Confidence and Hesitancy During the Early Roll-out of COVID-19 Vaccines Among Black, Hispanic, and Undocumented Immigrant Communities: a Review

Abstract

Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development (“warp speed”), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person’s decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.

A qualitative study of COVID-19 vaccine intentions and mistrust in Black Americans: Recommendations for vaccine dissemination and uptake

“…The current paper reports qualitative findings from semi-structured interviews with Black Americans who showed low vaccine confidence as well as stakeholders representing different Black communities during the early stage of the COVID-19 vaccine roll-out. We documented low COVID-19 vaccination intentions (e.g., the need to wait and see) and specific concerns around the COVID-19 vaccines (e.g., about rapid development and side effects), which are consistent with similar qualitative research in racially/ethnically diverse populations (including Black Americans) and quantitative evidence that showed greater COVID-19 vaccine related mistrust in Black Americans compared to White Americans [ 11 , 12 , 24 , 25 ]. Consistent with prior literature on disparities related to the vaccination intentions for COVID-19 as well as seasonal influenza, HPV, and future HIV vaccines in Black Americans and other racial/ethnic minority groups [ 11 , 26 – 30 ], our data also showed substantial and multiple structural barriers to vaccination (e.g., transportation, financial, technology barriers that block vaccine access), as well as the negative impact of persistent systemic racism on vaccination intentions among Black Americans.…”

“…Participants and stakeholders in the present study also identified system intervention strategies, from acknowledging systemic racism and improving the trustworthiness of institutions to preferred messaging contents, information sources and mode, and access points. While there were some novel ideas (e.g., discussing vaccination as empowerment), many of these strategies are consistent with the extant literature on strategies to increase COVID-19 vaccination update in Black communities and other racial/ethnic minority populations [ 11 , 12 ] as well as strategies to acknowledge medical mistrust in other health conditions such as HIV [ 13 , 17 ].…”

“…Although vaccine intentions and rates have increased over time in Black communities [ 8 ], vaccination rates among Black Americans were the lowest compared to other racial groups during most of 2021, suggesting insufficient efforts to increase access. News reports as well as recent research data have documented accommodation and accessibility barriers with COVID-19 vaccine access in Black and other underserved communities of color [ 9 – 12 ].…”

Strategies that Promote Equity in COVID-19 Vaccine Uptake for Undocumented Immigrants: A Review

“…The population groups most heavily affected by COVID-19 each require tailored interventions that address group-specific concerns [ 62 ]. For undocumented immigrants, this review highlights that the prominent issues around low vaccine uptake were less frequently attributed to medical mistrust which elsewhere in the literature was more often discussed as prominent for non-immigrant Black communities.…”

Pre- and post-COVID-19 all-cause mortality of Japanese citizens versus foreign residents living in Japan, 2015–2021

“…In particular, there is significant concern that the COVID-19 pandemic will exacerbate already existing health inequities between foreign residents and citizens ( Caron & Adegboye, 2021 ). Immigrants are more likely to experience COVID-19-related health disruptions because of crowded housing and large household size ( Kjollesdal et al, 2022 ), difficulty with health literacy ( Wang et al, 2020 ), concerns related to testing and treatment (e.g., requirements to present official identification or residency documentation) ( Lechuga et al, 2022 ), language barriers ( Caron & Adegboye, 2021 ), and inadequate insurance coverage ( McFadden et al, 2022 ). Furthermore, a multi-country analysis has shown that the threat posed by COVID-19 has led to increased “othering” of immigrant communities and anti-immigrant sentiment ( Mula et al, 2022 ).…”