Low Vaccine Uptake in Black Communities Often an Access Issue: Study

Marcia Frellick

January 21, 2022

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Black and White people had similar levels of hesitancy in getting COVID-19 vaccines when they first became available, but new data suggest that Black Americans overcame their hesitancy more quickly compared with Whites.

The results of a new study suggest that hesitancy is likely not the main driver behind comparatively low vaccine uptake in the Black community, the authors say, and that signs point to access problems.

Dr Tasleem J. Padamsee

"We've had a lot of discussion about hesitance as a primary driver of the gaps in vaccination and there's an assumption that people are not getting vaccinated because they don't want to get vaccinated. Here we find a mismatch. Black Americans are less commonly vaccinated than White Americans by quite a few percentage points, but they are equally or more willing," first author Tasleem J. Padamsee, PhD, assistant professor, Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus, Ohio, told Medscape Medical News.

She and her colleagues cite Centers for Disease Control and Prevention data in their research that find that "the percentage of White individuals who have received at least 1 vaccine dose is approximately 1.5 times the percentage for Black individuals; the vaccination rate among White individuals is higher within every state, although the size of the differences varies."

Findings were published online Friday in JAMA Network Open.

Clues to the reasons for low vaccine uptake are particularly important, as Black communities have been disproportionately burdened by COVID-19, with more cases, deaths, and more severe economic effects than other racial and ethnic communities.

This study is part of a larger project conducted by the market research firm YouGov, which examined beliefs and misperceptions about COVID-19 among a representative sample of adults in the United States. In the larger, 7-wave study, participants were contacted every month from December 2020 to June 2021. 

In Padamsee's study, the researchers' main outcome was self-reported intention to vaccinate, measured on a 6-point scale (1 indicates extremely unlikely and 6 extremely likely). Beliefs about the safety, effectiveness, and need for COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores indicating greater agreement.

The researchers found that by December 2020 only 36% to 49% of Black people (compared with 44%-59% of White individuals) said they intended to get the vaccine when they became eligible.

But the picture was different starting in March of 2021. Compared with baseline, Black participants' vaccine intention had increased more than that of White participants in wave 4 (March 2021; b = 0.666; P < .001), wave 5 (April 2021; b = 0.890; P < .001), wave 6 (May 2021; b = 0.695; P < .001), and wave 7 (June 2021; b = 0.709; P < .001).

Padamsee said there should be a shift in the assumption that there are low vaccination numbers in the Black community because of hesitancy. Instead, exploring access issues should be a priority, she said.

Access issues could be perceptions that wages will be lost if people have to take off work for ill effects of the vaccine. Access issues could also include misperceptions that getting the vaccine will be expensive, when in actuality it is free, Padamsee said.

"For both big state agencies and small community groups, it's about figuring out what really is in the way, being open to that it really may be about an access barrier and that those problems need to be addressed," she said.

Messenger as Important as Message

Padamsee said that a strength of their study is that it offers unique data that allowed her team to track the same people over time and track changes in their beliefs, eliminating the possibility that different information was observed because it was a different sample of people.

Jennifer Reich, PhD, professor of sociology at the University of Colorado Denver, said she agreed that "hesitancy is not the end of the conversation."

"People, when they express concerns about a vaccine are not unmovable and there's evidence that people do change their minds with new information," she told Medscape Medical News.

Dr Jennifer Reich

She said that in building on this work it will be important to know more about attitudes in the Black community by subgroups, such as geographic location, income, political affiliation, and employment status, to help tailor vaccination messages that are meaningful.

The authors mention that the messenger is often as important as the message for vaccine uptake.

In that regard, Reich pointed out that different states have different strategies on where to place vaccine clinics, noting that some rely only on contracts with corporate pharmacies while others use a community outreach strategy.

In Colorado, she said, "We have a structure where any community organization can request a vaccine clinic on site."

Many churches and elementary and high schools, even zoos in Colorado, offer vaccine clinics for all family members.

"Colorado has a mobile vaccine clinic that has gone everywhere from factories to nightclubs," she said.

"The idea that it can be readily accessible and we can bring healthcare to where people are already I hope is one of the lessons from COVID we keep," Reich said. "Primary care has never been easy to access for people who work."

Coauthors report grants from the National Science Foundation during the conduct of the study. Padamsee reports grants from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Kirwan Institute for the Study of Race and Ethnicity, and the Stefanie Spielman Fund during the conduct of the study. Reich declared no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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