New UCLA research identifies several factors influencing how people of color in Los Angeles County are making decisions about COVID-19 vaccination. The study, published in the peer-reviewed JAMA Network Open, reveals that misinformation and politicization, awareness of past injustices involving medical research, and fears about the inequitable distribution of vaccines all contributed to people’s hesitancy to be vaccinated.
Racial and ethnic minority communities in Los Angeles County have had an exceptionally high risk for COVID-19 infection, severe illness and death. To prevent further disparities, the study’s authors suggest, there should be a multifaceted outreach campaign to people in vulnerable groups in order to improve confidence in the vaccines, and access to the vaccines should be expanded.
“This work expands on our understanding of factors that contribute to COVID-19 vaccine decision-making for marginalized communities,” said Dr. Arleen Brown, a senior author of the study and a professor of medicine at the David Geffen School of Medicine at UCLA. “This work has implications for the public health system, health care providers and under-resourced communities that face the greatest burden from COVID-19.”
Brown also is director of Share, Trust, Organize, Partner: The COVID-19 California Alliance, or STOP COVID-19 CA, a project funded by the National Institutes of Health Community Engagement Alliance.
The researchers conducted 13 virtual focus groups between November 2020 and January 2021. They interviewed 70 participants, half of whom lived in high-poverty ZIP codes. Participants were Native American, Black/African American, Filipino, Latino and Pacific Islander.
One of the many concerns raised by the participants was the knowledge of unethical medical research conducted in the U.S. and the trauma it has caused, not only for the people in the experiments but also for their larger communities.
“I don’t want to call it a ‘dog whistle,’” one focus group participant said. “But just to hear that somehow what’s being discussed as, you know, the priorities of the African American communities — as if the African American communities aren’t aware of the past experiments, whether it’s social science, medical — that we have been a part of unknowing what the truth was behind it and the long-lasting effects that it’s had on our families.”
Other issues raised by participants in the study include:
- Lack of trust in information sources. Participants said they wanted to get recommendations about vaccines from medical providers and other trusted messengers. For example, one Latino participant said, “The Hispanic community needs information … not from social media but truthful information from newspapers or information channels that provide authentic or more reliable information.”
- Misconceptions and misinformation about vaccine development and safety, especially for certain populations. One Filipino participant said, “Most of these trials have been done on predominantly — at least from my belief, from what I’m seeing and hearing — white, Caucasian people. And although I look that way, how do I know that that’s not going to affect me or affect my people in a different way and my family?”
- Structural barriers to accessing vaccines. Participants cited lack of internet service, logistical and cost concerns related to transportation and childcare, and an inability to take time off from work, for example. As one Latino participant put it, “If they do qualify for the vaccine, they’d have to take a day off of work to go. And not everybody has the privilege of sick hours or anything like that.”
- Uncertainty over vaccine costs or eligibility. Some indicated that they were worried about not having health insurance or that they would be ineligible for vaccines because of their citizenship status.
- Fears about pharmaceutical companies’ interests and motives.
- A desire for autonomy over health care decisions.
The researchers provide several recommendations that could help overcome those barriers, including engaging community partners to help deliver trustworthy messaging and information about vaccines; ensuring that information is timely and accessible; using culturally congruent messaging; and improving the collection, transparency and translation of vaccine data for people of color.
The authors note some limitations to the research. For instance, they did not compare differences among the racial and ethnic groups among study participants or assess differences based on people’s ages. In addition, they write that the findings may not apply to other high-risk groups or geographic areas and that the study was conducted before vaccines were widely available.
The study was funded by the NIH National Center for Advancing Translational Science, the NIH CEAL STOP COVID-19 CA and the UCLA COVID-19 Oversight Research Committee.
In addition to Brown, the study’s authors are Dr. Savanna Carson, Dr. Alejandra Casillas, Dr. Yelba Castellon-Lopez, Dr. Lisa Mansfield, D’Ann Morris, Juan Barron, Ejiro Ntekume, Dr. Raphael Landovitz, Stefanie Vassar, Dr. Keith Norris, Dr. Steven Dubinett and Dr. Nanibaa’ Garrison, all of UCLA.