Columbus, OH—With COVID-19 disproportionately affecting Black individuals in the United States, the conventional wisdom has been that vaccine hesitancy has exacerbated the problem.
A new study published in JAMA Network Open, suggests, however, that the answer is more complex than that.
Researchers and colleagues from The Ohio State University sought to compare changes in vaccine hesitancy between Black and White cohorts and to help explain the observed differences. "We argue, however, that any emphasis on hesitancy as the primary challenge to vaccination among Black individuals in the U.S. would be a mistake," they wrote.
For the study, 1,200 English-speaking adults in the U.S. were recruited from a nonprobability online panel to build a census-matched sample, with participants contacted monthly between December 9, 2020, and June 16, 2021.
The study team focused on self-reported vaccination intention, measured on a 6-point scale (where 1 indicates "extremely unlikely" and 6 indicates "extremely likely"). In addition, viewpoints about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores signaling greater agreement. Of the participants, 52% were women, 64% were White, 107 were Black, with a mean age of 49.5 years. The survey participation rate was 57.0%.
"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)," researchers reported.
This survey study determined 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."
The belief that the vaccines are necessary for protection increased more among Black than White individuals in March 2021 (b = 0.221; P = .01) and April 2021 (b = 0.187; P = .04). Furthermore, 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 but no evidence associated those with race, the researchers indicated.
"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," the authors concluded. "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."
Based on that information, the authors recommended that efforts to increase vaccine uptake among Black individuals in the U.S. might be more effective if they focused on a range of vaccination barriers beyond hesitancy. The study defines access barriers as issues such as distant vaccine sites, lack of transportation, and inflexible work hours.
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