The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data

Abstract

Background African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. Objective The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. Methods Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. Findings Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines’ safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. Conclusion Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.

Human papillomavirus vaccine uptake among teens before and during the COVID-19 pandemic in the United States

“…It follows that a vaccine-skeptical parent when given a choice might be more likely to make the decision to skip HPV vaccine uptake, especially when it is a recommendation rather than a requirement. 54 , 55 As our findings allude to, there may be other behavioral factors that transcend traditional health equity and access issues in the United States that might impact HPV vaccine uptake. This highlights the complex social and behavioral factors associated with vaccine acceptance, beyond the science of vaccine safety and its importance in cancer prevention.…”

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

“…This concern is further amplified if a patient with COVID-19 is not only unvaccinated but also has comorbidities such as cancer, predisposing them to higher risk of morbidity and mortality. COVID-19 vaccine hesitancy has been studied previously in cancer patients worldwide [ 25 , 26 , 27 , 28 , 29 , 30 , 32 , 39 , 40 , 41 , 42 , 43 , 44 ] and in the United States [ 31 , 33 , 35 , 36 , 45 ], including multiple studies of ethnic minorities in the US [ 21 , 22 , 23 , 24 , 46 , 47 , 48 , 49 , 50 , 51 ], but no known research exists specifically examining ethnic minority cancer patients and their views on the COVID-19 vaccine. This study helps address this gap in the knowledge by uniquely examining two different time-points of vaccination status 6-months post-initial survey, employing a vaccine knowledge score composite and exploring a brief educational intervention to raise patients’ awareness, to gain valuable insight into this distinctly disadvantaged population in the US.…”

“…Additionally, a positive predictor of vaccination uptake as seen previously was having access to information about COVID-19 vaccines [ 26 , 33 , 44 ], and trusting medical advice on vaccination [ 29 , 35 , 39 ]. Yet, only 60% trusted the information they had received, reflecting wide prior research [ 25 , 27 , 28 , 29 , 33 , 43 , 45 ], and highlighting concerns around the need to acquire more information [ 21 , 46 , 47 , 49 , 50 , 51 ]. These results present another avenue where increased awareness of the issue can help alleviate this problem, and suggest that a focus on correcting misinformation may help increase vaccination rates.…”

“…The long-standing healthcare disparities have been stated in various studies on COVID-19 vaccine hesitancy in ethnic minority groups, referring to accessibility and equity concerns, mistrust in the healthcare system and government [ 21 , 46 , 47 , 49 , 50 , 51 ], structural, interpersonal, historical, and contemporary racism and anti-immigration [ 47 , 48 , 50 ], barriers in transport and technology [ 21 , 46 , 47 , 48 ], housing insecurity [ 24 ], and English as a second language [ 47 ]. In our study, about 41% of participants felt that some ethnic and religious groups in the community had difficulty getting vaccinations, and only 60% trusted the information they received, although neither employment nor race and ethnicity significantly determined vaccine uptake in our study.…”

Development of a Theory-Based, Culturally Appropriate Message Library for Use in Interventions to Promote COVID-19 Vaccination Among African Americans: Formative Research

“…For example, African Americans comprise 12.4% of the US population but only 10.1% of those who have initiated the series and 10.3% of those who have completed the series as of March 10, 2022 [3]. Despite African Americans being almost 2 times more likely than White Americans to die from COVID- 19 [4], vaccine hesitancy remains a major hindrance to reduced vaccine uptake among African Americans [5][6][7][8][9].…”