NEW YORK (AP) — Roughly 40 million African Americans are deciding minute by minute whether to put their faith in the government and in the medical field during the coronavirus pandemic.

Historic failures in government response to disasters and emergencies, medical abuse, neglect and exploitation have jaded generations of black people into a distrust of public institutions.

Some might call it the “Tuskegee effect," referring to the U.S. government’s once-secret syphilis study of black men in Alabama that one study shows later reduced their life expectancy due to distrust of medical science.

How well the government and medical community respond to the current crisis will be especially crucial for outcomes among black Americans, civil rights advocates and medical experts say.