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

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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.


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 (

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.

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