Addressing COVID-19 Vaccine Hesitancy Among Black and Hispanic Communities

By Abigail Clarkson-During, MD, and Miya Smith, MD on behalf of SAEM’s Residents and Medical Students

COVID-19 vaccines become increasingly available to the general public, but that news is not being met with the same excitement by all people groups. Despite facing higher rates of COVID-19 infection, morbidity, and mortality, a significant portion of Black and Latinx communities harbor skepticism towards the potentially lifesaving vaccination. This vaccination hesitancy is not completely unwarranted. Their mistrust of the medical community is rooted in a history of mistreatment and abuse. As emergency medicine (EM) physicians, it is imperative to understand the factors that contribute to vaccination hesitancy so that we can have constructive conversations that can lead to improved immunization rates.

A Historical Basis for Mistrust

Physicians must acknowledge that throughout American history, medical advancements have often been at the expense of Black and Brown people. In the mid-19th century, Dr. J. Marion Sims, often revered as the “Father of Gynecology”, trialed experimental operations on Black slave women in Alabama without consent or anesthesia.

During the Tuskegee Syphilis Study, spearheaded by the United States Public Health Service from 1932 to 1972, 600 poor Black men, thinking they were receiving treatment for “bad blood,” received no treatment at all. 399 of these men had latent syphilis, a contagious venereal disease. Ostensibly for the purpose of tracking the disease’s full progression, researchers provided no effective care as the study’s participants experienced severe health problems, including blindness, mental impairment, and death.

The United States Public Health Service also led the Guatemala Sexually Transmitted Disease Studies from 1946 to 1948, during which 5,500 Guatemalan prisoners, soldiers, children, sex workers, and psychiatric patients were purposely infected with syphilis, gonorrhea, or chancroid in order to observe disease progression.

More recently, according to the CDC, from 2007 to 2016, black maternal mortality was more than three times that of white maternal mortality. These high rates of racial and ethnic disparities in preventable, pregnancy-related deaths have added to the mistrust, which manifests as disinclination to seek medical care and, in the case of COVID-19, reluctance to get vaccinated.

Health Care Disparities with COVID-19

The COVID-19 pandemic highlights the disparities that Black and Hispanic communities face. A combination of issues have contributed to the ways these communities have been disproportionately impacted by COVID-19. Lack of access to health care presented another problem during the pandemic, as Black Americans are more likely to be uninsured and therefore less likely to seek care. Barriers to testing, which include lack of availability, inadequate transportation, fear, and misinformation, has also contributed to COVID spread in these communities. Socioeconomic factors are particularly detrimental. For example, a higher percentage of Black Americans and Hispanics are considered essential workers and/or are living in multigenerational homes, making it difficult to effectively self-quarantine, which increases COVID-19 exposures. Systemic racism is another common thread that connects many of these risk factors for exposure. The rates of infection and hospitalization amongst Black and Latinx populations compared to white populations are 1.4 and 1.7 times respectively, according to the CDC (as of February 2, 2021). More notably, the hospitalization rates among Black and Hispanic people are nearly four times that of white people (3.7 and 4.1 times more likely, respectively, as of February 1, 2021) The disparities do not end with contraction of and hospitalization with COVID-19. The rate at which Black Americans have died from COVID-19 is 2.8 times greater than that of white people and equal to Hispanic communities (as of February 1, 2021). Chronic comorbid conditions that disproportionately impact Black Americans (e.g., diabetes, lung disease, obesity, etc.) are associated with worse outcomes in COVID-19. This association likely accounts for the increased ratio of hospitalization-to-death among Black people. Considering this, efforts must be focused on preventing the spread of COVID-19 in all communities, but particularly Black and Latinx communities, which have especially suffered during this pandemic.

While traditional efforts like masks and social distancing help reduce transmission, the newly developed COVID-19 vaccines offer invaluable protection for these vulnerable communities and emergency physicians must accept the duty of emphasizing the importance of the vaccine.

Our Role as Emergency Medicine Physicians

In order to effectively encourage vaccination among vulnerable populations, health care providers must be understanding of the reasons behind vaccination hesitancy. As EM physicians, we have the unique ability to treat patients of every demographic and socioeconomic class. Cognizant of these facts during patient interactions, physicians can help by doing the following:

Recognize the historical context. Acknowledge that there are previous injustices that may produce distrust and use that as a framework for your approach.

Listen to patient concerns. Allow patients to voice concerns and listen to them thoroughly before attempting to refute any misinformation. This will establish trust and rapport that could improve communication.

Encourage personal reading and give an opportunity for questions. Many physicians anecdotally report the prevalence of misinformation about COVID-19 espoused by patients, typically from social media. The information surrounding the disease, even from official sources, was particularly inconsistent and often contradictory early in the pandemic.

Mistrust may be difficult to overcome, but by encouraging patients to seek out credible sources to do their own research, you can give them knowledge and agency. It may help to suggest some resources or provide educational pamphlets or discharge instructions in the emergency department. (Resources: Food and Drug Administration, UpToDate, Vaccine Trials)

Review FAQs. There are many guides that can help prepare you for conversations about the COVID-19 vaccine. Many resources discuss and provide evidence-based answers to the most frequently asked questions. (Resources: CDC, Chicago COVID-19 Communication Toolkit, Basic Vaccine questions)

Discuss your personal reasons for getting the vaccine. Many patients may feel reassured knowing that you and other health care workers support the vaccine. Providing personal reasons for your choice, to your comfort level, could positively influence a patient’s position.

Remember that you may not change their mind. Emergency physicians interact with so many patients and have a meaningful impact on their lives. While some people may not be immediately convinced about receiving the vaccine, this interaction could be the impetus that changes the patient’s mind eventually. Do not be discouraged if it does not yield immediate results.

Conclusion

The clear history of medical mistreatment among Black and Hispanic people plays a role in health care mistrust and vaccine hesitancy. This compounds the already disparate rates of COVID-19 infection, morbidity, and mortality in Black and Latinx communities. By opening conversations about the COVID-19 vaccines, empathizing with fears, debunking myths, and highlighting why prophylaxis is important in Black and Brown communities, we may effectively increase vaccination rates.

ABOUT THE AUTHORS: Dr. Clarkson-During is an emergency medicine resident physician at the University of Chicago with interests in global health, health policy, social emergency medicine, and diversity and inclusion. She currently serves on the SAEM Equity and Inclusion Committee, the Chicago Women in EM (ChiWEM) board, and as a community champion for the University of Chicago Graduate Medical Education Office. Dr. Smith is an emergency medicine resident at the University of Chicago with an interest in social emergency medicine, health care disparities, and forensic medicine. She currently serves on the Illinois State Medical Society and the ACEP Forensic Medicine Section. She is an EMRA Health Policy Academy Fellow and a community champion for the University of Chicago Graduate Medical Education Office.