Moving the needle on racial disparity: COVID-19 vaccine trust and hesitancy

Abstract

Health equity has grown in prominence during the pandemic. Racial disparities in COVID-19 infections and vaccine hesitancy (differences up to 26%) have generated concerns, research, and interventions with less-than-satisfactory results. Two longitudinal national surveys in the U.S. revealed previously overlooked patterns in the changes of COVID-19 vaccination intention across race/ethnicity. While White vaccine acceptance bounced back to the March 2020 level (65%) a year later, minority (except Asians) responses continued to lag and fluctuated with greater volatility. Though Hispanics' refusal aligned more with Blacks, the ratio of Hispanics willing to vaccinate was similar to Whites, even intermittently went above. Further, the magnitude and direction of changes varied by race at specific times (e.g., launch of Operation Warp Speed, reports of high vaccine efficacy in clinical trials or FDA approval), indicating subgroups react differently to events and thus require timely identification of driving factors for dynamic communications to encourage uptake. We also briefly reviewed the historical background of distrust in medicine and health authorities, including the Tuskegee Syphilis Study that led to the Belmont Report regulating human subject research and severe adverse reactions from the 1976 mass vaccination against the H1N1 swine flu. These examples, perpetuating inequity in the present healthcare system, and logistical barriers illustrate the contextual complexity and importance of instilling confidence in vaccines among the minority population.

Keywords: Access; Attitudes; Equity; Health behavior; Health disparity; Vaccine hesitancy.

Fig. 1

Rates of participants answered “Yes” to vaccine intention question by race. Data sources: Morning Consult and YouGov, compiled by the research team. Both are cross-sectional, longitudinal surveys with stratified random samples representative of the U.S. population by demographics and regions. Morning Consult polled about 2200 participants each time and YouGov polled 1500 participants. With more vaccine rollouts, the question wordings and answer options of the survey item were adjusted by the respective pollsters in March 2021, thus the response data thereafter were not included in the graphs for direct comparison. * Despite few earlier positive outcomes and President Trump’s promotion of the use of hydroxychloroquine as a treatment for Covid-19, AHA, ACC, and HRS jointly issued cautionary guidelines for the drug, especially warning the application for Covid-19 patients with heart conditions.. † CDC changed its guidelines, stating testing may not be needed for exposed but asymptomatic individuals, generating confusion. The guideline was later reversed on September 17, citing it did not go through CDC’s regular scientific review . Abbreviations: ACC: American College of Cardiology; AHA: American Heart Association; CDC: Centers for Disease Control and Prevention; DOD: Department of Defense; HHS: Department of Health and Human Services; HRS: Heart Rhythm Society; WHO: World Health Organization.

Fig. 2

Rates of participants expressed vaccine resistance or hesitancy by race. Data sources: Morning Consult and YouGov, compiled by the research team. Abbreviations: EUA: Emergency Use Authorization; FDA: Food and Drug Administration.