COVID-19 vaccine hesitancy in underserved communities of North Carolina

Abstract

Background In the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina. Methods We conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 –December 15, 2020. Vaccine hesitancy was defined as the response of “no” or “don’t know/not sure” to whether the participant would get the COVID-19 vaccine as soon as it became available. Results The sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]). Conclusions This study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.

Sociodemographic Factors Associated with Vaccine Hesitancy in Central Texas Immediately Prior to COVID-19 Vaccine Availability

“…The finding that individuals of Black or African American race are less likely to obtain the COVID-19 vaccine is not surprising. In fact, our finding is consistent with the literature for both the COVID-19 vaccine and for the seasonal influenza vaccine [ 15 , 16 , 17 , 20 ]. In a study of 948 persons from North Carolina, individuals who identified as Black were more likely to be COVID-19 vaccine-hesitant than compared to the referent group (OR: 1.69, p = 0.002, 95% CI: 1.16, 2.45) [ 20 ].…”

“…In fact, our finding is consistent with the literature for both the COVID-19 vaccine and for the seasonal influenza vaccine [ 15 , 16 , 17 , 20 ]. In a study of 948 persons from North Carolina, individuals who identified as Black were more likely to be COVID-19 vaccine-hesitant than compared to the referent group (OR: 1.69, p = 0.002, 95% CI: 1.16, 2.45) [ 20 ]. In a study of seasonal influenza among health care workers, non-Hispanic blacks had lower uptake of vaccination than non-Hispanic whites based on a total direct effect (PR = 0.87; 95% CI = 0.75, 0.99) [ 21 ].…”

“…This finding is consistent with other COVID-19 studies, including the North Carolina study. Data from that study showed a higher likelihood of hesitancy toward the COVID-19 vaccine among women (OR: 1.90, p < 0.0001, 95% CI: 1.36, 2.64) [ 20 ]. This finding is supported by other published studies showing vaccine hesitancy for females associated with the COVID-19 vaccine, the H1N1 pandemic influenza vaccine, and the seasonal influenza vaccine [ 22 , 23 , 24 ].…”

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

“…( Ruiz and Bell, 2021 , Malik et al, 2020 , Shaw et al, 2021 ) However, females were associated with 1.3 to 2.5 times the odds of being COVID-19 vaccine hesitant when compared to males after adjusting for multiple covarites. ( Daly and Robinson, 2021 , Latkin et al, 2021 , Callaghan et al, 2021 , Coe et al, 2021 , Tram et al, 2021 , Khubchandani et al, 2021 , Doherty et al, 2021 , Nikolovski et al, 2021 , Halbrook et al, 2021 , Garcia et al, 2021 )…”

Trends in COVID-19 Health Disparities in North Carolina: Preparing the Field for Long-Haul Patients

“…This hesitancy in communities of color could be explained by past and present experiences and distrust of the healthcare and criminal systems, lack of adequate access to regular healthcare, transportation and language barriers, and the disproportionate burden of this pandemic [ 28 , 29 ]. A recent study of attitudes related to vaccination among racial minority and marginalized populations across nine counties in NC [ 30 ] found that factors associated with hesitancy in multivariable logistic regression included being female, being Black, calendar month, safety concerns, and government distrust [ 30 ]. To address vaccine hesitancy, particularly among minority populations, a multifaceted strategy prioritizing community engagement and considering people’s experiences must be employed [ 28 ]…”