Low vaccine uptake in black communities typically an entry situation: research

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Blacks and whites were similarly reluctant to receive COVID-19 vaccines when they first became available, but new data suggests black Americans overcame their reluctance faster than whites.

The results of a new study suggest that hesitancy is unlikely to be the main reason for comparatively low vaccine uptake in the black community, the authors say, and that evidence points to problems in access.

dr Tasleem J. Padamsee

“We have discussed a lot about hesitation as the main reason for not being vaccinated and it is assumed that people do not get vaccinated because they do not want to be vaccinated. Here we find a discrepancy. Black Americans are less commonly vaccinated than white Americans by a few percentage points, but they are as likely or more likely to be,” first author Tasleem J. Padamsee, PhD, Assistant Professor, Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus , Ohio, to Medscape Medical News.

In their research, she and her colleagues cite data from the Centers for Disease Control and Prevention showing that “the percentage of whites who have received at least one dose of the vaccine is about 1.5 times the percentage of blacks; immunization coverage among whites is higher within each state, although the size of the disparity varies.”

The results were published online in JAMA Network Open on Friday.

Evidence of the reasons for low vaccine uptake is particularly important given that black communities have been disproportionately impacted by COVID-19, with more cases, deaths and a more severe economic impact than other racial and ethnic communities.

This study is part of a larger project by market research firm YouGov that 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 the Padamsee study, the researchers’ main outcome was self-reported intention to vaccinate, measured on a 6-point scale (1 represents extremely unlikely and 6 represents extremely likely). Beliefs about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores indicating greater agreement.

The researchers found that as of December 2020, only 36% to 49% of blacks (compared to 44% to 59% of whites) said they plan to get the vaccine if they are eligible.

As of March 2021, however, the picture was different. Compared to baseline, in wave 4 (March 2021; b=0.666; p<0.001), wave 5 (April 2021), black participants' intention to vaccinate had increased more than that of white participants; b = 0.890; P<0.001), wave 6 (May 2021; b=0.695; P<0.001) and wave 7 (June 2021; b=0.709; P<0.001).

Padamsee said there should be a shift in the assumption that there are low vaccination rates in the black community because of the hesitation. Instead, investigating access issues should be a priority, she said.

Access issues could be perceptions that wages will be lost if people are forced to stop working because of negative effects from the vaccine. Access issues could also include misperceptions that the vaccine will be expensive to obtain when in reality it is free, Padamsee said.

“For both large state agencies and small community groups, it’s about figuring out what’s really getting in the way, being open to the fact that it might really be a barrier to entry and that those issues need to be addressed,” she said.

Messenger as important as message

Padamsee said a strength of her study is that it offers unique data that allowed her team to follow 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, a professor of sociology at the University of Colorado Denver, said she agrees that “hesitation isn’t the end of the conversation.”

“People who raise concerns about a vaccine are not immobile, and there is evidence that people are changing their minds with new information,” she told Medscape Medical News.

dr Jennifer Rich

She said that as we build on this work, it will be important to know more about attitudes in the black community by subgroup, such as: B. geographic location, income, political affiliation and employment status to tailor meaningful immunization messages.

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

In this regard, Reich pointed out that different states have different strategies for placing vaccine clinics, noting that some rely solely on contracts with corporate pharmacies, while others follow an outreach strategy.

In Colorado, she said, “We have a structure where any community organization can request an on-site immunization clinic.”

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

“Colorado has a mobile vaccination clinic that has gone everywhere from factories to nightclubs,” she said.

“The idea that it can be easily accessible and we can take healthcare to where people are already is hopefully one of the lessons from COVID that we keep,” Reich said. “Basic services have never been easily accessible for people who work.”

Co-authors 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 a contributing editor to the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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