Understanding vaccine hesitance among Black and Brown women continues to have a major impact on controlling the ongoing spread of COVID-19 in this country. It also speaks to addressing ongoing health equity issues beyond the pandemic. If COVID-19 taught America anything, it is that good and current data is a significant piece of the health equity puzzle. Data is key to making the invisible become visible and tracking to see if outreach solutions are having an impact. It took a global pandemic and the lack of solid data to show that we must be committed to digging deeper to uproot inequities if we are going to build a healthier America.
In an effort to get deeper insights into the decisions people are making about getting the COVID-19 vaccine, the Commonwealth Fund has partnered with the African American Research Collaborative (AARC) on the recently published report, What Do Americans Think About Getting Vaccinated Against COVID-19?, to gain insight into what drives health care decisions among the unvaccinated, especially among people of color. The poll had the largest sample of African Americans, Latinos, Asian Americans, Pacific Islanders, and Native Americans of any study of COVID-19 vaccine uptake to date.
We talked to the Commonwealth Fund’s Laurie Zephyrin, MD. MPH, MBA, Vice President for Advancing Health Equity, and Linda Goler Blount, MPH, President and CEO of the Black Women’s Health Imperative about the vaccines, hesitancy and the role of data collection in reaching women of color to address health equity.
What did you learn about the way Black and Brown women process information around COVID-19 vaccines?
Dr. Zephyrin: Our poll’s questions sought to find out how Americans, especially rural residents, people of color, and the unvaccinated, are currently thinking about the COVID-19 vaccines, what their concerns are, and what they think of having their children vaccinated and how those concerns might be addressed. While this information is important now, as it relates to getting as many people vaccinated as possible and ending this pandemic. It also casts light on how we might approach health inequities more broadly and improved outcomes moving forward. Some of our specific findings are:
- We find higher vaccine hesitancy among women generally than among men.
- There are similar levels of hesitancy among white, Black and Latina women with much lower levels of hesitancy among AAPI women (though AAPI women do have higher levels of hesitancy than AAPI men).
- Young women (18-34) are much more likely to be hesitant than women 60+
- For white young women, pregnancy issues move into the top 5 concerns (unsafe for pregnancies and causes infertility are both over 30%). This is also an important concern for young Native American women, but less so for other young women of color (does not exceed 30%).
- Income plays a big role. For Black women earning less than $50k, about 50% are hesitant. For those earning more than $50k, about 34% are hesitant.
Why is data collection and gathering information from the poll so important?
Dr. Zephyrin: Over a year later, the pandemic continues to show that the weak links in data collection, when it comes to the numbers of people who are diagnosed with COVID-19, the severity of their diagnosis, and mortality rates. Our survey adds a layer of depth to the conversation—addressing the impact of health system experiences and testing messages that can affect perception across unvaccinated groups of people, and how these findings can translate into individual and community action (or lack thereof).
Linda Blount: At the Black Women’s Health Imperative we have had our finger on the pulse of the challenges that Black women have had in dealing with COVID-19 over the past two years, including their decisions around being vaccinated. Since the first roll out of the vaccines, even in the discussions around boosters, we have gotten daily questions and requests for advice. Our role has been to make sure that we are sharing the best and most recent scientific data and evidence available, and what it means to them.
What did you learn from the survey?
Dr. Zephyrin: More than 40% of people of color who self-identified as vaccine hesitant indicated that they or a member of their household experienced discrimination in their interactions with the medical profession because of their race, ethnicity, or language. This poll emphasizes that perceptions and trust levels impact the way people interact with systems of care. Participants cited the experience of discrimination within the health care system as one reason why they have chosen not to get a COVID-19 vaccine and how they make other health decisions.
27% of Black and 22% of Native American respondents indicated that they believe discrimination from medical professionals against their racial/ethnic group makes it hard to trust that COVID-19 vaccines are safe and effective for themselves and others from their community. The health disparities contributing to this burden are long-standing. More survey participants cited the current day experience of discrimination as a more significant factor in their vaccine hesitancy that the historical knowledge of the Tuskegee syphilis experiments. This points to the urgent need to take action to help build trust between the medical and public health community and patients of color.
Linda Blount: It’s interesting that from what we were hearing in the early days that vaccine hesitancy wasn’t an issue—then it became one. There were many articles and newscasts discussing fear and hesitancy among Black and Brown women and men, emphasizing a historical medical mistrust that goes back generations. And we must remember that there is a high level of distrust of the government when it comes to the health and wellbeing of minoritized and marginalized communities.
Dr. Zephyrin: While survey results give us insights into where we are in managing this pandemic, they also tell us some important things about how we all move forward with providing affordable access to care, addressing health status and ways to improve interaction with providers among underserved, minoritized and marginalized populations in the future. Our survey shows that more than half (53%) of all unvaccinated people would prefer to get vaccinated at their personal doctor’s office, with modest variation by race, ethnicity, and residence. Additionally, not having health insurance is major obstacle to the vaccine- with only 24% of the uninsured reported being vaccinated.
Linda Blount: It goes much deeper than simply asking Black and Brown women to trust a system that has not been all that trustworthy for them. Our work, including our reports, Thriving and Surviving and Index US show that Black and Brown women want to be heard. They want to be believed. And yet they will tell you they don’t feel that way. We have a lot of work to do if we really want to build an inclusive and proactive way to address the health and wellness needs of Black and Brown women during the COVID-19 crisis and beyond.
How Do We Build on What We’ve Learned to Improve Engagement and Access to Care Beyond COVID-19?
Dr. Zephyrin: These findings call for ways to address risk factors for, and better management of, chronic conditions moving forward. We can start by strengthening access to care and primary care systems. We do know from previous Commonwealth Fund surveys that adults in the U.S. experience greater affordability barriers to accessing physician visits, tests, and treatments. Increasing access to affordable health care and strengthening primary care systems are two of the most important challenges for the U.S. health care system.
This is a time for all of us to work together to ask the key questions and listen to the answers. We must also gather standardized data on key health issues and get insights on how we can turn the tide on decades of discrimination and inequity and distrust that keep minoritized and marginalized people out of care and distanced from optimal health and wellness as we navigate COVID-19 and beyond.