Factors Associated With Racial/Ethnic Group–Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US

Thompson, Hayley S.; Manning, Mark; Mitchell, Jamie A.; Kim, Seongho; Harper, Felicity W. K.; Cresswell, Sheena; Johns, Kristopher; Pal, Shoma; Dowe, Brittany; Tariq, Madiha; Sayed, Nadia; Saigh, Lisa M; Rutledge, Lisa H.; Lipscomb, Curtis; Lilly, Jametta Y; Gustine, Heidi; Sanders, Annie; Landry, Megan; Marks, Bertram

doi:10.1001/jamanetworkopen.2021.11629

Cited by 158 publications

(124 citation statements)

References 14 publications

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“…We identified some studies related to COVID-19 vaccination and minority ethnic groups in our search; however, these were all excluded due to age criteria or their focus on vaccinations in development. Recent studies that have explored COVID-19 vaccination hesitancy amongst minority ethnic groups of all ages have reported similar barriers to those we have identified: perceived risk of getting infected with COVID-19, concerns about side effects and safety, and medical mistrust amongst Hispanic and African Americans [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 60%

Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review

et al. 2021

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Background Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and have increased risk of mortality. Whilst an age-based vaccination approach prioritising older groups is being implemented worldwide, vaccine hesitancy is high amongst minority ethnic groups. Methods and findings We conducted a systematic review and convergent synthesis to systematically examine perceptions of vaccinations amongst older adults from minority ethnic backgrounds. We included studies that reported on perceptions, beliefs, and attitudes towards vaccinations in older adults aged ≥65 years from a minority ethnic background. We excluded studies of vaccinations in investigation or development, studies focused on specific medical conditions, studies where ethnic background or age group was unidentifiable, systematic reviews, editorials, and conference abstracts. We searched MEDLINE, Embase, Virtual Health Library, Web of Science, Cochrane Library, medRxiv, and PROSPERO databases from inception to 15 July 2021. Risk of bias for studies was assessed using the Mixed Methods Appraisal Tool. The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative research (GRADE–CERQual) framework. A total of 28 eligible studies conducted between 1997 and 2020 were included in the final analysis (17 quantitative surveys, 8 focus group or interview studies, 2 mixed methods studies, and 1 case–control study). The majority were US studies in English or Spanish, except for 6 studies set in Hong Kong, 2 studies in Japan, 1 study in Brazil, and 1 multi-centre study (including China, Indonesia, Turkey, South Korea, Greece, UK, Brazil, and Nigeria). In total, 28,262 individuals with an estimated mean age of 69.8 years were included, 63.2% of whom were female. We summarised the common concepts and themes across studies and populations using a convergent synthesis analysis. Thirteen themes categorised as barriers or facilitators were identified and grouped into structural factors—healthcare provider and system related, patient related, and policy and operational—and were analysed by minority ethnic group. The main limitation of the study was the predominance of studies from the US and East Asia. Conclusions In this systematic review, we found that factors influencing vaccination uptake involve healthcare provider and system, patient-related, and governance-level factors that are specific to the older ethnic minority community being served. The evidence included in this review is supported by high or moderate certainty and can be translated to practice and policy. A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact of widespread vaccination policies.

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Section: Discussionmentioning

confidence: 60%

Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review

et al. 2021

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“…Like influenza, mistrust is now being highlighted as a significant barrier to COVID‐19 vaccination. 10 These issues are often multi‐faceted. In a 3‐month cross‐sectional UK study by Impact on Urban Health previous healthcare discrimination, and historical unethical medical practice, both contributed to current vaccine hesitancy amongst majority Black communities in South London, who were more likely to be negatively impacted by COVID‐19.…”

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confidence: 99%

COVID‐19 vaccinations among Black Asian and Minority Ethnic (BAME) groups: Learning the lessons from influenza

et al. 2021

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Background The COVID‐19 vaccination roll‐out continues to grow at significant pace around the world. There is, however, growing concern regarding vaccine hesitancy amongst Black, Asian and Minority Ethnic (BAME) populations. Such inequalities have the potential for exposing, an already at‐risk population, further. Whilst the COVID‐19 vaccination programme is in its infancy, influenza programmes have been undertaken for over 50 years, and may provide invaluable insights. In this commentary, we aim to examine the lessons from influenza vaccinations, and how this can help reduce inequalities with COVID‐19 vaccinations. Main Text Several factors have been associated with both seasonal and pandemic influenza vaccine hesitancy amongst BAME groups. One of the most prevalent barriers in both types of immunisation programmes is the mistrust of medical organisations. This is often a multi‐faceted issue, with previous negative healthcare discrimination, and historical unethical practices contributing towards this scepticism. This mistrust, however, is predominantly aimed towards healthcare systems, as opposed to individual physicians. In fact, physician endorsement is often a strong driver to vaccination, with Black patients who receive this support 8 times more likely to receive seasonal influenza vaccination. On the other hand, with H1N1 pandemic influenza vaccination, social norms or community influence, was an important determinant. In both seasonal and pandemic immunisation programmes, a significant amount of concern regarding side‐effects, including misinformation, was reported amongst BAME groups. Conclusions The use of community‐based approaches, with local advocacy, has the potential to counteract misinformation, and concerns regarding side‐effects. Moreover, using consistent physician endorsement not only in media campaigns but also through messaging would potentially help to address longstanding healthcare mistrust amongst minority ethnic groups. Close attention regarding how the vaccination programme, and the health policies introduced as a consequence, affect BAME communities in order to prevent widening inequalities in the future.

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“…Although multiple highly effective SARS-CoV-2 vaccines have been rapidly developed and are now available, public health measures remain critical to controlling the pandemic [ 5 ]. Vaccination rates vary widely by state, with vaccine accessibility, hesitancy, misinformation, and mistrust contributing to incomplete uptake, particularly among historically underrepresented groups [ 6 – 9 ]. Furthermore, the Centers for Disease Control and Prevention (CDC) has recorded more than 10,000 breakthrough infection cases, [ 10 ] contributing to vaccine hesitancy.…”

Section: Introductionmentioning

confidence: 99%

At-home testing to mitigate community transmission of SARS-CoV-2: protocol for a public health intervention with a nested prospective cohort study

et al. 2021

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Background The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve as a global health crisis. Although highly effective vaccines have been developed, non-pharmaceutical interventions remain critical to controlling disease transmission. One such intervention—rapid, at-home antigen self-testing—can ease the burden associated with facility-based testing programs and improve testing access in high-risk communities. However, its impact on SARS-CoV-2 community transmission has yet to be definitively evaluated, and the socio-behavioral aspects of testing in underserved populations remain unknown. Methods As part of the Rapid Acceleration of Diagnostics–Underserved Populations (RADx-UP) program funded by the National Institutes of Health, we are implementing a public health intervention titled “Say Yes! COVID Test” (SYCT) involving at-home self-testing using a SARS-CoV-2 rapid antigen assay in North Carolina (Greenville, Pitt County) and Tennessee (Chattanooga City, Hamilton County). The intervention is supported by a multifaceted communication and community engagement strategy to ensure widespread awareness and uptake, particularly in marginalized communities. Participants receive test kits either through online orders or via local community distribution partners. To assess the impact of this intervention on SARS-CoV-2 transmission, we will conduct a non-randomized, ecological study using community-level outcomes. Specifically, we will evaluate trends in SARS-CoV-2 cases and hospitalizations, SARS-CoV-2 viral load in wastewater, and population mobility in each community before, during, and after the SYCT intervention. Individuals who choose to participate in SYCT will also have the option to enroll in an embedded prospective cohort substudy gathering participant-level data to evaluate behavioral determinants of at-home self-testing and socio-behavioral mechanisms of SARS-CoV-2 community transmission. Discussion This is the first large-scale, public health intervention implementing rapid, at-home SARS-CoV-2 self-testing in the United States. The program consists of a novel combination of an at-home testing program, a broad communications and community engagement strategy, an ecological study to assess impact, and a research substudy of the behavioral aspects of testing. The findings from the SYCT project will provide insights into innovative methods to mitigate viral transmission, advance the science of public health communications and community engagement, and evaluate emerging, novel assessments of community transmission of disease.

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Factors Associated With Racial/Ethnic Group–Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US

Cited by 158 publications

References 14 publications

Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review

Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review

COVID‐19 vaccinations among Black Asian and Minority Ethnic (BAME) groups: Learning the lessons from influenza

At-home testing to mitigate community transmission of SARS-CoV-2: protocol for a public health intervention with a nested prospective cohort study

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