Strategies That Promote Equity in COVID-19 Vaccine Uptake for Black Communities: a Review

AbstractBlack communities have had a high burden of COVID-19 cases, hospitalizations, and death, yet rates of COVID-19 vaccine uptake among Blacks lag behind other demographic groups. This has been due in part to vaccine hesitancy and multi-level issues around access to COVID-19 vaccines. Effective strategies to promote vaccine uptake among Black communities are needed. To perform a rapid review covering December 2020–August 2021, our search strategy used PubMed, Google, and print media with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during the early period of vaccine roll-out and real-time perspectives were crucially needed. Analyses included expert opinion, descriptions of implemented projects, and project outcomes. The strategies described in these reports largely converged into three categories: (a) addressing mistrust, (b) combatting misinformation, and (c) improving access to COVID-19 vaccines. When working to reduce hesitancy, it is important to consider messaging content, messengers, and location. To address mistrust, reports detailed the importance of communicating through trusted channels, validating the real, history- and experience-based reasons why people may be hesitant to establish common ground, and addressing racism embedded within the healthcare system. To combat misinformation, strategies included dispelling myths and answering questions through town halls and culturally intelligent outreach. Black physicians and clinicians are considered trusted messengers and partnering with community leaders such as pastors can help to reach more people. The settings of vaccination sites should be convenient and trusted such as churches, barbershops, and community sites. While a number of individual and combination efforts have been developed and implemented, data that disentangle components that are the most effective are sparse. This rapid review provides a basis for developing strategic implementation to increase COVID-19 vaccine uptake in this ongoing pandemic and planning to promote health equity for future bio-events and health crises.

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Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

Vaccines ◽

10.3390/vaccines10010036 ◽

2021 ◽

Vol 10 (1) ◽

pp. 36

Author(s):

Abram L. Wagner ◽

Lydia Wileden ◽

Trina R. Shanks ◽

Susan Door Goold ◽

Jeffrey D. Morenoff ◽

...

Keyword(s):

Racial Differences ◽

Race And Ethnicity ◽

Healthcare Providers ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Black Communities ◽

Vaccination Acceptance ◽

Black Residents ◽

Trust In Healthcare Providers ◽

The Impact

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

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Confidence and Hesitancy During the Early Roll-out of COVID-19 Vaccines Among Black, Hispanic, and Undocumented Immigrant Communities: a Review

Journal of Urban Health ◽

10.1007/s11524-021-00588-1 ◽

2021 ◽

Author(s):

SarahAnn M. McFadden ◽

Jemal Demeke ◽

Debbie Dada ◽

Leo Wilton ◽

Mengzu Wang ◽

...

Keyword(s):

Hispanic Americans ◽

Vaccine Development ◽

Early Period ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Future Health ◽

Search Terms ◽

Literature Searches ◽

Survey Results ◽

Roll Out

AbstractBlack and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development (“warp speed”), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person’s decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.

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Vaccine Confidence and Hesitancy at the Start of COVID-19 Vaccine Deployment in the UK: An Embedded Mixed-Methods Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.745630 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chrissy h. Roberts ◽

Hannah Brindle ◽

Nina T. Rogers ◽

Rosalind M. Eggo ◽

Luisa Enria ◽

...

Keyword(s):

Mixed Methods ◽

Online Survey ◽

Vaccine Development ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Demographic Groups ◽

Vaccine Confidence ◽

The Uk ◽

Dominant Narratives

Background: Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups.Methods: This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modeling and anthropological assessments.Results: Of 4,535 respondents, 85% (n = 3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20–30.30, p < 0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p = 0.021) and truthfulness (OR 8.76, 95% CI 4.15–19.90, p < 0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were, respectively, more (OR 2.05, 95%CI 1.51–2.80, p < 0.001) and less (OR 0.30, 95% CI 0.22–0.41, p < 0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility.Conclusion: Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviors, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.

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Beyond the “Hullabaloo” of the Vaccine “Debate”: Understanding Parents’ Assessment of Risks When Making Vaccine Decisions

Rhetoric of Health & Medicine ◽

10.5744/rhm.2020.1003 ◽

2020 ◽

Vol 3 (1) ◽

pp. 63-92

Author(s):

Lauren Kolodziejski

Keyword(s):

Common Ground ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Health Issues ◽

Structured Interviews ◽

Environmental Threats ◽

Health Initiatives ◽

The Common ◽

The Difference ◽

Vaccine Debate

To ascertain the risk assessments parents use when making vaccine decisions, I conducted semi-structured interviews with mothers of young children. Treating these interviews as texts, I rhetorically analyzed how parents talk about their children’s vaccination in order to better understand reasons for vaccine hesitancy. My analysis reveals that despite the difference in behavior between parents who vaccinate and parents who hesitate, there is a commonality in discourse. Three topoi emerged within these mothers’ explanation of their vaccination decisions: perceptions of diseases, perceptions of environmental threats, and assessment of their child’s vulnerability. Considering the common ground these topoi reflect, I explore possible alternative messaging about vaccines that might better encourage vaccine uptake. Ultimately, I argue a rhetorical approach to studying public and personal discourses about health issues can prove useful for identifying key topoi, which can generate communication strategies for addressing public concerns while potentially improving support for public health initiatives

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Vaccine Confidence and Hesitancy at the start of COVID-19 vaccine deployment in the UK: An embedded mixed-methods study

10.1101/2021.07.13.21260425 ◽

2021 ◽

Author(s):

Chrissy h Roberts ◽

Hannah Brindle ◽

Nina Trivedy Rogers ◽

Rosalind M Eggo ◽

Luisa Enria ◽

...

Keyword(s):

Mixed Methods ◽

Online Survey ◽

Vaccine Development ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Demographic Groups ◽

Vaccine Confidence ◽

The Uk ◽

Dominant Narratives

Introduction Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups. Methods This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modelling and anthropological assessments. Results Of 4,535 respondents, 85% (n=3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20-30.30, p<0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p=0.021) and truthfulness (OR 8.76, 95% CI 4.15-19.90, p<0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were respectively more (OR 2.05, 95%CI 1.51-2.80, p<0.001) and less (OR 0.30, 95% CI 0.22-0.41, p<0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility. Conclusion Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviours, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.

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SARS-CoV-2: Vaccine Hesitancy among Underrepresented Racial and Ethnic Groups with HIV in Miami, Florida

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab154 ◽

2021 ◽

Author(s):

Deborah L Jones ◽

Ana S Salazar ◽

Violeta J Rodriguez ◽

Raymond R Balise ◽

Claudia Uribe Starita ◽

...

Keyword(s):

Race And Ethnicity ◽

Cross Sectional Study ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Baseline Survey ◽

Advisory Group ◽

Medical Mistrust ◽

Cross Sectional ◽

Exact Test ◽

Novel Coronavirus

Abstract Background SARS-CoV-2 and HIV disproportionally affect underrepresented ethnoracial groups in the US. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. Methods We conducted a cross-sectional study of adults ≥18 years with HIV residing in Miami, FL. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April-August 2020 and followed by a COVID-19 vaccine hesitancy survey from August-November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of Fisher’s exact test Results A total of 94 participants were enrolled, mean age 54.4 years, 52% female, 60% Black non-Latinx, and 40% non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, p=0.009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, p=0.029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, p=0.002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, p=0.049). Conclusion Medical mistrust, vaccine hesitancy and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.

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Willingness to Receive the COVID-19 and Seasonal Influenza Vaccines among the Saudi Population and Vaccine Uptake During the Initial Stage of the National Vaccination Campaign: A Cross-Sectional Survey

Vaccines ◽

10.3390/vaccines9070765 ◽

2021 ◽

Vol 9 (7) ◽

pp. 765

Author(s):

Amel Ahmed Fayed ◽

Abeer Salem Al Shahrani ◽

Leenah Tawfiq Almanea ◽

Nardeen Ibrahim Alsweed ◽

Layla Mohammed Almarzoug ◽

...

Keyword(s):

Saudi Arabia ◽

Perceived Risk ◽

Online Survey ◽

Seasonal Influenza ◽

Vaccination Campaign ◽

Vaccine Uptake ◽

Influenza Vaccines ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

To Receive

This study aimed to assess the willingness to receive the coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines and vaccine uptake during the early stage of the national vaccination campaign in Saudi Arabia. A cross-sectional online survey was conducted among adult Saudis between 20 January and 20 March 2021. The questionnaire addressed vaccine hesitancy, perceived risk, willingness, and vaccine uptake. Approximately 39% of the participants expressed vaccine hesitancy, and 29.8% and 24% felt highly vulnerable to contracting COVID-19 and seasonal influenza, respectively. The majority (59.5%) were willing to receive the COVID-19 vaccine, although only 31.7% were willing to receive the flu vaccine. Adjusted analysis showed that vaccine hesitancy (OR 0.34, 95% CI 0.27–0.43) and the perception of being at high risk (OR 2.78, 95% CI 1.68–4.60) independently affected the intention to be vaccinated. Vaccine hesitancy was similar among those who were willing to be vaccinated (29.8%) and those who had already been vaccinated (33.1%). The perceived risk was significantly higher among those who had been vaccinated (48.1%) than among those who were willing to be vaccinated but had not yet been vaccinated (29.1%). In conclusion, the acceptance of the COVID-19 vaccine in Saudi Arabia is high. Saudis who received the vaccine had a similar level of vaccine hesitancy and a higher level of perceived risk.

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Vaccine Hesitancy and Differential Susceptibility to Media Coverage: A Critical Documentary Led to Substantial Reductions in Human Papillomavirus Vaccine Uptake in Denmark

Medical Decision Making ◽

10.1177/0272989x211003589 ◽

2021 ◽

pp. 0272989X2110035

Author(s):

Maria Knoth Humlum ◽

Niels Skipper ◽

Peter Rønø Thingholm

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Media Coverage ◽

Differential Susceptibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Human Papillomavirus Vaccine ◽

Policy Makers ◽

Quasi Experimental ◽

Papillomavirus Vaccine

Objectives To investigate whether negative media coverage of the human papillomavirus (HPV) vaccine led to a decrease in the uptake of the first dose of the HPV vaccine (HPV1) in Denmark and, importantly, whether some groups of individuals were more susceptible to negative media coverage. Methods We measured HPV vaccine uptake of 12-year-old girls born in 2001 to 2004 using Danish administrative data. A quasi-experimental design was employed to assess whether a documentary that was critical of the HPV vaccine and aired in March 2015 affected HPV uptake. Results The documentary led to a quick and substantial decrease in the monthly propensity to vaccinate, which dropped 3 percentage points—or about 50%—in response to the documentary. Responses differed substantially across subgroups, and girls from families with high socioeconomic status (SES) were more susceptible to the negative media coverage. Conclusions Susceptibility to negative media coverage varied substantially across subgroups, highlighting the need for policy makers to appropriately target and differentiate initiatives to improve vaccine compliance rates.

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1.C. Workshop: How are digital solutions contributing to enhance immunization programmes and policies?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.005 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Conceptual Framework ◽

World Health Organization ◽

Local Level ◽

Vaccine Uptake ◽

Childhood Vaccination ◽

World Health ◽

Vaccine Hesitancy ◽

The World ◽

Health Organization ◽

Immunization Programmes

Abstract As vaccine hesitancy and decreasing immunization coverage have been identified by the World Health Organization as global alarming health threats, it is of crucial importance to exploit the potential offered by digital solutions to enhance immunization programmes and ultimately increase vaccine uptake. We have previously developed and published a conceptual framework outlining how digitalization can support immunization at different levels: i) when adopted for health education and communication purposes, ii) in the context of immunization programmes delivery, and iii) in the context of immunization information systems management. The proposed workshop is co-organized by the EUPHA Digital health section (EUPHA-DH) and EUPHA Infectious diseases control section (EUPHA-IDC) and aims at discussing the current AVAILABILITY, USE and IMPACT of digital solutions to support immunization programmes at the international, national and local level, as well as, debating on how technical infrastructures on one side and normative and policy frameworks on the other side enable their implementation. We plan to have a rich set of contributions covering the following: the presentation of a conceptual framework identifying and mapping the digital solutions' features having the potential to bolster immunization programmes, namely: i) Personalization and precision; ii) Automation; iii) Prediction; iv) Data analytics (including big data and interoperability); and v) Interaction; the dissemination of key results and final outputs of a Europe-wide funded project on the use of Information & Communication Technology to enhance immunization, with particular reference to the use and comparative impact of email remainders and personal electronic health records, as well as the results of an international survey conducted to map and collect best practices on the use of different digital solutions within immunization programmes at the national and regional level; the firsthand experience of the United Kingdom NHS Digital Child Health Programme which developed, implemented and is currently evaluating a number of solutions to increase childhood vaccination uptake in England, including an information standard and information sharing services developed to ensure that the details of children's vaccinations can be shared between different health care settings the perspective and experience of the European Centre for Disease Prevention and Control (ECDC) for Europe and of the World Health Organization (WHO) for the global level of what has worked so far in the digitalization of immunization programmes around the world, what recommendations were developed and which barriers identified at the technical normative and policy level Key messages Digitalization has great potential to support immunization programmes but its practice and impact need to be measured. Country-level and international experiences have created qualitative and quantitative evidence on the effectiveness of digital intervention aimed at increasing vaccine uptake.

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Lack of Informations about COVID-19 Vaccine: From Implications to Intervention for Supporting Public Health Communications in COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116141 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6141

Author(s):

Silva Guljaš ◽

Zvonimir Bosnić ◽

Tamer Salha ◽

Monika Berecki ◽

Zdravka Krivdić Dupan ◽

...

Keyword(s):

Vaccine Efficacy ◽

Health Belief ◽

Ordinary Least Squares ◽

Vaccine Hesitancy ◽

Equal Proportion ◽

Least Squares Regression ◽

Online Questionnaire ◽

Demographic Groups ◽

Population Immunity ◽

Wide Range

Lack of knowledge and mistrust towards vaccines represent a challenge in achieving the vaccination coverage required for population immunity. The aim of this study is to examine the opinion that specific demographic groups have about COVID-19 vaccination, in order to detect potential fears and reasons for negative attitudes towards vaccination, and to gain knowledge on how to prepare strategies to eliminate possible misinformation that could affect vaccine hesitancy. The data collection approach was based on online questionnaire surveys, divided into three groups of questions that followed the main postulates of the health belief theory—a theory that helps understanding a behaviour of the public in some concrete surrounding in receiving preventive measures. Ordinary least squares regression analyses were used to examine the influence of individual factors on refusing the vaccine, and to provide information on the perception of participants on the danger of COVID-19 infection, and on potential barriers that could retard the vaccine utility. There was an equal proportion of participants (total number 276) who planned on receiving the COVID-19 vaccine (37%), and of those who did not (36.3%). The rest (26.7%) of participants were still indecisive. Our results indicated that attitudes on whether to receive the vaccine, on how serious consequences might be if getting the infection, as well as a suspicious towards the vaccine efficacy and the fear of the vaccine potential side effects, may depend on participants’ age (<40 vs. >40 years) and on whether they are healthcare workers or not. The barriers that make participants‘ unsure about of receiving the vaccine, such as a distrust in the vaccine efficacy and safety, may vary in different socio-demographic groups and depending on which is the point of time in the course of the pandemic development, as well as on the vaccine availability and experience in using certain vaccine formulas. There is a pressing need for health services to continuously provide information to the general population, and to address the root causes of mistrust through improved communication, using a wide range of policies, interventions and technologies.

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