¹College of Public Health, The Ohio State University, Columbus
²School of Communication, The Ohio State University, Columbus
³Department of Communication and Media, Merrimack College, North Andover, Massachusetts
⁴School of Communication, Northwestern University, Evanston, Illinois
⁵Psychology Department, The Ohio State University, Columbus

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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

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

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

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 PubMed Google Scholar Crossref

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

World Health Organization. WHO coronavirus (COVID-19) dashboard. Accessed July 14, 2021. https://covid19.who.int/

Centers for Disease Control and Prevention. COVID data tracker. Published March 28, 2020. Accessed July 14, 2021. https://covid.cdc.gov/covid-data-tracker

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/

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

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

10.

Black S , Rappuoli R . A crisis of public confidence in vaccines. Sci Transl Med. 2010;2(61):mr1. doi:10.1126/scitranslmed.3001738 PubMed Google Scholar Crossref

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 PubMed Google 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 PubMed Google Scholar Crossref

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/s11606-021-06698-5 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google 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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google 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 PubMed Google Scholar Crossref

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 PubMed Google 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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google 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 PubMed Google 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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

32.

U.S. Census Bureau. 2018 ACS 1-year estimates. Accessed December 12, 2021. https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2018/1-year.html

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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/

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

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