COVID-19 vaccine attitudes among a majority black sample in the Southern US: public health implications from a qualitative study

Abstract

Background The COVID-19 pandemic continues to have high caseloads in the US, with vaccines a critical component of the response. Disparities in COVID-19 morbidity and mortality have been identified across states and racial/ethnic groups, which are likely in part due to disparities in COVID-19 vaccine uptake. This study aims to better understand and contextualize COVID-19 vaccine hesitancy among persons from under-represented racial/ethnic populations in the Southern US. Methods We conducted 29 in-depth interviews with a sample of households in Atlanta, GA that were selected from an address-based sampling frame. We purposively approached households, from February 6 to June 27, 2021, that declined participation in a national COVID-19 serosurvey to gain perspectives of people who are often under-represented in research. Interviews were conducted in-person or over phone calls for participants with that preference. Thematic analysis was used to identify barriers and facilitators of COVID-19 vaccination, and to contextualize drivers of vaccine hesitancy. Results Decision-making about vaccination was described as dynamic, and was compared to the feeling of being on a roller coaster. The predominant reported sources of information were mass media and social media. Facilitators of vaccination included altruism, positive communication from trusted community members and workplace colleagues, and local vaccine provision sites. Driving reasons for vaccine hesitancy included limited trust in the government and concerns about COVID-19 vaccine safety, which one participant compared to jumping off a cliff without a tested rope. Among a subset of participants, beliefs regarding perceived intent to harm the Black community were prevalent. Opportunities to optimally address vaccine hesitancy included countering negative social media messages with positive messaging that matches the community’s vivid ways of discussing vaccines, collaborating with community stakeholders on vaccine promotion efforts, and offering workplace-based vaccine promotion efforts. Conclusions This study presents data that indicate it may be optimal to more broadly define ‘community’ in COVID-19 vaccine promotion efforts to include social media and workplace venues. To optimize vaccine and vaccine booster uptake and equity, public health must address historic racism and other concerns by using outreach that is grounded in communities.

Understanding Stakeholders’ Perspectives to Increase COVID‐19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions

“…Our findings regarding barriers to vaccination among Black individuals with rheumatic conditions are congruent with previous studies among the general Black population (21–25). A recent qualitative study of Black churchgoers from a single congregation in Boston found lack of trust, rushed development, fear of side effects, history of medical mistreatment, and a perception of low risk as reasons for vaccine hesitancy in this group (26).…”

Understanding the concept of trust and other factors related to COVID-19 vaccine intentions among Black/African American older adults prior to vaccine development

“…This recommendation is consistent with other studies that identified the successful dissemination of health promotion messages, such as public health awareness campaigns involving social media influencers and celebrities of color ( Portacolone et al, 2020 ). Such collaborations effectively countered negative social media messages with positive messages that mirrored communities' discussions around vaccine uptake ( Bateman et al, 2022 ; Huang et al, 2022 ). In addition, our findings also underscored the value of resorting to one's own agency while finding inspiration and comfort in the words of Black/African American leaders, such as Martin Luther King, which provides insights into how public health and government officials can leverage Black/African American legacy and history to foster empowerment and rebuild trust ( Bunch, 2021 ; LaVeist et al, 2000 ).…”

“…Some of the predictors of vaccine receptivity identified among Black/African Americans were high levels of mistrust stemming from historical and contemporary experiences of systemic racism against the Black community, structural barriers such as inaccessible vaccination sites, fear of the unknown, and lack of accurate information from trusted community and public health officials. Additional barriers to vaccine receptivity included the belief that the speed at which the vaccines were developed was evidence of intentions to harm the Black/African American community ( Dong et al, 2022 ; Huang et al, 2022 ).…”

Attitude toward vaccination against COVID-19 and acceptance of the national “QazVac” vaccine in the Aktobe city population, West Kazakhstan: A cross-sectional survey

“…According to Huang et al, the main reasons for vaccination hesitancy were concerns about the safety of the COVID-19 vaccine and limited trust in the government [ 27 ]. Other researchers have also mentioned that ideology, which can result in the rejection of science due to conspiracist ideation and limited trust in government medical experts, is a factor that indirectly affects immunization propensity [ 10 , 28 ].…”

“…Other researchers have also mentioned that ideology, which can result in the rejection of science due to conspiracist ideation and limited trust in government medical experts, is a factor that indirectly affects immunization propensity [ 10 , 28 ]. Huang et al listed the presence of local vaccine distribution points among the factors contributing to vaccination [ 27 ]. In our study, respondents did not experience difficulties in reaching the vaccination points but faced challenges of other nature when receiving vaccines.…”