What Contributes to COVID-19 Vaccine Hesitancy in Black Communities, and How Can It Be Addressed?

"Although providing information about the vaccine is important and necessary for increasing trust, it is insufficient by itself to prompt behavior change."

Evidence to date suggests that the percentage of Black individuals who show COVID-19 vaccine hesitancy has stayed consistently high, relative to other racial and ethnic groups in the United States (US), since April 2020. Black communities in the US have suffered a long history of discrimination, racism, and harmful experiences on the part of the healthcare system, healthcare providers, and the US government. Due to the concern that lower vaccination rates among Black Americans would further widen COVID-19 inequities in diagnosis, hospitalisation, and mortality, these researchers conducted a survey of Black Americans, with follow-up interviews, to better understand the drivers of their reluctance. Based on the findings, they engaged with community stakeholders to identify public health messaging and communication strategies for addressing COVID-19 vaccine hesitancy and increasing vaccination in Black communities.

The survey was conducted between November 17 and December 2 2020 among 207 Black Americans who are participants in the RAND American Life Panel (ALP), a nationally representative internet panel. The survey began about a week after public announcements about the high efficacy of the Pfizer and BioNTech and Moderna COVID-19 vaccines. Selected findings:

• 32% of all survey participants agreed or strongly agreed they would not get a COVID-19 vaccine, and an additional 25% said "don't know"; only 40% indicated they would get vaccinated. Participants in healthcare fields showed higher vaccine hesitancy, with 48% indicating they would not get vaccinated.
• Perceived necessity for the vaccine and belief in its effectiveness contributed to intention to be vaccinated for COVID-19; for example, about one-quarter of those who said they would not get vaccinated, versus 9% of those who said they would, had doubts about the vaccine's effectiveness.
• Participants who agreed with the statement, "When it comes to COVID-19, Black people cannot trust health care providers" were less likely to say they would get vaccinated.
• Mistrust in the government around COVID-19, as well as perceptions of racism and unequal treatment in health care around COVID-19, were high. For example, 59% of all respondents agreed or strongly agreed that, "The government cannot be trusted to tell the truth about COVID-19."
• When asked which sources they trusted for information about COVID-19, healthcare providers are more trusted than elected officials. Furthermore, healthcare providers were trusted by higher percentages of participants who said they would get the vaccine (72%) than those who said they would not (56%). Although religious leaders are commonly mentioned as trusted sources in Black communities, only 8% said they would trust faith-based organisations (FBOs) for information about COVID-19 - possibly because FBOs may not be seen as a source for scientific information. Low percentages of respondents trusted media sources for COVID-19 information, and 14% said they did not trust any of the information sources listed in the survey.
• Subjective social norms (i.e., social pressure from others, such as friends and family) emerged as a key component of vaccine hesitancy: The more that participants believed that people close to them would want them to get vaccinated, the more likely they were to say they would get vaccinated, too.

In addition, the researchers conducted in-depth semi-structured telephone interviews with 18 of the 66 participants who indicated high COVID-19 vaccine hesitancy on the ALP survey. (Interviews are ongoing.) The next section of the report describes themes that have emerged to date, illustrated through quotations from participants explaining in their own words what might help to address COVID-19 vaccine hesitancy. Sample suggestions:

• Public health campaigns should involve trusted, known community members and trusted local organisations.
• Partnerships with Black celebrities (e.g., hip-hop artists) could encourage vaccination.
• Concerns about effectiveness, long-term side effects, and costs could be addressed openly by healthcare providers through informational webinars, community forums, and other online events.
• Black doctors and scientists are especially important messengers to both promote trust in the vaccine and encourage broader trust in science and research trials.
• Prior to providing information about the vaccine, public health messages and healthcare providers should acknowledge historical and contemporary racism, including systemic inequity and structural racism, as justifiable reasons for mistrust.

Finally, the researchers engaged with an advisory committee comprising eight key stakeholders who represent organisations in Black communities or subgroups of Black communities (e.g., people living with HIV, sexual and gender minority individuals, immigrant communities) that have been most affected by COVID-19. Some of their recommendations:

• Tailor to each community the content, information source, and mode of public health messages and communication strategies to address vaccine hesitancy.
• Do the necessary background research to understand reasons for vaccine hesitancy and to identify trusted sources of information in each community.
• Ensure that messages and communication strategies to promote vaccination address key predictors of hesitancy, including concerns about harm and side effects, with specific information and data from vaccine trials.
• Provide education and opportunities for dialogue, preferably led by trusted Black healthcare providers, that are focused on addressing healthcare workers' concerns about COVID-19 vaccines through transparent, factual information.
• Guide healthcare personnel to avoid simply telling patients to get vaccinated and instead to listen to them with empathy, acknowledge their reasons for hesitancy in a nonjudgmental, nonconfrontational manner, and provide accurate information so that patients can make an informed decision.
• Engage in long-term, authentic efforts to increase the trustworthiness of healthcare organisations, pharmaceutical companies, and the government.

In conclusion, the researchers hope the results of this research can inform new and ongoing efforts to encourage COVID-19 vaccine uptake, build trust, and, ultimately, reduce health inequities in Black communities.