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The federal government never intended to provide treatment, and though penicillin became widely available in 1943, the men were not treated. At least 28 and perhaps up to 100 men died from syphilis or its complications by the time the study was halted in 1972. Hundreds went on to infect their wives, some of whom then transmitted the disease to their children.

Second, the federal government knowingly withheld treatment for 40 years from the same citizens it was supposed to protect.

There have been numerous reports of Black people being turned away at emergency departments, sent home without having been examined or treated and later dying of the virus

In an August essay about Covid-19 treatment written for the California Health Care Foundation, Dr. Vanessa Grubbs, a nephrologist, noted, "No available data suggest such implicit bias is happening on a large scale and resulting in worse outcomes. But the lack of data is less a sign that the problem does not exist than a reflection of what data we choose not to gather."

First, the study had been developed to test the repulsive idea that Black people are biologically different than White people. This idea -- suggesting Black people are somehow less than human -- has powerful echoes in medical training and practice today.

We live in a country organized around structural racism. This means Black Americans are less likely to receive the health care we deserve. We are more likely to live in neighborhoods with poor air quality and fewer outlets to purchase healthy food. We are more likely to work in low-paying "essential" jobs that put us more at risk for contracting Covid-19.

Because the vaccine came to market so quickly, we do not have long-term safety studies, and there are still many unanswered questions.

One of the lasting lessons of Tuskegee is that denying medical care is among the biggest breaches of trust between citizens and their governments. We must ensure that marginalized groups like Black, Indigenous and people of color, immigrants, disabled people and people in prison can receive this vaccine. We must also ensure people are allowed to ask questions to make informed and uncoerced decisions about their health care.

Misinformation has complicated efforts by some states to reach out to Black and Hispanic residents, particularly when health officials have provided special registration codes for vaccine appointments. Instead of a benefit, in some cases the codes have become the basis for new false narratives.

Anti-vaccine activists have drawn on historical examples, including Nazi doctors who ran experiments in concentration camps, and the Baltimore hospital where, 70 years ago, cancer cells were collected from Henrietta Lacks, a Black mother of five, without her consent.

The state figures vary widely. In Texas, where people who identify as Hispanic make up 42 percent of the population, only 20 percent of the vaccinations had gone to that group. In Mississippi, where Black people make up 38 percent of the population, they received 22 percent of the vaccinations

According to an analysis by The New York Times, the vaccination rate for Black Americans is half that of white people, and the gap for Hispanic people is even larger

Research conducted by the nonprofit Kaiser Family Foundation in mid-February showed a striking disparity between racial groups receiving the vaccine in 34 states that reported the data.

An experiment conducted in 1943 on nearly 400 Black men in Tuskegee, Ala., is one of the most researched examples of medical mistreatment of the Black community. Over four decades, scientists observed the men, whom they knew were infected with syphilis, but didn’t offer treatments so that they could study the disease’s progression. When the experiment came to light in the 1970s, it was condemned by the medical community as a major violation of ethical standards.

While Tuskegee averaged several hundred mentions a week on Facebook and Twitter, there were several noticeable spikes that coincided with the introduction of Covid-19 vaccines, according to Zignal Labs, a media insights company.

Last month, a poll by the NORC Center for Public Affairs Research found that 23 percent of Republicans said they would “definitely” not get vaccinated, while 21 percent said they “probably” would not get a coronavirus vaccine.

Native American groups have been battling vaccine fears in their communities, and doctors have reported that some of their Chinese-American patients have been bringing in articles in Chinese-language media outlets questioning vaccines made in the United States.

Many Black and Hispanic people were already struggling to make appointments and reach vaccination sites that are often in whiter, wealthier neighborhoods

Misinformation about who is allowed to receive the vaccine, when it is available and how it was safety tested has added even more difficulty, Ms. Mitchell, said.

The Democrats’ message, Schrier said, should be clear and simple: All vaccines are good. And the best thing American can do to protect themselves and their loved ones is to get a shot.

Pelosi spokesman Henry Connelly said the Speaker was simply reflecting concerns in her diverse caucus about whether minority communities were being treated equitably in the aggressive push to vaccinate all Americans.

That disparity has been attributed, in part, to the fact that the earlier Moderna and Pfizer vaccines each require two shots and colder refrigeration, complicating storage and distribution. That’s created additional barriers for getting the vaccine to poorer, historically underserved populations and rural communities.

Black people are nearly three times more likely to be hospitalized with COVID-19 than white people and nearly two times more likely to die from the disease; Hispanics are more than three times more likely to be hospitalized with COVID-19 than whites and 2.3 times more likely to die. 

White people have been vaccinated for COVID-19 at two times the rate of Black people, according to a New York Times analysis. The figures are worse for Hispanics. 

The disagreement among Democrats comes during a pivotal moment in the fight against the coronavirus pandemic as states like Texas and Mississippi end their mask mandates and lift restrictions on businesses, and health experts worry about a surge in cases driven by COVID-19 variants.

Because the new Johnson & Johnson vaccine requires only one shot and regular refrigeration levels, some officials like New Jersey Gov. Phil Murphy (D) have ordered that shipments of that vaccine be prioritized for harder-to-reach Black and brown communities. 

But while Pfizer and Moderna vaccines have an overall efficacy of about 95 percent in preventing moderate to severe disease, that number for the Johnson & Johnson version is just 66 percent — though experts point out the J&J vaccine was being tested after more contagious variants had begun spreading in the U.S., unlike the Pfizer and Moderna versions. 

That's led to some in those minority communities voicing concerns in recent days that they are being given a less-effective vaccine than more affluent, white communities.

Rep. André Carson (D-Ind.), another CBC member, noted that those suspicions have historic roots, pointing to the infamous Tuskegee syphilis study — a deadly federal research project that targeted poor Black people in rural Alabama in 1930s — as evidence of the "painful history" of biomedical mistreatment of African Americans in the United States. 

Despite such reservations, the broad consensus in the caucus appears to favor efforts to maximize vaccinations in the shortest possible time, regardless which shot is available in a given community.

On Wednesday, Kelly is set to join Rep. Joyce BeattyJoyce Birdson BeattyDemocrats spar over COVID-19 vaccine strategy Black Caucus backs Biden's pick to head DOJ Civil Rights Division Sole GOP vote on House police reform bill says he 'accidentally pressed the wrong voting button' MORE (D-Ohio), head of the Black Caucus, in an online forum with medical experts designed to educate minority communities on best vaccine practices. 

Rep. Anthony BrownAnthony Gregory BrownOvernight Defense: Pentagon chief to press for Manchin's support on Colin Kahl | House Dems seek to limit transfer of military-grade gear to police Democrats spar over COVID-19 vaccine strategy 140 lawmakers call for Biden administration to take 'comprehensive' approach to Iran MORE (D-Md.) said officials should monitor the distribution of vaccines to identify “patterns” that might indicate prejudices in the dispensation. But he’s also encouraging all of his constituents to get whatever vaccine is available first, and he highlighted the advantages of the one-dose Johnson & Johnson shot, particularly in hard-to-reach populations like the homeless. 

Many Flint residents are Black, and they have long memories of racist treatment by doctors who dismissed or neglected their medical needs.

Dr. Joneigh Khaldun, chief medical executive of the state Department of Health and Human Services, said the state's plan to vaccinate 70 percent of residents as quickly as possible includes efforts to enlist people like block club captains, fraternity and sorority presidents and religious leaders to promote the vaccine — an effort Khaldun said is especially important in the Black community, where what she called "vaccine hesitancy" is high.

"When you tell us that the water is safe but it really wasn't, that relationship between leadership and the community is still damaged," said Todd Womack, the pastor of community connections at Central Church of the Nazarene in Flint. "That just layers the historical trauma that has presented itself in our community."

"In this country, we know that African Americans have always been targeted as test dummies," he said, referring to unethical medical experiments including the infamous Tuskegee study, which left hundreds of Black men with untreated syphilis for decades.

"There is still systemic racism that exists. There is still, quite frankly, sometimes explicit bias that exists in the health care system, and so I think we need to name it and not shame these groups of people where they may have some hesitancy."

The process of spreading the information is just beginning, but it's going to need to come from more than one place, said Debra Furr-Holden, an epidemiologist who has been leading community discussions about the virus as director of the Flint Center for Health Equity Solutions

But at the same time, "relationships are built on trust, and trust takes time," she said. "They developed a vaccine at warp speed, and they're trying to skip a bunch of processes in the trust and relationship-building process."

"You don't allow your pulpit to become a platform," he said, adding that he understands "what you are risking when you open these platforms to a community that's already been taken advantage of, misused, abused."

"There's a reason, a quite valid reason, for there to be concerns about how the health care system in general, and often health care systems and the government together, have treated the African American community historically in the United States,"

"There was this push for everybody to use the water from the city," both during the crisis and after the city switched to a cleaner water source and started distributing filters and replacing corroded pipes, Womack said.