Exploring Barriers and Facilitators to COVID-19 Vaccine Uptake Among Black and Latinx Communities

In the battle against COVID-19, population-wide vaccination campaigns continue to be one of the best tools in our public health toolkit. Sadly, more than 90 million eligible US adults remain unvaccinated, and many express hesitancy or refusal to become vaccinated in the future.¹ These rates are especially high among Black, Indigenous, Latinx, and people of color communities that have also experienced higher rates of COVID-19 infection, hospitalization, and death than White communities.^2,3 The reasons for vaccine hesitancy, reluctance, or outright refusal are many and are important to continue to explore, particularly as deadly SARS-CoV-2 variants, like Delta, drive high transmission, morbidity, and mortality rates. The study by Balasuriya et al⁴ explores the factors associated with facilitating and mitigating vaccine hesitancy among Black and Latinx populations. Using semistructured qualitative interviews of 72 community participants, Balasuriya et al⁴ identify 3 themes: (1) vaccine hesitancy is associated with a history of racist mistreatment and distrust among Black and Latinx communities; (2) the use of trusted messengers, choice in vaccine administered, and presence of social support were associated with increased willingness to vaccinate; and (3) structural barriers need to be addressed to improve vaccine uptake.

This study by Balasuriya et al⁴ is timely and critical for many reasons. The use of a qualitative methods allowed participants’ reasoning to be deeply explored, thereby providing a richness of insights that quantitative survey strategies may miss. For a charged and nuanced issue, such as COVID-19 vaccine uptake, the ability to probe and explore participants’ attitudes and beliefs is vital, particularly as public health practitioners continue to strategize how best to push further COVID-19 vaccine acceptance. Notably, the study not only included individuals who were hesitant—a population that has been highly studied⁵—but also engaged with participants who had received at least 1 vaccine dose and participants who were planning to get the vaccine. Exploring the reasoning behind the population of willing Black and Latinx adults is just as helpful as discussions with those who are resistant to vaccine uptake because the factors that facilitate uptake could potentially be replicated and scaled.

By pairing with local public health and community organizations, Balasuriya et al⁴ were able to recruit directly from populations that have historically been underrepresented in academic research.⁶ Their success is reflected in the varied socioeconomic status and employment of their participants, including individuals who identified as homemakers, custodial workers, students, and health care workers, to name a few. By offering some focus groups in Spanish, the researchers ensured they were reaching a wide portion of the Latinx population, again those who may otherwise be overlooked in academic research.

There are some challenges to applying the findings of Balasuriya et al⁴ to our current public health landscape. Apart from being restricted to one locale in the Northeast (New Haven, Connecticut), the study by Balasuriya et al⁴ research is also challenged by the constrictions of social desirability bias, wherein participants may overstate their willingness to get vaccinated—only 13% of study participants said they were not planning to get vaccinated, which is far below the 25% national refusal rate in April 2021⁷—and may understate reasons driving their vaccine hesitancy. All focus group interviews were conducted in March 2021, and in the rapidly changing times of COVID-19, that represents an almost completely different landscape. So while some of the insights this study offers are likely still pertinent as we head into fall of 2021, many circumstances have changed. It would be interesting to understand how the growing vaccine mandates, the charged discussions around mask mandates for school-aged children, or even the current predominance of the deadly Delta variant might impact participants’ perspectives of barriers and facilitators to vaccination.

Finally, the lessons highlighted about structural barriers bear repeating. To be sure, the reality is different now than in March 2021, when many populations were just becoming eligible to get vaccinated and vaccine supplies were low. Yet, the concerns voiced about COVID-19 vaccine cost, facilitating simple appointment signups, and convenience of vaccine availability, including bringing vaccine distribution sites to schools and workplaces, all continue to be helpful and applicable recommendations.

Each stage of the US public health response to managing COVID-19 has required a careful consideration of the realities of communities who are most impacted by the pandemic. By deeply probing the components associated with facilitating and obstructing vaccine uptake, the study by Balasuriya et al⁴ offers local and national public health practitioners a guidepost for innovative solutions as we head into another wave of the COVID-19 pandemic.

Published: October 13, 2021. doi:10.1001/jamanetworkopen.2021.29675

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Safo SA. JAMA Network Open.

Corresponding Author: Stella A. Safo, MD, MPH, Mount Sinai Icahn School of Medicine, Mount Sinai West, 1000 10th Ave, Ste 2T, New York, NY 10019 (stella.safo@mssm.edu).

Conflict of Interest Disclosures: None reported.