Overcoming Barriers to COVID-19 Vaccination in African Americans

The Need for Cultural Humility

Keith C. Ferdinand, MD, FACC, FAHA, FNLA, FASPC


Am J Public Health. 2021;111(4):586-588. 

In This Article

Abstract and Introduction


"Rescue work by helicopter was slow. That stopped at dark about 7 o'clock … people began to panic. I told Kenneth and Keith and those around me that we may as well make the best of it, for no one knows we are here … help won't come until morning. The rain fell so hard that I had to take off my glasses & hide my head… . The water, still slowly rising, had two more inches to go before it reached the rooftop. We learned: that communication [and] cooperation are necessary factors for survival in a disaster."

—Letter from Inola Copelin Ferdinand to her sister, Narvalee, after our family and others spent days amid the drowning death of my paternal grandfather and many of her neighbors, abandoned on rooftops in the Lower Ninth Ward, New Orleans, LA, during Hurricane Betsy, September 9, 1965


Racial/ethnic minorities suffer disproportionately from US COVID-19–associated deaths.[1] The tragically higher COVID-19 mortality among African Americans from multiple conditions, including cardiovascular diseases (CVD) and certain cancers, highlights deep-rooted, unacceptable failures in US health care. The social determinants of health (limited finances, healthy food, education, health care coverage, job flexibility) make disadvantaged communities more vulnerable to COVID-19 infectivity and mortality and amplify higher comorbid conditions.[2] The Healthy People 2020 Social Determinants of Health include the Economic Stability domain, with employment as a key issue. Suboptimal job benefits such as health insurance, paid sick leave, and parental leave can affect the health of employed individuals, and African Americans are more likely to work in blue-collar service jobs.[3] This toxic gumbo of suboptimal health and adverse environments profoundly diminishes overall African American longevity, fueling a decades-long White–Black death gap, with African American men having the shortest life expectancy.[2] Although December 2020 Pew Research data note that a growing share of Americans report they probably or definitely will accept COVID-19 vaccination, African Americans continue to stand out as less inclined to get vaccinated: 42% would do so, compared with 63% of Hispanic and 61% of White adults.[4]