COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.
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The datasets generated and analyzed during the current study are not publicly available due the fact that they constitute an excerpt of research in progress but are available from the corresponding author on reasonable request.
Liveris A, Stone ME Jr, Markel H, et al. When New York City was the COVID-19 pandemic epicenter: The impact on trauma care. J Trauma Acute Care Surg. 2022;93(2):247–55. https://doi.org/10.1097/TA.0000000000003460.
Thompson CN, Baumgartner J, Pichardo C, et al. COVID-19 outbreak - New York City, February 29-June 1, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1930. https://doi.org/10.15585/mmwr.mm6946a2.
Kalyanaraman Marcello R, Dolle J, Grami S, et al. Characteristics and outcomes of COVID-19 patients in New York City's public hospital system. PLoS One. 2020;15(12):e0243027. https://doi.org/10.1371/journal.pone.0243027.
About New York City Government. 2023. https://www1.nyc.gov/nyc-resources/about-the-city-of-new-york.page. Accessed 30 Oct 2022.
DiMaggio C, Klein M, Berry C, Frangos S. Black/African American Communities are at highest risk of COVID-19: Spatial modeling of New York City ZIP code-level testing results. Ann Epidemiol. 2020;51:7–13. https://doi.org/10.1016/j.annepidem.2020.08.012.
Sina-Odunsi AJ. COVID-19 vaccines inequity and hesitancy among African Americans. Clin Epidemiol Glob Health. 2021;12:100876. https://doi.org/10.1016/j.cegh.2021.100876.
Majee W, Anakwe A, Onyeaka K, Harvey IS. The past is so present: Understanding COVID-19 vaccine hesitancy among African American adults using qualitative data. J Racial Ethn Health Disparities. 2023;10(1):462–74. https://doi.org/10.1007/s40615-022-01236-3.
L. M. Bogart et al. What contributes to COVID-19 vaccine hesitancy in Black communities, and how can it be addressed? 2021. https://view.ckcest.cn/AllFiles/ZKBG/Pages/288/341536abb73df3df6ad0682d1c3ced3a0b416e9c.pdf. Accessed 1 Jun 2023.
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):2130–3. https://doi.org/10.1007/s11606-021-06698-5.
Demographic vaccination data, Department of Health. https://coronavirus.health.ny.gov/demographic-vaccination-data. Accessed 27 Oct 2022.
COVID-19: Data on vaccines - NYC Health. https://www1.nyc.gov/site/doh/covid/covid-19-data-vaccines.page. Accessed 30 Oct 2022.
N. Ndugga, L. Hill, S. Artiga, and S. Haldar. Latest data on COVID-19 vaccinations by race/ethnicity. 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/. Accessed 27 Oct 2022.
Padamsee TJ, Bond RM, Dixon GN, et al. Changes in COVID-19 vaccine hesitancy among Black and White individuals in the US. JAMA Netw Open. 2022;5(1):e2144470. https://doi.org/10.1001/jamanetworkopen.2021.44470.
Webb Hooper M, Mitchell C, Marshall VJ, et al. Understanding multilevel factors related to urban community trust in healthcare and research. Int J Environ Res Public Health. 2019;16(18):3280. https://doi.org/10.3390/ijerph16183280.
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA. 2016;113(16):4296–301. https://doi.org/10.1073/pnas.1516047113.
Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018;61(2):387–99. https://doi.org/10.1097/GRF.0000000000000349.
Racial disparities in maternal and infant health: An overview - issue brief. https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/. Accessed 30 Oct 2022.
Saluja B, Bryant Z. How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. J Womens Health (Larchmt). 2021;30(2):270–3. https://doi.org/10.1089/jwh.2020.8874.
Kuter BJ, Offit PA, Poland GA. The development of COVID-19 vaccines in the United States: Why and how so fast? Vaccine. 2021;39(18):2491–5. https://doi.org/10.1016/j.vaccine.2021.03.077.
Rémy V, Zöllner Y, Heckmann U. Vaccination: The cornerstone of an efficient healthcare system. J Mark Access Health Policy. 2015;3 https://doi.org/10.3402/jmahp.v3.27041.
Tregoning JS, Brown ES, Cheeseman HM, et al. Vaccines for COVID-19. Clin Exp Immunol. 2020;202(2):162–92. https://doi.org/10.1111/cei.13517.
Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: An overview. Hum Vaccin Immunother. 2013;9(8):1763–73. https://doi.org/10.4161/hv.24657.
Tuckerman JL, Collins JE, Marshall HS. Factors affecting uptake of recommended immunizations among health care workers in South Australia. Hum Vaccin Immunother. 2015;11(3):704–12. https://doi.org/10.1080/21645515.2015.1008886.
Bagasra AB, Doan S, Allen CT. Racial differences in institutional trust and COVID-19 vaccine hesitancy and refusal. BMC Public Health. 2021;21(1):2104. https://doi.org/10.1186/s12889-021-12195-5.
Sullivan MC, Mistler C, Copenhaver MM, et al. Race, trust, and COVID-19 vaccine hesitancy in people with opioid use disorder. Health Psychol. 2022;41(2):115–20. https://doi.org/10.1037/hea0001120.
Lin C, Tu P, Terry TC. Moving the needle on racial disparity: COVID-19 vaccine trust and hesitancy. Vaccine. 2022;40(1):5–8. https://doi.org/10.1016/j.vaccine.2021.11.010.
Willis DE, Andersen JA, Bryant-Moore K, et al. COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear. Clin Transl Sci. 2021;14(6):2200–7. https://doi.org/10.1111/cts.13077.
Elam-Evans LD, Jones CP, Vashist K, et al. The association of reported experiences of racial and ethnic discrimination in health care with COVID-19 vaccination status and intent - United States, April 22, 2021-November 26, 2022. MMWR Morb Mortal Wkly Rep. 2023;72(16):437–44. https://doi.org/10.15585/mmwr.mm7216a5.
Renelus BD, Khoury NC, Chandrasekaran K, et al. Racial disparities in COVID-19 hospitalization and in-hospital mortality at the height of the New York City pandemic. J Racial Ethn Health Disparities. 2021;8(5):1161–7. https://doi.org/10.1007/s40615-020-00872-x.
Sparks S, Langer G, De Jong A., and Filer C. Coronavirus vaccination hesitancy in the Black and Latinx communities. 2020. https://www.covidcollaborative.us/s/COVID-Collaborative-Vaccination-Attitudes-Survey-Report-2.docx. Accessed 14 Jul 2021.
R Core Team. R: A language and environment for statistical computing. http://www.R-project.org/. Accessed on 15 May 2023.
Erdfelder E, Faul F, Buchner A. GPOWER: A general power analysis program. Behav Res Meth Instrum. 28:1–11.
Sanders-Jackson A, Gonzalez M, Adams RB, Rhodes N. Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States. Prev Med Rep. 2021;24:101516. https://doi.org/10.1016/j.pmedr.2021.101516.
Kricorian K, Civen R, Equils O. COVID-19 vaccine hesitancy: Misinformation and perceptions of vaccine safety. Hum Vaccin Immunother. 2022;18(1):1950504. https://doi.org/10.1080/21645515.2021.1950504.
Lee M, Miao E, Rapkin B, Halmos B, Shankar V, Goel S. Prevalence and assessment of factors associated with COVID-19 vaccine hesitancy in an ethnic minority oncology patient population. Vaccines (Basel). 2022;10(10):1711. https://doi.org/10.3390/vaccines10101711.
Chu A, Gupta V, Unni EJ. Utilizing the theory of planned behavior to determine the intentions to receive the influenza vaccine during COVID-19: A cross-sectional survey of US adults. Prev Med Rep. 2021;23:101417. https://doi.org/10.1016/j.pmedr.2021.101417.
Gargano LM, Herbert NL, Painter JE, et al. Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines. Hum Vaccin Immunother. 2013;9(12):2627–33. https://doi.org/10.4161/hv.25823.
Stout ME, Christy SM, Winger JG, Vadaparampil ST, Mosher CE. Self-efficacy and HPV vaccine attitudes mediate the relationship between social norms and intentions to receive the HPV vaccine among college students. J Community Health. 2020;45(6):1187–95. https://doi.org/10.1007/s10900-020-00837-5.
Lucia VC, Kelekar A, Afonso NM. COVID-19 vaccine hesitancy among medical students. J Public Health (Oxf). 2021;43(3):445–9. https://doi.org/10.1093/pubmed/fdaa230.
Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine. 2020;38(42):6500–7. https://doi.org/10.1016/j.vaccine.2020.08.043.
Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: What is it, can it be measured, and does it matter? Milbank Q. 2001;79(4):613–v. https://doi.org/10.1111/1468-0009.00223.
Freimuth VS, Jamison AM, An J, Hancock GR, Quinn SC. Determinants of trust in the flu vaccine for African Americans and Whites. Soc Sci Med. 2017;193:70–9. https://doi.org/10.1016/j.socscimed.2017.10.001.
Jamison AM, Quinn SC, Freimuth VS. "You don't trust a government vaccine": Narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med. 2019;221:87–94. https://doi.org/10.1016/j.socscimed.2018.12.020.
Marie Reinhart A, Tian Y, Lilly AE. The role of trust in COVID-19 vaccine hesitancy and acceptance among Black and White Americans. Vaccine. 2022;40(50):7247–54. https://doi.org/10.1016/j.vaccine.2022.10.067.
Lazarus JV, Ratzan SC, Palayew A, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2021;27(2):225–8. https://doi.org/10.1038/s41591-020-1124-9.
Huang W, Dove-Medows E, Shealey J, et al. COVID-19 vaccine attitudes among a majority black sample in the Southern US: Public health implications from a qualitative study. BMC Public Health. 2023;23(1):88. https://doi.org/10.1186/s12889-022-14905-z.
Balasuriya L, Santilli A, Morone J, et al. COVID-19 vaccine acceptance and access among Black and Latinx communities. JAMA Netw Open. 2021;4(10):e2128575. https://doi.org/10.1001/jamanetworkopen.2021.28575.
Savoia E, Piltch-Loeb R, Goldberg B, et al. Predictors of COVID-19 vaccine hesitancy: Socio-demographics, co-morbidity, and past experience of racial discrimination. Vaccines (Basel). 2021;9(7):767. https://doi.org/10.3390/vaccines9070767.
Willis DE, Andersen JA, Montgomery BEE, et al. COVID-19 vaccine hesitancy and experiences of discrimination among Black adults. J Racial Ethn Health Disparities. 2023;10(3):1025–34. https://doi.org/10.1007/s40615-022-01290-x.
Willis DE, Montgomery BEE, Selig JP, et al. COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep. 2022;31:102074. https://doi.org/10.1016/j.pmedr.2022.102074.
Curtis MG, Whalen CC, Pjesivac I, Kogan SM. Contextual pathways linking cumulative experiences of racial discrimination to Black American men's COVID vaccine hesitancy. J Racial Ethn Health Disparities. 2022:1–13. https://doi.org/10.1007/s40615-022-01471-8.
Callaghan T, Moghtaderi A, Lueck JA, et al. Correlates and disparities of intention to vaccinate against COVID-19. Soc Sci Med. 2021;272:113638. https://doi.org/10.1016/j.socscimed.2020.113638.
Gatwood J, McKnight M, Fiscus M, Hohmeier KC, Chisholm-Burns M. Factors influencing likelihood of COVID-19 vaccination: A survey of Tennessee adults. Am J Health Syst Pharm. 2021;78(10):879–89. https://doi.org/10.1093/ajhp/zxab099.
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):964–73. https://doi.org/10.7326/M20-3569.
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. Am J Transplant. 2021;21(4):1650–6. https://doi.org/10.1111/ajt.16560.
Xiao H, Vaidya R, Liu F, Chang X, Xia X, Unger JM. Sex, racial, and ethnic representation in COVID-19 clinical trials: A systematic review and meta-analysis. JAMA Intern Med. 2023;183(1):50–60. https://doi.org/10.1001/jamainternmed.2022.5600.
Bergen N, Kirkby K, Fuertes CV, et al. Global state of education-related inequality in COVID-19 vaccine coverage, structural barriers, vaccine hesitancy, and vaccine refusal: findings from the Global COVID-19 Trends and Impact Survey. Lancet Glob Health. 2023;11(2):e207–17. https://doi.org/10.1016/S2214-109X(22)00520-4.
Tang S, Liu X, Jia Y, et al. Education level modifies parental hesitancy about COVID-19 vaccinations for their children. Vaccine. 2023;41(2):496–503. https://doi.org/10.1016/j.vaccine.2022.11.060.
NYU Langone Vaccine Center- Brooklyn site staff: Akeem Moore, Jasmine Briscoe, Diandra Williams, Heycha Rosado Lebron, Andrew Korman, Thomas Jenkins, Kelsey Smith, Kelly Minus, Grace Lioue, and Stephanie Sterling.
This work was supported by the National Institutes of Health, including grant AI148574 and contract 75N93021C00014, and by institutional funding provided by NYU Grossman School of Medicine for salary support.
Ethics Approval and Informed Consent
The study was approved by NYU Grossman School of Medicine Institutional Review Board (IRB) which also provides the ethics approval for the study. All subjects were consented by a verbal script approved by IRB. No Private Health Information was collected in the study.
Dr. Parameswaran reported potential competing interest: contract funding from Pfizer for an influenza vaccine; Dr. Mulligan reported potential competing interests: laboratory research and clinical trials contract funding for vaccines or monoclonal antibodies for SARS-CoV-2 with Lilly, Pfizer, and Sanofi; personal fees for Scientific Advisory Board service from Merck, Meissa Vaccines Inc., and Pfizer. All authors declare no competing interests.
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Parameswaran, L., Jaysing, A., Ding, H. et al. Vaccine Equity: Lessons Learned Exploring Facilitators and Barriers to COVID-19 Vaccination in Urban Black Communities. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01680-9