Vaccine "deliberate" is more accurate than "hesitant," some experts say.
Much has been made about people of color being hesitant to get a COVID-19 vaccine. Numbers have shown that Black and Latino vaccination rates are lagging behind those of white people in America.
About 40% of Black people and 45% of Latinos have been at least partially vaccinated as of Aug. 16, compared to 50% of white people, according to the latest data by the Kaiser Family Foundation.
And as of Aug. 16, 72% of people eligible for the COVID-19 vaccine were at least partially vaccinated, according to the Centers for Disease Control and Prevention. So far, researchers only have race or ethnicity data of 58% of the vaccinated population, of which 58% is white, 10% Black and 17% Hispanic.
There have been myriad efforts to explain the racial and ethnic vaccine rate disparity. Misinformation online has been blamed. Throughout the course of the COVID-19 pandemic, many were exposed to a slew of misleading health information, including hoaxes about the COVID-19 vaccines, some specifically targeted at Blacks and Latinos. Other experts identify structural barriers to vaccines, including health literacy, vaccine safety concerns, and physical access as contributing factors. Distrust of the medical system and government was also cited as an underlying source of vaccine disparity.
Instead of "vaccine hesitant," a more accurate term explaining lagging vaccine rates in communities of color is "vaccine deliberate" — waiting and seeing if concerns about the vaccine can be mitigated, according to a report from First Draft — an organization focused on combating online misinformation — though arguably, some may see little difference between the two phrases.
Recent research by First Draft found misinformation to only play a small role in vaccine deliberation among Black and Latino communities, but it also concluded that the role of misinformation should not be understated as it may be effective on people who exhibit higher levels of mistrust in institutions.
Brandi Collins-Dexter, a digital ethnographer who tracks the spread of disinformation within the Black community, said many vaccine hoaxes draw on both historical and modern instances of racism.
One such hoax that circulated among the Black community claimed that the vaccines could lead to issues with fertility, piggybacking on the Black genocide frame, Reuters reported.
Latinos have also been subject to widespread vaccine-related misinformation due to social media platforms' lack of ability to accurately detect misinformation written in Spanish. A study conducted by Change Research on behalf of Voto Latino, in March found that 51% of unvaccinated Latino respondents stated they would not get vaccinated against COVID-19 and found the primary agent driving such resistance was Facebook and its role in spreading misinformation.
In 2020, an analysis by Avaaz, a nonprofit organization that investigates disinformation, found that Facebook did not post warning labels on 70% of Spanish-language misinformation, compared to 29% of English-language content.
For instance, a Facebook post written in Spanish claimed that one could kill the virus by drinking a lot of water and gargling with water, salt or vinegar, according to the Avaaz report. Though the original post has been taken down, its clones continue to replicate online.
The Markup, a nonprofit organization using a data-driven approach to investigate tech companies like Facebook, found in May that Facebook was still full of anti-vaccine groups and misinformation despite the company's commitment to shut down unauthorized health groups and curb COVID-19 vaccine misinformation.
"The most common reason respondents gave for not wanting to get vaccinated, or being unsure about getting vaccinated, is fear that the vaccine is not safe… 37% of Latinx respondents said they had seen material or information that made them think the COVID-19 vaccine is not very safe or not very effective," said Lauren Goldstein, the lead researcher on the Voto Latino poll.
The federal government, recognizing the racial and cultural disparity in vaccination rates, has organized outreach programs to try and reach out to minority communities that have been more reluctant to receive the COVID-19 vaccine. For example, the Department of Health and Human Services launched “culturally resonant” mass media campaigns in partnership with trusted messengers like faith leaders to reinforce the safety of the COVID-19 vaccines, according to a report published by the Office of the Assistant Secretary for Planning and Evaluation.
The federal government has also addressed structural barriers to getting vaccinated – including transportation, time and vaccine site locations – by expanding mobile vaccine options to homebound individuals and setting up pop-up vaccine clinics in underserved areas.
But the challenges in reaching these communities are more deeply rooted and go beyond disinformation – many simply lack access, experts say.
Though the media frequently places blame for the Black community's distrust on the notorious Tuskegee syphilis study in 1932, the current distrust stems from more contemporary issues such as access, said Karen Lincoln, a professor at University of Southern California specializing in social work.
According to preliminary results from a voter survey conducted by HIT Strategies, the majority of Black respondents are willing to get vaccinated and do not know how, waiting to see how the vaccine develops over time, or could be incentivized immediately.
"It is time to stop blaming vaccine-hesitant individuals and arm people with the information and tools they need to overcome the real and perceived barriers that they are experiencing," said Terrance Woodbury, founding partner and CEO of HIT Strategies.
"The most common reason respondents gave for not wanting to get vaccinated, or being unsure about getting vaccinated, is fear that the vaccine is not safe… 37% of Latinx respondents said they had seen material or information that made them think the COVID-19 vaccine is not very safe or not very effective," said Lauren Goldstein, the lead researcher on the poll.
For older African American adults, culturally tailored health information – using plain or colloquial language – can help enhance understanding and receptiveness, Lincoln said, but there is currently a lack of structured intervention with tailored information about the vaccines.
"There's no real focus on tailoring information or an overall focus on language because the expectation is that if we speak English, we can read English. And that's not necessarily the case," said Lincoln.
In addition to gaps in health literacy, Lincoln said that the older adults she works with cite a variety of reasons for waiting on getting vaccinated. Some are more concerned about other medical or personal issues, for instance, in which case vaccines are simply not a priority, said Lincoln.
But an underlying sense of distrust toward medical institutions always persists, Lincoln said, which is no different during the COVID-19 pandemic.
When vaccinations first became available, there was not enough focus on equitable distribution, during which white and affluent people got vaccinated first. So when vaccine sites later started popping up in Black neighborhoods, some may have experienced a cognitive dissonance between the existing health gaps and a sudden heightened level of concern for the Black community, Lincoln said.
"It's really hard to reconcile. What does that mean and what do I believe? It can cause a level of confusion and I think that feeds into this larger discussion around hesitancy," Lincoln said.
For Latinos as well, mistrust toward official institutions may play a role in engendering vaccine deliberation. The First Draft research found that often, vaccination sites are perceived as "deportation traps" by Latinos, especially by undocumented immigrants.
Though there are hopes that the formal Food and Drugs Administration approval of the Pfizer vaccine would increase vaccination rates, Lincoln said those who were already distrustful of official institutions may remain hesitant.
"There are other factors that we need to consider to ensure that people have true access to the vaccine," said Lincoln.
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