Background COVID-19 vaccination rates are lower among historically marginalized populations, including Black/African American and Latinx populations, threatening to contribute to already high COVID-19 morbidity and mortality disparities for these groups. We conducted a community-based participatory research study using qualitative methods to explore knowledge and beliefs about COVID-19 vaccination among Black/African American, Latinx, and Chinese American residents of the San Francisco Bay Area and assess their views on vaccination outreach and delivery strategies. Methods and findings Data were collected from January 14, 2021, to February 24, 2021, with adult residents (N = 109 [Female: N = 76; 70%]) in San Francisco. Focus groups (N = 10) and in-depth interviews (N = 25) were conducted among Black/African Americans (N = 35), Latinx (N = 40), and Chinese Americans (n = 34) in English, Spanish, Cantonese, or Mandarin. Themes were identified using grounded field theory, and included misinformation, mistrust of government and health institutions, and linguistic and other barriers to vaccine access. All three racial/ethnic groups had experiences with vaccine misinformation and information overload. Many African American and Latinx participants cited structural and interpersonal racism, and anti-immigrant discrimination, as factors reducing their trust in government and public health disseminated information and their willingness to be vaccinated. Participants expressed trust in community-based organizations, including faith-based organizations and community-run clinics. Participants often experienced barriers to vaccine access, such as transportation to drive-in sites, with Latinx and Chinese American groups also frequently citing language barriers. Conclusions Vaccine outreach strategies must acknowledge how longstanding systemic, institutional, and structural racism contributes to mistrust in government and health institutions and engage with and support trusted messengers from the community to eliminate cultural, linguistic, and other barriers to vaccine access.

Background: COVID-19 vaccination rates among U.S. young adults, particularly in communities of color, remain lower than other age groups. We conducted a qualitative, community-based participatory study to explore beliefs and attitudes about COVID-19 vaccines among young adults in Black/African American, Latinx, and Asian American or Pacific Islander (AAPI) communities in the San Francisco Bay Area. Methods: We conducted six focus groups between June and August 2021. Participants were recruited by partnering with community-based organizations in the San Francisco Bay Area. Focus groups included Black/African American ( N =13), Latinx ( N =20), and AAPI ( N =12) participants between 18 and 30 years of age. Emerging themes were identified using a modified Grounded Theory approach. Results: Prominent themes among all three racial-ethnic groups included mistrust in medical and government institutions, strong conviction about self-agency in health decision-making, and exposure to a thicket of contradictory information and misinformation in social media. Social benefit and a sense of familial and societal responsibility were often mentioned as reasons to get vaccinated. Young adult mistrust had a generational flavor fueled by anger about increasing inequity, the profit-orientation of pharmaceutical companies and health institutions, society's failure to rectify injustice, and pessimism about life prospects. Conclusion: Factors influencing vaccine readiness among Black/African American, Latinx, and AAPI young adults have a distinct generational and life-course texture. Outreach efforts should appeal to young adults' interest in family and social responsibility and the social benefits of vaccination, while being cognizant of the friction mandates pose for young adults' sense of self-agency. Efforts will be most effective coming from trusted messengers with a proven commitment to communities of color and health equity.

Black and Latinx individuals in the US continue to be less likely than White individuals to have received the COVID-19 vaccine. 1 Achieving racial and ethnic equity in COVID-19 vaccination requires both individual and health system readiness. Individuals must be ready to get vaccinated, and systems administering vaccines must be ready to reach historically marginalized populations to ensure equitable access. Readiness is often viewed as a static proposition. Individuals are characterized as being either vaccine willing or hesitant, systems as prepared or unprepared.Our work with community members, patients, public health departments, and health care organizations has led us to conclude that for both individuals and systems, vaccination readiness is a dynamic and deliberative process. One of us (O.O.H.) adapted a theoretical model of stages of individual readiness to the training of contact tracers in California to conduct vaccination outreach. Two of us (K.G. and M.C.) have conducted community-based focus groups and interviews with Black/ African American, Chinese American, and Latinx residents in the San Francisco area to gain insight into their views about vaccination. One of us (K.G.) helps to lead the COVID Equity Work Group at UCSF Health, an academic health center; collaborates with the San Francisco Department of PublicHealth and community-based organizations on vaccine access and outreach programs; and assists patients in his primary care practice with vaccination decision-making. In this Viewpoint, we describe a model for stages of health system readiness for equitable vaccine delivery that may be used by public health departments, health care systems, federally qualified health centers, and other organizations involved in vaccine administration to assess and improve their capacity for achieving vaccination equity.

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