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Research Questions

  1. Why are Black Americans less willing to get a COVID-19 vaccine than Americans of other races or ethnicities?
  2. How trusted are health care providers and public health officials?
  3. How trusted are elected local and federal officials?
  4. What contributes to mistrust in the COVID-19 vaccine?
  5. What messaging strategies would be effective in encouraging COVID-19 vaccine acceptance in the Black community?

Recent polls show that Black Americans are less willing than Americans of other races or ethnicities to be vaccinated for COVID-19. These lower vaccination rates among Black Americans would further widen COVID-19 inequities in diagnosis, hospitalization, and mortality. A main driver of hesitancy among Black Americans is thought to be general mistrust of health care systems and providers. Such mistrust has arisen in Black communities as an understandable, rational, and self-protective reaction to history, knowledge, and continuous and repeated discrimination, racism, and harmful experiences toward Black Americans by the health care system, health care providers, and the U.S. government. Such repeated, systemic discrimination experiences, as well as the perceived failure of health care organizations to take authentic measures to build trust and become more trustworthy, have led to avoidance of health care among Black Americans, which may translate further into unwillingness to accept COVID-19 vaccination.

To support efforts to reduce COVID-19 vaccine hesitancy in Black communities, RAND Corporation researchers conducted a survey of Black Americans in November–December 2020 to better understand the drivers of such reluctance. The researchers also conducted follow-up interviews with survey respondents who expressed hesitancy. Based on the results of the survey and interviews, the authors engaged with community stakeholders to identify an initial set of public health messaging and communication strategies likely to be successful in addressing COVID-19 vaccine hesitancy and increasing vaccination in Black communities.

Key Findings

  • This survey of a nationally representative sample of 207 Black Americans (conducted in November–December 2020) found high levels of vaccine hesitancy and mistrust of COVID-19 vaccines in the overall sample, and among health care workers in particular.
  • Those who expressed vaccine hesitancy also showed high levels of overall mistrust, concerns about potential harm and side effects, and lack of confidence in vaccine effectiveness and safety.
  • Participants reported higher trust in COVID-19 information from health care providers and public health officials than from elected local and federal officials.
  • Mistrust of the government's motives and transparency around COVID-19, as well as beliefs about racism in health care, appear to be contributing to mistrust of the vaccine.
  • Black Americans attribute their mistrust of vaccines in general and COVID-19 vaccines in particular to systemic racism, including discrimination and mistreatment in health care, as well as by the government.

Recommendations

  • Public health messages and communication strategies to address vaccine hesitancy should be tailored through authentic community engagement over the short term. In addition, it is critical to increase the trustworthiness of health care organizations, pharmaceutical companies, and the government over the long term.
  • COVID-19 vaccine messaging should first acknowledge systemic racism as a justifiable reason for mistrust before providing information about the vaccine.
  • Education and dialogue to address health care providers' concerns are essential, because these providers have the credibility to address vaccine hesitancy in Black communities, but many Black health care workers in our survey reported hesitancy to take the vaccine themselves.

Research conducted by

Funding for this research was provided by gifts from RAND supporters and income from operations. The research was carried out within the Access and Delivery Program in RAND Health Care.

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