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Why is COVID-19 Vaccine Hesitancy and Mistrust So High Among Black Americans?

MedicalResearch.com Interview with:
Laura M. Bogart, PhD
Senior Behavioral Scientist
RAND Corporation
Santa Monica, CA 90407-2138

MedicalResearch.com: What is the background for this study?

Response: Recent media polls continue to show that Black Americans are less likely to intend to get the COVID-19 vaccine than White Americans, and initial state data show a similar racial/ethnic disparity in vaccination rates. Initial uptake of the vaccine has been significantly affected by inequities in vaccine access and supply. In addition to these challenges, other factors contribute to hesitancy around vaccination, including self-perceived risk of infection, trust in the vaccine itself, trust in healthcare systems, healthcare providers, and policymakers who support the vaccine, and trust in the pharmaceutical industry and clinical research. In this study, we conducted a survey of a nationally representative sample of 207 Black Americans in late 2020, after initial COVID-19 vaccine effectiveness and safety data were released to the public. We also did in-depth interviews with a subsample of those surveyed who said that they would not get vaccinated. In addition, we engaged with a stakeholder advisory committee comprised of individuals who represent different subgroups and organizations in Black communities in the U.S., in order to discuss the results and make recommendations for policies to increase COVID-19 vaccination among Black Americans.

MedicalResearch.com: What are the main findings?

Response: About a third of Black Americans overall, and 48 percent of Black health care workers, said that they would not get vaccinated for COVID-19. Those who had high mistrust of the vaccine itself (including concerns about harm and side effects), and low confidence that the vaccine is effective and necessary, were less likely to say that they would get vaccinated. In addition, participants who said that people close to them would want them to get vaccinated were more likely to say that they would get vaccinated. Participants also reported that they trusted information about COVID-19 more from health care providers and public health officials than from elected officials. In analyses of the survey data as well as in the in-depth interviews, mistrust of the vaccine seemed to be mainly driven by mistrust of the government’s motives and transparency around COVID-19, as well as beliefs about unequal treatment in health care. In interviews, participants further attributed their mistrust of the vaccine to systemic racism, including discrimination and mistreatment in health care, as well as by the government.

MedicalResearch.com: What should readers take away from your report?

Response: COVID-19 vaccine hesitancy and mistrust is high among Black Americans. Systemic racism, including historical and ongoing discrimination and mistreatment in health care and by the government, contributes to vaccine hesitancy. Systemic racism has manifested around COVID-19 around inequities in terms of who is most vulnerable to severe disease and death, and who has access to the vaccine. We hope that this report serves as a call to action for policymakers to begin a dialogue about how to increase the trustworthiness of the government, the pharmaceutical industry, and health care organizations, in order to reduce health inequities.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: As a next step, future research is needed to determine ways to increase access to vaccination and healthcare overall, and reduce medical mistrust – not only for COVID-19, but for the next big health issue that we might face as a country. Public health messages around COVID-19 vaccination efforts need to address mistrust with transparent communication about the effectiveness and safety of each of the COVID-19 vaccines. We can start by gathering data through health departments around which vaccine access points are working well, and which communities and access points have low vaccination rates. In addition, we can gather information from key community stakeholders around which information sources are trusted, what concerns are contributing to vaccine hesitancy, and preferred ways to receive the vaccine, in their communities.

It is also important to allow for safe spaces for open dialogues about the vaccines with healthcare providers, such as in town-hall meetings with Q&A periods, in order to ensure that individuals feel that their questions have been answered in a genuine and respectful way. Communications about vaccination also need to acknowledge the history of racism and discrimination in this country as leading to COVID-19 inequities and as reasons for justifiable and understandable mistrust of COVID-19 vaccines.

Finally, future research is needed to understand the reasons behind healthcare workers’ concerns around COVID-19 vaccination, in order to improve vaccination rates in Black healthcare workers. This is especially important because, as shown in our study, Black communities trusted their healthcare workers most compared with other sources such as elected officials, and healthcare workers may play a key role in the vaccine roll-out in Black and other communities of color.

There are no disclosures to report.

Citation:

Bogart, Laura M., Lu Dong, Priya Gandhi, Samantha Ryan, Terry L. Smith, David J. Klein, Luckie-Alexander Fuller, and Bisola O. Ojikutu, What Contributes to COVID-19 Vaccine Hesitancy in Black Communities, and How Can It Be Addressed?. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA1110-1.html.

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