Building Vaccine Confidence in Communities of Color

  • Within Black American communities, lack of access to affordable, quality preventive care has been a hurdle to vaccination.
  • “We can talk about misinformation all day, but until we provide information, trustworthiness, and access, we’ll continue to have these problems,” says Jessica Anne Mitchell Aiwuyor, the founder of National Black Cultural Information Trust. 

Sandra Lindsay isn’t one to camp out for concert tickets. She’s never joined the Black Friday shopping rush, swarming stores in pursuit of post-Thanksgiving bargains. But the COVID vaccine was different: As the Director of Nursing for Critical Care at Long Island Jewish Medical Center in the borough of Queens in New York City, Lindsay was on the pandemic’s frontlines, tending patients ravaged by the virus in one of the nation’s hardest-hit areas. “I was always saying, ‘Whenever this vaccine comes to market… I would camp out anywhere the vaccine was being offered,’” she recalls. On December 14th, she showed up to work to get her vaccine — and made international news as the first person in the United States to receive the vaccine outside of clinical trials. “So much weight was lifted off my shoulders,” she says. “The light in the tunnel got a little brighter on that day.”

Since then, Lindsay has become a fierce advocate for COVID vaccines. While the vaccine left her feeling “hopeful, a little safer,” she knows that for many Americans, the COVID vaccine can feel out of reach — or out of the question. Given the racism that has been endemic to American medicine, historically uneven access to preventive care, and waves of misinformation about COVID vaccines, Black Americans may be particularly wary of the public-health enterprise and of the COVID vaccine in particular. 

To Lindsay, this makes it especially important for Black healthcare workers like her to create an open dialogue in their communities. “This virus does not discriminate,” she says. “The vaccine is what is going to help to get us out of this crisis and stop the death and the harm and the pain, which is what we’re suffering two to three times more than our white counterparts.” 

In Episode 69 of EPIDEMIC, Lindsay and fellow Black healthcare workers discuss the importance of serving as trusted messengers of vaccine safety.  

Inequities in healthcare systems 

Polls show that compared to the general population, fewer Black Americans are currently planning to get vaccinated, leading to descriptions of Black Americans as “vaccine hesitant.” But this phrase misses the point, says Rhea Boyd, a pediatrician and public-health advocate — and misses the truth as well. “Black folks … have shared legitimate questions and concerns about the process by which the current COVID vaccines were developed, whether the vaccines themselves [are] safe. And some folks just have questions about whether they’re affordable.”

That’s not the same as being “vaccine hesitant.” Boyd says Black Americans are actually just as likely as other groups to get essential, and commonly recommended, vaccinations. But this wasn’t always the case: For decades, Black Americans often had less access to children’s vaccines because of systemic barriers in care and cost. But in 1993, the federal government addressed persistent disparities in vaccination rates that were tied to race, ethnicity, and family income, through the Vaccines for Children program, which provides free vaccines for children whose families might otherwise not be able to afford them. The program covers all vaccines required to attend US public schools, including those for polio, measles, and whooping cough. By 2005, says Boyd, those disparities in access had disappeared.

The case of the vaccine for human papilloma virus (HPV) offers another corrective to the notion of Black “vaccine hesitancy”: While the Centers for Disease Control recommends the HPV vaccine for all children over age 11, this vaccine is not required by public schools. Yet even with this purely optional vaccine, Boyd cites “rates of vaccination for Black children … [at] 95 percent or above.” The primary barrier to vaccination has always been cost, Boyd suggests: “When we look… historically at children’s vaccinations, we see that Black caregivers vaccinate their kids.”

But cost is not the only barrier Black Americans face. Consider the seasonal flu vaccine, which Boyd says about 4 in 10 Black Americans receive each year — a rate substantially lower than the general population, over half of which typically gets vaccinated for flu.The difference in vaccination rates is not because Black Americans are refusing the flu shot; it’s often because fewer are offered the shot in the first place. 

Boyd points to the case of Black adults aged 65 and older who have Medicare Part B: “The number one thing that shapes whether… Black folks get the flu vaccine,” she says, “is if their provider offers it to them.” When providers offer the vaccine, she continues, Black adults are as likely as any other group to accept. Yet “providers who predominantly serve a Black patient population… are the least likely to recommend preventative services to Black patients, including vaccination.” 

Often, says Boyd, those providers are in a hurry: Because health systems that predominantly serve Black Americans are so commonly under-resourced, doctors and nurses may be rushing from one patient to the next, focused more on critical care than on preventive measures. But the more insidious factor may be the same racism and unconscious bias that make providers less likely to offer routine mammograms to Black patients, or less likely to offer pain medication when a Black child shows up with a broken arm — a consistently different standard of care. “These are the challenging questions that we have to start to confront in healthcare, because they’re all a manifestation of how racism shows up,” says Boyd. 

Until our healthcare system acknowledges these disparities, says Boyd, debates about vaccine confidence can only achieve so much: “We have spent, as a healthcare system, tens of millions of dollars on trying to address ‘vaccine hesitancy’ in Black communities, instead of actually getting to the root of the problem — which is that folks need access to the vaccines and they need access to credible information about the COVID vaccines.”

Combating misinformation with personal truths

That notion of “credible information” is multifaceted, says Jessica Anne Mitchell Aiwuyor, founder of the National Black Cultural Information Trust, a group that works to challenge cultural misconceptions. “It’s not just misinformation that’s the problem,” says Aiwuyor. “It’s under-communication” — questions that go unanswered by “official” sources, and instead draw speculation… and sometimes, misinformation, too. 

Social media, of course, buzzes with such questions and speculation. But it also offers a place for healthcare workers to fill the void with evidence-based answers. Amid a raging pandemic and the vaccine rollout, Black healthcare workers have branched out to different outlets to answer questions and share their stories. Some have created Twitter threads on how people can prevent and fight the virus; others have joined Clubhouse, an audio-based social-media platform, to lead and moderate discussions.

Boyd has helped launch a campaign called “The Conversation: Between Us, About Us,” a collaboration between the Black Coalition Against COVID-19 and the Kaiser Family Foundation. The project, created by Black healthcare workers and aimed at Black communities, creates what Boyd calls “a credible rabbit hole,” drawing people in with lively and compelling stories, and offering accurate information on why the COVID vaccine is safe. Through a collection of fifty short videos hosted by stand-up comedian and television host W. Kamau Bell, Black healthcare workers answer common questions about COVID and vaccines. The aim is a mix of seriousness — grappling with the pandemic’s inordinate toll on Black Americans — and levity.

But not all campaigns for scientific truth are mediated by scientists or celebrities: In a pandemic that has upended people’s daily lives, the sharing of individual experiences — private moments, common fears — can have a different kind of resonance.

Like many teachers awaiting a return to the classroom, Tierra Rich, a sexual-health educator and activist living in Philadelphia, greeted news of a COVID vaccine with a mix of interest and caution. Rich was wary of teaching in person without being vaccinated first — yet she didn’t feel confident about the vaccine. So she reached out to a cousin who works in the pharmaceutical industry. During a Thanksgiving Zoom call with Rich’s family, this cousin allayed concerns about the Pfizer vaccine.

Rich got vaccinated on Christmas Eve. And just as her cousin had reassured her over Zoom, she took to social media to reassure others. Following her appointment, she documented her experience on a Facebook live stream, telling her audience she was feeling well and reminding them, “Knowledge is power. Your mind is your strongest tool.” Friends who’d been uneasy about the vaccine have told Rich that “just seeing [her] go through it” changed their minds — and helped them on a path to vaccination.

It’s an example of what Lindsay, the nurse in New York, calls “get[ting] off the fence.” 

“The only way to do this … is to present the facts, share the experience,” she says — just as so many watched Lindsay make history one Monday morning last December, as she sat calmly in a blue chair and received the COVID-19 vaccine. “We need much more of the population to get the vaccine before we can all be safe.”