New Study Finds Vaccine Hesitancy Highest Among African Americans

Researchers say understanding hesitancy is key to minimizing health inequities.

Black female physician vaccinates Black male patient

Researchers at the University of Arkansas for Medical Sciences have found that trust in vaccines, fear of infection and race or ethnicity play a large role in whether or not people will get a COVID-19 vaccine, particularly when looking at socio-demographic factors.

In the study, “COVID-19 Vaccine Hesitancy: Race/Ethnicity, Trust and Fear,” published in Clinical and Translational Science, researchers found the majority of respondents who were surveyed in July and August of 2020 were not hesitant. Only about one in five (21 percent) reported vaccine hesitancy.

However, when looking at socio-demographic factors, the findings were much more pronounced across age, sex, race and ethnicity, income and education, according to a press release. Research subjects who were younger, African American, lower income and those who had some college or a technical degree were more likely to report hesitancy as opposed to those who were older, white, higher income and who had a four-year college degree.

Prevalence of COVID-19 vaccine hesitancy was highest among African Americans (50 percent), respondents with household income less than $25,000 (30.68 percent), people with some college (32.17 percent), people with little to no fear of infection from COVID-19 (62.50 percent) and people with low trust in vaccines in general (55.84 percent).

In addition, the odds of COVID-19 vaccine hesitancy were:

  • 2.42 greater for African American respondents compared to white respondents
  • 1.67 greater for respondents with some college or a technical degree compared to respondents with a four-year degree
  • 5.48 greater for respondents with no fear of COVID-19 infection compared to those who fear infection to a great extent
  • 11.32 greater for respondents with low trust in vaccines in general

Trust is a major factor in people’s hesitancy to get a COVID-19 vaccine, said Don Willis, co-principal investigator and lead author on the research study.

“It’s like you’re hanging on to the edge of a cliff and someone throws you a rope,” Willis said in a recent conversation on the ASCPT Podcast Channel. “You’re terrified to fall, but you are also not sure if you can trust the strength of the rope or the person that threw you the rope.”

In this case, Willis was specifically describing those people who are both fearful of infection and hesitant towards the vaccine. He pointed out that most people who had high fear of infection were not hesitant, but this relationship was different specifically for African American respondents who on average had the highest prevalence of both fear and hesitancy.

“Building trust in institutions takes a concerted effort and time,” he said. “Although the urgency of the pandemic is spurring efforts toward trust and transparency, without a sustained effort of community engagement, any gains in trust may be lost.”

The researchers surveyed 1,205 adult Arkansans online in July and August 2020 to determine vaccine hesitancy based on socio-demographics, COVID-19 health literacy, fear of COVID-19 infection and general trust in vaccines.

“Arkansas is an important place to look at this subject,” Willis said. “Arkansas is a very rural state, and there has been earlier research suggesting that rural areas have higher rates of vaccine hesitancy. Arkansas also has a large population of people who are at high risk for serious illness due to COVID-19, a large population of people who are over 65 and suffer from chronic illnesses such as diabetes, heart disease, COPD, asthma and BMI greater than 40.”

The researchers emphasized that understanding and minimizing COVID-19 vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic.

“I think one takeaway is understanding that hesitancy isn’t all about information and facts and education,” Willis said. “It would be nice if it was that way. We could just inform and educate, and everything would be solved. But hesitancy is also about feelings and trust and the social meanings that we attach to vaccines, as well as past experiences and historical legacies of medical racism.”

Joining Willis on this research were Jennifer Andersen, Keneshia Bryant-Moore, James Selig, Christopher Long, Holly Felix, Geoffrey Curran and Pearl McElfish.