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Changes in COVID-19 Vaccine Hesitancy Among Black and White Individuals in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How has COVID-19 vaccine hesitancy changed among Black and White individuals in the US since vaccines became publicly available?

Findings  This survey study of 1200 US adults found that COVID-19 vaccine hesitancy decreased more rapidly among Black individuals than among White individuals since December 2020. A key factor associated with this pattern seems to be the fact that Black individuals more rapidly came to believe that vaccines were necessary to protect themselves and their communities.

Meaning  This study suggests that ongoing efforts to increase vaccine uptake among Black individuals in the US should attend to a range of vaccination barriers beyond vaccine hesitancy.

Abstract

Importance  COVID-19 has disproportionately affected Black individuals in the US; however, vaccination rates among Black individuals trail those among other racial groups. This disparity is often attributed to a high level of vaccine hesitancy among Black individuals, but few studies have examined changes in vaccine hesitancy over time.

Objectives  To compare changes in vaccine hesitancy between Black and White individuals in the US and to examine mechanisms that might help explain the observed differences.

Design, Setting, and Participants  This survey study used 7 waves of data collected using a panel design. A total of 1200 English-speaking adults in the US were recruited from a nonprobability online panel to construct a census-matched sample. Participants were contacted monthly between December 9, 2020, and June 16, 2021.

Main Outcomes and Measures  The main outcome of interest was self-reported vaccination intention, measured on a 6-point scale (where 1 indicates extremely unlikely and 6 indicates extremely likely). Beliefs about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores denoting greater agreement.

Results  The baseline data included 1200 participants (693 women [52.0%; weighted]; 921 White individuals [64.0%; weighted], 107 Black individuals [12.2%; weighted]; weighted mean [SD] age, 49.5 [17.6] years). The survey participation rate was 57.0% (1264 of 2218). Black and White individuals had comparable vaccination intentions in December 2020, but Black individuals experienced larger increases in vaccination intention than White individuals relative to baseline in March 2021 (b = 0.666; P < .001), April 2021 (b = 0.890; P < .001), May 2021 (b = 0.695; P < .001), and June 2021 (b = 0.709; P < .001). The belief that the vaccines are necessary for protection also increased more among Black than White individuals in March 2021 (b = 0.221; P = .01) and April 2021 (b = 0.187; P = .04). Beliefs that the vaccines are safe and effective (b = 0.125; P < .001) and necessary (b = 0.405; P < .001) were positively associated with vaccination intention. There was no evidence that these associations varied by race.

Conclusions and Relevance  This survey study suggests that the intention of Black individuals to be vaccinated was initially comparable to that of White individuals but increased more rapidly. There is some evidence that this increase is associated with changes in beliefs about the vaccine. Vaccination rates continue to be lower among Black individuals than White individuals, but these results suggest that this might be less likely the result of vaccine hesitancy than other factors.

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Article Information

Accepted for Publication: November 29, 2021.

Published: January 21, 2022. doi:10.1001/jamanetworkopen.2021.44470

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Padamsee TJ et al. JAMA Network Open.

Corresponding Author: Tasleem J. Padamsee, PhD, College of Public Health, The Ohio State University, 1841 Neil Ave, 280F Cunz Hall, Columbus OH 43210 (padamsee.1@osu.edu).

Author Contributions: Drs Bond and Garrett had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Padamsee, Bond, Na, Nisbet, Wegener, Garrett.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Padamsee, Bond, Dixon, Nisbet, Garrett.

Critical revision of the manuscript for important intellectual content: Padamsee, Bond, Hovick, Na, Nisbet, Wegener, Garrett.

Statistical analysis: Bond, Garrett.

Obtained funding: Bond, Dixon, Nisbet, Wegener, Garrett.

Administrative, technical, or material support: Dixon, Hovick, Garrett.

Supervision: Garrett.

Conflict of Interest Disclosures: Drs Na, Nisbet, and Garrett reported receiving grants from the National Science Foundation during the conduct of the study. Dr Padamsee reported receiving grant funding 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. No other disclosures were reported.

Funding/Support: This material is based on work supported by the National Science Foundation under grant SES-2031705.

Role of the Funder/Sponsor: The National Science Foundation had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Disclaimer: Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

Additional Contributions: We thank Olivia Bullock, MA, Ohio State University, for her assistance with data collection. Ms Bullock was compensated for her contribution.

References
1.
Abedi  V , Olulana  O , Avula  V ,  et al.  Racial, economic and health inequality and COVID-19 infection in the United States.   medRxiv. Preprint posted online May 1, 2020. doi:10.1101/2020.04.26.20079756 Google Scholar
2.
Gross  CP , Essien  UR , Pasha  S , Gross  JR , Wang  SY , Nunez-Smith  M .  Racial and ethnic disparities in population-level COVID-19 mortality.   J Gen Intern Med. 2020;35(10):3097-3099. doi:10.1007/s11606-020-06081-w PubMedGoogle ScholarCrossref
3.
Hardy  BL , Logan  TD . Racial economic inequality amid the COVID-19 crisis. The Hamilton Project. Published August 2020. Accessed December 10, 2021. https://www.hamiltonproject.org/assets/files/EA_HardyLogan_LO_8.12.pdf
4.
World Health Organization. WHO coronavirus (COVID-19) dashboard. Accessed July 14, 2021. https://covid19.who.int/
5.
Centers for Disease Control and Prevention. COVID data tracker. Published March 28, 2020. Accessed July 14, 2021. https://covid.cdc.gov/covid-data-tracker
6.
Ndugga N, Pham O, Hill L, Artiga S, Parker N. Latest data on COVID-19 vaccinations by race/ethnicity. Kaiser Family Foundation. Published July 8, 2021. Accessed July 14, 2021. https://web.archive.org/web/20210709203754/https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/
7.
Nemeth  JM , Padamsee  TJ, . Ohio’s COVID-19 populations needs assessment. College of Public Health, The Ohio State University. Published October 2020. Accessed July 14, 2021. https://cph.osu.edu/inequitable-burdens-covid-19
8.
MacDonald  NE ; SAGE Working Group on Vaccine Hesitancy.  Vaccine hesitancy: definition, scope and determinants.   Vaccine. 2015;33(34):4161-4164. doi:10.1016/j.vaccine.2015.04.036 PubMedGoogle ScholarCrossref
9.
Larson  HJ , Cooper  LZ , Eskola  J , Katz  SL , Ratzan  S .  Addressing the vaccine confidence gap.   Lancet. 2011;378(9790):526-535. doi:10.1016/S0140-6736(11)60678-8 PubMedGoogle ScholarCrossref
10.
Black  S , Rappuoli  R .  A crisis of public confidence in vaccines.   Sci Transl Med. 2010;2(61):mr1. doi:10.1126/scitranslmed.3001738PubMedGoogle ScholarCrossref
11.
Olive  JK , Hotez  PJ , Damania  A , Nolan  MS .  The state of the antivaccine movement in the United States: a focused examination of nonmedical exemptions in states and counties.   PLoS Med. 2018;15(6):e1002578. doi:10.1371/journal.pmed.1002578 PubMedGoogle Scholar
12.
Quinn  SC , Jamison  AM , An  J , Hancock  GR , Freimuth  VS .  Measuring vaccine hesitancy, confidence, trust and flu vaccine uptake: results of a national survey of White and African American adults.   Vaccine. 2019;37(9):1168-1173. doi:10.1016/j.vaccine.2019.01.033 PubMedGoogle ScholarCrossref
13.
National Foundation for Infectious Diseases. National survey: Black adult perspectives on COVID-19 and flu vaccines. Published February 4, 2021. Accessed July 14, 2021. https://www.nfid.org/national-survey-black-adult-perspectives-on-covid-19-and-flu-vaccines/
14.
Webb Hooper  M , Nápoles  AM , Pérez-Stable  EJ .  No populations left behind: vaccine hesitancy and equitable diffusion of effective COVID-19 vaccines.   J Gen Intern Med. 2021;36(7):2130-2133. doi:10.1007/s11606-021-06698-5PubMedGoogle ScholarCrossref
15.
Szilagyi  PG , Thomas  K , Shah  MD ,  et al.  National trends in the US public’s likelihood of getting a COVID-19 vaccine—April 1 to December 8, 2020.   JAMA. 2020;325(4):396-398. doi:10.1001/jama.2020.26419 PubMedGoogle ScholarCrossref
16.
Nguyen  KH , Srivastav  A , Razzaghi  H ,  et al.  COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination—United States, September and December 2020.   MMWR Morb Mortal Wkly Rep. 2021;70(6):217-222. doi:10.15585/mmwr.mm7006e3 PubMedGoogle ScholarCrossref
17.
Callaghan  T , Moghtaderi  A , Lueck  JA ,  et al.  Correlates and disparities of intention to vaccinate against COVID-19.   Soc Sci Med. 2021;272:113638. doi:10.1016/j.socscimed.2020.113638 PubMedGoogle Scholar
18.
Ruiz  JB , Bell  RA .  Predictors of intention to vaccinate against COVID-19: results of a nationwide survey.   Vaccine. 2021;39(7):1080-1086. doi:10.1016/j.vaccine.2021.01.010 PubMedGoogle ScholarCrossref
19.
Fisher  KA , Bloomstone  SJ , Walder  J , Crawford  S , Fouayzi  H , Mazor  KM .  Attitudes toward a potential SARS-CoV-2 vaccine: a survey of U.S. adults.   Ann Intern Med. 2020;173(12):964-973. doi:10.7326/M20-3569 PubMedGoogle ScholarCrossref
20.
Stern  MF , Piasecki  AM , Strick  LB ,  et al.  Willingness to receive a COVID-19 vaccination among incarcerated or detained persons in correctional and detention facilities—four states, September-December 2020.   MMWR Morb Mortal Wkly Rep. 2021;70(13):473-477. doi:10.15585/mmwr.mm7013a3 PubMedGoogle ScholarCrossref
21.
Kreps  S , Prasad  S , Brownstein  JS ,  et al.  Factors associated with US adults’ likelihood of accepting COVID-19 vaccination.   JAMA Netw Open. 2020;3(10):e2025594. doi:10.1001/jamanetworkopen.2020.25594 PubMedGoogle Scholar
22.
Dodd  RH , Pickles  K , Nickel  B ,  et al.  Concerns and motivations about COVID-19 vaccination.   Lancet Infect Dis. 2021;21(2):161-163. doi:10.1016/S1473-3099(20)30926-9 PubMedGoogle ScholarCrossref
23.
Romer  D , Jamieson  KH .  Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S.   Soc Sci Med. 2020;263:113356. doi:10.1016/j.socscimed.2020.113356 PubMedGoogle Scholar
24.
Pummerer  L , Böhm  R , Lilleholt  L , Winter  K , Zettler  I , Sassenberg  K . Conspiracy theories and their societal effects during the COVID-19 pandemic.  Soc Psychol Personal Sci. Published online March 19, 2021. doi:10.1177/19485506211000217
25.
Bunch  L .  A tale of two crises: addressing COVID-19 vaccine hesitancy as promoting racial justice.   HEC Forum. 2021;33(1-2):143-154. doi:10.1007/s10730-021-09440-0 PubMedGoogle ScholarCrossref
26.
Corbie-Smith  G .  Vaccine hesitancy is a scapegoat for structural racism.   JAMA Health Forum. 2021;2(3):e210434. doi:10.1001/jamahealthforum.2021.0434 Google Scholar
27.
Fair  MA , Johnson  SB .  Addressing racial inequities in medicine.   Science. 2021;372(6540):348-349. doi:10.1126/science.abf6738 PubMedGoogle ScholarCrossref
28.
Warren  RC , Forrow  L , Hodge  DA  Sr , Truog  RD .  Trustworthiness before trust—COVID-19 vaccine trials and the Black community.   N Engl J Med. 2020;383(22):e121. doi:10.1056/NEJMp2030033 PubMedGoogle Scholar
29.
Bajaj  SS , Stanford  FC .  Beyond Tuskegee—vaccine distrust and everyday racism.   N Engl J Med. 2021;384(5):e12. doi:10.1056/NEJMpv2035827 PubMedGoogle Scholar
30.
Jaiswal  J , Halkitis  PN .  Towards a more inclusive and dynamic understanding of medical mistrust informed by science.   Behav Med. 2019;45(2):79-85. doi:10.1080/08964289.2019.1619511 PubMedGoogle ScholarCrossref
31.
Ferdinand  KC .  Overcoming barriers to COVID-19 vaccination in African Americans: the need for cultural humility.   Am J Public Health. 2021;111(4):586-588. doi:10.2105/AJPH.2020.306135 PubMedGoogle ScholarCrossref
33.
American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. Revised 2016. Accessed November 12, 2021. https://www.aapor.org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal.pdf
34.
Allison  PD . Liao TF, ed. Fixed Effects Regression Models. Vol 160. Sage Publications; 2009.
35.
African American Leadership Forum. COVID-19. Accessed July 14, 2021. https://web.archive.org/web/20210507164215/https://tcaalf.com/covid-19/
36.
American Public Health Association. COVID-19 and equity. Accessed July 14, 2021. https://apha.org/topics-and-issues/communicable-disease/coronavirus/equity
37.
The News & Observer. Rev. William Barber: “Show up and be vaccinated”. YouTube video. Accessed July 14, 2021. https://www.youtube.com/watch?v=ZLWQFsZ7Yo4
38.
The Ohio State University Wexner Medical Center. Making the decision to get the COVID-19 vaccine. Accessed July 14, 2021. https://wexnermedical.osu.edu/features/coronavirus/patient-care/covid-19-vaccine/making-the-decision-to-get-vaccinated
39.
Jones  M . The COVID-19 vaccine in the Black community: let’s take care of each other. Raleigh News & Observer. March 16, 2021. Accessed July 14, 2021. https://www.newsobserver.com/opinion/article249951699.html
40.
Johns Hopkins Medicine. COVID-19 vaccines and people of color. Updated April 16, 2021. Accessed July 14, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-vaccines-and-people-of-color
41.
Kaiser Permanente. Supporting equitable COVID-19 vaccine education. Published March 9, 2021. Accessed July 14, 2021. https://about.kaiserpermanente.org/our-story/news/announcements/supporting-equitable-covid-19-vaccine-education
42.
Perkins  DEA .  A COVID-19 vaccination challenge.   Am J Nurs. 2021;121(3):11-11. doi:10.1097/01.NAJ.0000737224.48167.78 PubMedGoogle ScholarCrossref
43.
Privor-Dumm  L , King  T .  Community-based strategies to engage pastors can help address vaccine hesitancy and health disparities in Black communities.   J Health Commun. 2020;25(10):827-830. doi:10.1080/10810730.2021.1873463 PubMedGoogle ScholarCrossref
44.
Schaeffer K. The most common age among Whites in U.S. is 58—more than double that of racial and ethnic minorities. Pew Research Center. Published July 30, 2019. Accessed July 14, 2021. https://www.pewresearch.org/fact-tank/2019/07/30/most-common-age-among-us-racial-ethnic-groups/
45.
Ward  E , Halpern  M , Schrag  N ,  et al.  Association of insurance with cancer care utilization and outcomes.   CA Cancer J Clin. 2008;58(1):9-31. doi:10.3322/CA.2007.0011 PubMedGoogle ScholarCrossref
46.
Simon  K , Soni  A , Cawley  J .  The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions.   J Policy Anal Manage. 2017;36(2):390-417. doi:10.1002/pam.21972 PubMedGoogle ScholarCrossref
47.
Kaiser Family Foundation. KFF COVID-19 vaccine monitor dashboard. Accessed July 14, 2021. https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard/
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