnerable nations, would protect low-income and minority people from higher infection and mortality rates. Additionally, underrepresentation of minorities in medical research worldwide is detrimental to both a physician’s understanding of how various diseases affect the body and the quality and quantity of care that minority patients receive. Clinical studies have historically been based in European populations, which has overlooked other ethnic groups. Minority recruitment goals, community engagement efforts, and multisite studies may all boost minority inclusion, which would increase access to genetic testing, treatments, and more (Haga). Overall, the aforementioned remedies can provide a solid foundation towards equitable healthcare for all.

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