Differential willingness to undergo smallpox vaccination among African-American and white individuals

Abstract

OBJECTIVE:To examine potential disparities in willingness to be vaccinated against smallpox among different U.S. racial/ ethnic groups. DESIGN:Cross-sectional survey using an experimental design to assess willingness to be vaccinated among African Americans compared to whites according to 2 strategies: a post-exposure "ring vaccination" method and a pre-exposure national vaccination program. SETTING: Philadelphia County district courthouse.PARTICIPANTS: Individuals awaiting jury duty. MEASUREMENTS:We included 2 scenarios representing these strategies in 2 otherwise identical questionnaires and randomly assigned them to participants. We compared responses by African Americans and whites. MAIN RESULTS:In the pre-exposure scenario, 66% of 190 participants were willing to get vaccinated against smallpox. In contrast, 84% of 200 participants were willing to get vaccinated in the post-exposure scenario ( P = = = = .0001). African Americans were less willing than whites to get vaccinated in the pre-exposure scenario (54% vs 77%; P = = = = .004), but not in the post-exposure scenario (84% vs 88%; P = = = = .56). In multivariate analyses, overall willingness to undergo vaccination was associated with vaccination strategy (odds ratio, 3.29; 95% confidence interval, 1.8 to 6.1). CONCLUSIONS:Racial disparity in willingness to get vaccinated varies by the characteristics of the vaccination program. Overall willingness was highest in the context of a postexposure scenario. These results highlight the importance of considering social issues when constructing bioterror attack response plans that adequately address the needs of all of society's members.

Will Public Health's Response to Terrorism Be Fair? Racial/Ethnic Variations in Perceived Fairness During a Bioterrorist Event

“…African Americans and Asian/Pacific Islanders were the least likely groups to report perceived fairness (African American, 63.0%; Asian/Pacific Islander, 68.2%; Latino, 73.1%; white, 76.6%; p Ͻ 0.005 for group differences). Other variables associated with lower endorsement of perceived fairness were younger age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) fairness both overall and stratified by race/ethnicity subgroup. Even after adjusting for other covariates, the difference between African Americans and whites persisted, with African Americans less often reporting perceived fairness compared to whites (aOR 0.45; 95% CI 0.26-0.79).…”

“…6 For instance, distrust is already an important barrier to disenfranchised populations' acceptance of standard vaccines such as hepatitis B 21 and influenza 22 and is likely to influence vaccine acceptance in a bioterror attack. 23 Minority groups less willing to obtain smallpox vaccination could suffer higher morbidity and mortality rates in a smallpox attack, and this could even jeopardize the broader success of a smallpox vaccination program. 23 Recognizing that the willingness to be vaccinated may vary by race/ethnicity, public health agencies should prepare to tailor vaccination strategies to minority populations.…”

“…23 Minority groups less willing to obtain smallpox vaccination could suffer higher morbidity and mortality rates in a smallpox attack, and this could even jeopardize the broader success of a smallpox vaccination program. 23 Recognizing that the willingness to be vaccinated may vary by race/ethnicity, public health agencies should prepare to tailor vaccination strategies to minority populations.…”

Parting reflections on the best of JGIM

“…I also see evidence of the value of a generalist's perspective in studies that present new methods for addressing health care problems 62,63 and in systematic reviews of clinical topics 23,33 , 34,40 , 42,64–66 . In addition, I see that our authors have addressed recent developments that have important implications for primary care practitioners, including the hospitalist movement, 67–74 online communication, 17 genetic testing, 75 and even bioterrorism preparedness 76,77 . Of course, JGIM has an extremely important role in supporting scholarly work in medical education.…”

Public Response to an Anthrax Attack: A Multiethnic Perspective

“…Studies in these areas suggest that racial minorities may respond less to government efforts in a crisis: for example, African Americans were less likely to evacuate from New Orleans when Hurricane Katrina struck, were less likely to get vaccinated during the H1N1 influenza pandemic, and are less likely to want to get the smallpox vaccine in the event of a future episode. [15][16][17][18][19] African Americans also reported they were less likely to (be able to) adhere to significant social distancing measures (eg, staying away from work for many weeks) in the case of a future influenza pandemic, 20 but they were more likely to take less costly measures of personal protection during the H1N1 pandemic. 21…”