A Tale of Two Crises: Addressing Covid-19 Vaccine Hesitancy as Promoting Racial Justice

COVID-19 ethics: unique aspects and a review as of early 2024

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.

Important Barriers to COVID-19 Vaccination Among African Americans in Black Belt Region

BACKGROUND

To identify important barriers to COVID-19 vaccination among African Americans living in the Black Belt region.

METHODS

A cross-sectional, web-based questionnaire survey was conducted using best-worst scaling case 1 (the object case). Thirty-two potential barriers to COVID-19 vaccination were identified from the literature and confirmed by an expert. A nested balanced incomplete block design was used to generate 62 sets of 16 choice tasks. Each choice task included six barriers. Participants were asked to choose the most and least important barriers to their COVID-19 vaccination in each choice task of one set. The natural logarithm of the square root of best counts divided by the worst counts of each barrier was calculated to rank the importance of barriers.

RESULTS

Responses from a total of 808 participants were included. Among 32 barriers to COVID-19 vaccination, the five most important barriers were "safety concern of COVID-19 vaccines," "rapid mutation of COVID-19," "ingredients of COVID-19 vaccines," "Emergency Use Authorization (Fast-track approval) of COVID-19 vaccines," and "inconsistent information of COVID-19 vaccines." On the other hand, the five least important barriers were "religious reasons," "lack of time to get COVID-19 vaccine," "no support from my family and friends," "political reasons," and "fear of the needle."

CONCLUSIONS

Important barriers to the COVID-19 vaccination for African Americans living in the Black Belt region centered around the issues that could be resolved by communication strategies.

The First Steps to Building Research Collaborative Using Strength-Based Assessments and GIS Maps with a Sample of Community-Based Organizations in the Bronx, NY

Introduction

Community-based participatory research (CBPR) is one of the most effective strategies for conceptualizing, developing, and executing programs or interventions that address health disparities in community settings. The City University of New York (CUNY)'s Institute for Health Equity (CIHE) focuses on the social determinants that affect the physical and mental health of New York City's poor and underserved.

Methods

This study utilized a modified Strengths, Weaknesses, Opportunities, and Threats (SWOT) tool as a strength-based assessment (SBA) to evaluate community-based organization (CBO)'s Areas for Growth (SWOT-SBA). This approach was used to identify CBOs' strengths, prospects, and priorities to address the Bronx's health disparities. Furthermore, this study collected descriptive information on CBO's catchment areas, services provided, and population served to create interactive and static maps and contingency tables using the Arch-GIS software.

Results

This study was the first step to building CIHE Healthy-Bronx Research Collaborative to address the Bronx's health disparities. The results indicate that Hunts Point and Longwood Community Districts are the most served by CBOs. The SWOT-SBA suggests that CBOs' engagement through "appreciative inquiry" to conduct a CBPR has the most promise for a successful partnership between CBOs, research partners, and local stakeholders.

Conclusion

This analysis suggests that CBOs center their resources to function as a leader in the Bronx and have identified the need to expand services during the pandemic. Findings from this study suggest that CBOs want to collaborate in CBPR initiatives.

Threatening experts: Correlates of viewing scientists as a social threat

Despite widespread trust in scientists, efforts to curtail their influence suggest some Americans distrust scientists and may even perceive them to be a social threat. Using panel survey data, we examine who holds this viewpoint and potential implications of threat perceptions. Results suggest Republicans and Evangelical identifying individuals perceived more social threat from scientists. News media uses were associated with threat perceptions in divergent ways. Threat perceptions were strongly associated with inaccurate science beliefs, support for excluding scientists from policy-making, and retributive actions toward scientists. Findings highlight the importance of social identity considerations amid concerns about partisan social sorting and politicization of science.

Integrating civil liberty and the ethical principle of autonomy in building public confidence to reduce COVID-19 vaccination inequity in Africa

Concerns regarding the safety of COVID-19 vaccination have caused hesitancy and lowered uptake globally. While vaccine hesitancy is documented globally, some continents, countries, ethnic groups and age groups are disproportionately affected, resulting in significant global inequities. To date, Africa has the lowest COVID-19 coverage globally, with only 22% of its population completely vaccinated. It might be argued that the difficulty with COVID-19 vaccine acceptance in Africa was triggered by the anxiety created by misinformation on social media platforms, particularly with the misinformation regarding depopulating Africa, given the significance of maternity in the continent. In this work, we examine numerous determinants of poor vaccination coverage that have received little attention in primary research and that may need to be considered by various stakeholders engaged in the COVID-19 vaccine strategy at the national and continental levels. Our study also emphasizes the importance of a multidisciplinary team when introducing a new vaccine, for people to trust that the vaccine is truly helpful to them and to be convinced that immunization is, all things considered, worthwhile.

Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran

BACKGROUND

Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers.

METHODS

A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used.

RESULTS

By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease.

CONCLUSIONS

Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.

COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults

PURPOSE

The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups.

METHODS

We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake.

FINDINGS

At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination.

CONCLUSIONS

By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.

Addressing Racial Capitalism's Impact on Black Essential Workers During the COVID-19 Pandemic: Policy Recommendations

Black Americans are more likely to be essential workers due to racial capitalism. Because of the COVID-19 pandemic, essential workers are less able to adhere to social distancing and stay-at-home guidelines due to the nature of their work, because they are more likely to occupy crowded households, and are more likely to possess pre-existing health conditions. To assist Black essential workers in preventing infection or reducing the intensity of symptoms if contracted, vaccination against the virus is essential. Unfortunately, Black essential workers face considerable barriers to accessing vaccinations and are hesitant to receive the vaccine due to widespread misinformation and justified historical mistrust of the American medical system. The purpose of this work is to (1) describe the disproportionate impact of COVID-19 on Black essential workers due to racial capitalism, (2) outline the socioeconomic and racial barriers related to vaccination within this population, and (3) to suggest policy-related approaches to facilitate vaccination such as access to on-site vaccination opportunities, the funding of community outreach efforts, and the mandating of increased employee benefits.

Lessons to Build an Educational Model for Higher Education Institutions Defined as Anchor Institutions to Tackle Public Health Crises: A Pilot Study on COVID-19 Vaccine Hesitancy Among Faculty and Students in Hebert L. College in the Bronx, NY

Coronavirus disease 2019 exacerbated health inequities in Bronx Communities. This study explored vaccine hesitancy among a random sample of faculty and students from Hebert Lehman College. Findings suggest faculty are largely vaccinated (87%), while 59% of students are unvaccinated. Significant gaps in information were found related to safety and complications. This suggests universities need to adopt an educational model with a multipronged social support strategy to gain students' trust and a greater sense of belonging.

Decrease in Overall Vaccine Hesitancy in College Students during the COVID-19 Pandemic

The COVID-19 pandemic changed our world as we know it and continues to be a global problem three years since the pandemic began. Several vaccines were produced, but there was a considerable amount of societal turmoil surrounding them that has affected the way people view not only COVID-19 vaccines but all vaccines. We used a survey to compare how attitudes towards vaccination have changed in college students during the pandemic. An initial survey was administered in 2021, then a follow-up in 2022. Out of 316 respondents who answered the first survey, 192 completed the follow-up. The survey was designed to measure trends in changes to vaccine attitudes since the COVID-19 pandemic began. By comparing the first survey in 2021 and the follow-up, we found that roughly 55% of respondents' vaccine attitudes did not change, roughly 44% of respondents' attitudes towards vaccines became more positive, and only about 1% of the respondents' vaccine attitudes became more negative. Improved view of vaccines was associated with political views and increased trust in medicine and the healthcare system. Worsened opinions of vaccines were associated with a belief that the COVID-19 vaccine affected fertility.

COVID-19 Virus and Vaccination Attitudes among Healthcare Workers in Michigan: A Cross-Sectional Study

BACKGROUND

Defining the characteristics of healthcare worker (HCW) attitudes toward the coronavirus disease 2019 (COVID-19) vaccine can provide insights into vaccine hesitancy. This study's goal is to determine HCWs' attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy.

METHODS

This cross-sectional study surveyed HCWs working in institutions in Saginaw, Sanilac, and Wayne counties in Michigan (N = 120) using tipping-scale questions. Analysis of variance and t-test were used to measure HCWs' attitudes toward the COVID-19 virus and vaccines.

RESULTS

Most HCWs received (95.9%) and recommended (98.3%) a COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine were: (1) efficacy of the vaccine, (2) current exposure to patients with active COVID-19 infection and risk of virus spread, and (3) safety of vaccine and long-term follow-up. Female HCWs or HCWs aged 25-54 years were more concerned about contracting COVID-19. Physicians or HCWs aged 55-64 were less concerned regarding the effectiveness and side effects of the vaccine.

CONCLUSIONS

Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among COVID-19 attitudes. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

Understanding the concept of trust and other factors related to COVID-19 vaccine intentions among Black/African American older adults prior to vaccine development

Background

Black/African Americans are receiving COVID-19 vaccines at much lower rates than whites. However, research is still evolving that explains why these vaccination rates are lower. The aim of this study was to examine the effects of the pandemic among older Black/African Americans, with an emphasis on trust and vaccine intention prior to vaccine development.

Methods

Data were collected between July and September 2020 from 8 virtual focus groups in Detroit, MI and San Francisco Bay Area, CA with 33 older African Americans and 11 caregivers of older African Americans with cognitive impairment, supplemented by one virtual meeting with the project's Community Advisory Board. Inductive/deductive content analysis was used to identify themes.

Results

Five major themes influenced the intention to be vaccinated: uncertainty, systemic abandonment, decrease in trust, resistance to vaccines, and opportunities for vaccination. The last theme, opportunities for vaccination, emerged as a result of interaction with our CAB while collecting project data after the vaccines were available which provided additional insights about potential opportunities that would promote the uptake of COVID-19 vaccination among older Black/African Americans. The results also include application of the themes to a multi-layer framework for understanding precarity and the development of an Integrated Logic Model for a Public Health Crisis.

Conclusions

These findings suggest that trust and culturally relevant information need to be addressed immediately to accelerate vaccine uptake among older Black/African Americans. New initiatives are needed to foster trust and address systemic abandonment from all institutions. In addition, culturally relevant public health campaigns about vaccine uptake are needed. Thus, systemic issues need immediate attention to reduce health disparities associated with COVID-19.

COVID-19 vaccine hesitancy, vaccination, and mental health: A national study among U.S. parents

The COVID-19 pandemic led to increased mental health concerns among parents. Emerging studies have shown links between COVID-19 vaccine hesitancy and psychological distress, including among parents. The primary aim of this study was to extend these emerging findings by examining the role of COVID-19 vaccine hesitancy in mental health functioning in a national sample of U.S. parents, accounting for the effects of COVID-19 vaccination status and underlying medical conditions increasing COVID-19 risk. A nationally representative sample of U.S. parents (N = 796) completed a cross-sectional survey between February-April 2021, including measures of depressive, anxiety, and COVID-19 acute stress symptoms; COVID-19 vaccination status; underlying medical conditions increasing COVID-19 risk; and COVID-19 vaccine hesitancy. The sample consisted of 51.8% fathers, Mage=38.87 years, 60.3% Non-Hispanic white, 18.1% Hispanic/Latinx, 13.2% Non-Hispanic Black/African American, 5.7% Asian, and 2.8% Other Race. Hierarchical regression models adjusted for demographic covariates revealed that greater COVID-19 vaccination hesitancy and presence of an underlying medical condition were consistently associated with higher levels of depressive, anxiety, and COVID-19 acute stress symptoms among parents. Having had at least one COVID-19 vaccination dose was associated with greater levels of COVID-19 acute stress, but was not associated with depressive or anxiety symptoms. Results add new evidence from the U.S. in support of the link between COVID-19 vaccine hesitancy and psychological distress, point to the potential utility of behavioral health care workers in helping reduce vaccine hesitancy, and provide tentative data suggesting that COVID-19 vaccination for parents alone may not have provided mental health relief.

Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies

COVID-19 has caused tremendous consequences in the U.S., and combating the pandemic requires a significant number of Americans to receive COVID-19 vaccines. Guided by prominent health communication theories, this project took a formative evaluation approach and employed a national sample (N = 1041) in the U.S. to explore the potential differences between vaccine-inclined vs. -hesitant individuals and to generate profiles of hesitant individuals as the foundation for audience segmentation and message targeting. Five distinct profiles emerged in the sample. Characteristics of each profile were described, and appropriate messaging strategies were identified to target each group. Theoretical and practical implications were discussed.

Targeting COVID-19 vaccine-hesitancy in college students: An audience-centered approach

Objective: The study tested potential factors that differentiated the COVID-19 vaccine-hesitant and -inclined college students and, based on these factors, identified subgroups of the vaccine-hesitant students. Participants: Participants were 1,183 U.S. college students attending four-year universities or community colleges recruited through Qualtrics between January 25 and March 3, 2021. Methods: Participants completed an online survey assessing their COVID-19 vaccination intention, perceived risks of COVID-19 and the COVID-19 vaccines, efficacy beliefs regarding COVID-19 and the COVID-19 vaccines, and emotions toward taking the COVID-19 vaccines. Results: Vaccine-hesitant and -inclined college students varied in their emotions, risk perceptions, and efficacy beliefs regarding the virus and the vaccines. Using these factors as indicators, vaccine-hesitant college students were classified into five latent subgroups with distinct characteristics. Conclusions: In identifying subgroups of the vaccine-hesitant college students, the study has important insights to offer regarding the design of vaccine-promotion messaging strategies targeting the college student population.

Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study

BACKGROUND

COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures.

METHODS

A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51).

RESULTS

Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively).

CONCLUSIONS

Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.

Associations Between COVID-19 Vaccine Hesitancy and Socio-Spatial Factors in NYC Transit Workers 50 Years and Older

This analysis investigates how age, race/ethnicity, and geographic location contributed to vaccine hesitancy in a sample of 645 New York City (NYC) Transport Workers Union (TWU), Local 100 members surveyed in August 2020. Union members ages 50+ were 46% less likely to be vaccine hesitant than their younger counterparts (OR 0.64; 95% CI 0.42, 0.97). Non-Whites (OR 3.95; 95% 2.44, 6.39) and those who did not report their race (OR 3.10; 95% CI 1.87, 5.12) were significantly more likely to be vaccine hesitant than Whites. Those who were not concerned about contracting COVID-19 in the community had 1.83 greater odds (95% CI 1.12, 2.98) of being vaccine hesitant than those who were concerned. Older respondents tended to reside in Queens while vaccine hesitant and non-White respondents were clustered in Brooklyn. General trends observed in COVID-19 vaccine hesitancy persist in a population of high risk, non-healthcare essential workers.

Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology

OBJECTIVE

Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally.

SETTING AND PARTICIPANTS

Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021.

RESULTS

Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries.

CONCLUSION

Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.

Perception of Availability, Accessibility, and Affordability of COVID-19 Vaccines and Hesitancy: A Cross-Sectional Study in India

Background: The current study aimed to identify the perceptions and issues regarding the affordability, availability, and accessibility of COVID-19 vaccination and determine the extent of vaccine hesitancy among non-vaccinated individuals. Methods: A Prospective cross-sectional study was conducted among 575 individuals for a period of six months. All the relevant information was collected using the peer-validated survey questionnaire. An independent t-test was applied to check the association between variables. Results: Among 575 participants, 80.8% were vaccinated, and 19.2% were non-vaccinated. Among the vaccinated, 35.1% were vaccinated in private centres and 64.9% in public health centres (PHC). In total, 32% had accessibility issues and 24.5% had availability issues. However, responders vaccinated at PHC were having more issues in comparison to other groups which was statistically significant (p < 0.05). Among the 163 privately vaccinated participants, 69.9% found it completely affordable. Another 26.9% and 3.1% found vaccines partly affordable and a little unaffordable. Among the 110 non-vaccinated, 38.1% were found to be vaccine-hesitant. Conclusions: Individuals vaccinated at PHC experienced issues such as long waiting times, unavailability of doses, and registration. Further, a significant level of hesitancy towards COVID-19 vaccines was observed. The safety and efficacy of COVID-19 vaccines contributed to negative attitudes.

Trust and Coping Beliefs Contribute to Racial Disparities in COVID-19 Vaccination Intention

Racial disparities in intention to obtain the COVID-19 vaccination have been noted in academic and popular press reports. The present study sought to identify cognitive and affective factors that contribute to the observed lack of acceptance of COVID-19 vaccination, even before a vaccine was made publicly available, among Black and White Americans through a national survey (N = 487; 50.6% female, 24.8% Black). Our findings are consistent with previous studies that Black respondents had lower intention to obtain the eventual COVID-19 vaccine than White respondents. Protection motivation theory's construct of coping efficacy and an additional COVID-19-relevant variable, trust in vaccination, mediated the effect of race on behavioral intention. Lastly, beliefs were elicited from Black and White Americans to identify communication strategies regarding the issue.

Exploring Perspectives on Establishing COVID-19 Vaccine Confidence in Black Communities

Objective

To explore factors influencing COVID-19 vaccine decision-making among Black adults at high-risk for COVID-19 infection. Despite effective treatment and vaccination availability, Black Americans continue to be disproportionately impacted by COVID-19.

Design Setting and Participants

Using community-engaged qualitative methods, we conducted virtual, semi-structured focus groups with Black residents in Los Angeles County before widespread vaccine rollout. Recruitment occurred through local community partners.

Main Outcome Measures

Themes and subthemes on factors for vaccine confidence and accessibility.

Methods

As part of a larger study exploring COVID-19 vaccine decision-making factors among multiethnic groups, two-hour virtual focus groups were conducted between December 15, 2020 and January 27, 2021. Transcripts were analyzed using reflexive thematic analysis.

Results

Three focus groups were conducted with 17 Black participants, who were primarily female (n=15), residents of high-poverty zip codes (n=11) and employed full-time (n=6). Black-specific considerations for vaccine confidence and accessibility include: 1) reduced confidence in COVID-19 vaccines due to historical government inaction and racism (existing health inequities and disparities are rooted in racism; historical unethical research practices); 2) misunderstanding of Black communities' vaccine concerns ("vaccine hesitancy" as an inaccurate label to describe vaccine skepticism; ignorance to root causes of vaccine skepticism); and 3) recognizing and building on resources (community agency to address COVID-19 vaccine needs adequately).

Conclusions

Vaccination campaigns should improve understanding of underlying vaccination concerns to improve vaccine outreach effectiveness and should partner with, provide resources to, and invest in local, trusted Black community entities to improve COVID-19 vaccination disparities.

Race, ethnicity and mortality in the United States during the first year of the COVID-19 pandemic: an assessment

The fact that a disproportionate share of the disease burden from COVID-19, including mortality, has been borne by racial and ethnic minority communities is well documented. The purpose of this paper is to reassess the "race/ethnicity effect" in COVID-19 mortality in the United States. Using an ecological regression framework and county-level data, the study aims to make two contributions. First, it estimates the race/ethnicity effect for all major racial/ethnic groups at four important junctures during the first year of the pandemic. In doing so, it seeks to provide the fullest possible picture of the nature and evolution of the race/ethnicity effect. Second, it estimates the race/ethnicity effect net of basic socioeconomic factors (SEF). This helps to identify the likely mechanisms through which the race/ethnicity effect operates. Racial/ethnic composition is flexibly measured in two ways-by percentage contributions to county population and by indicators of group plurality. The ecological regressions revealed a positive association between the size of three racial/ethnic groups-non-Hispanic Blacks, non-Hispanic American Indian and Alaskan Natives (AIAN) and Hispanics-and county mortality, although the association was stronger and more consistent for Blacks and AIANs. Furthermore, accounting for basic SEF had different impacts on the race/ethnicity-mortality association for the three groups. For Hispanics, it was almost fully mediated. For Blacks, it decreased but remained statistically significant [62-6% higher mortality associated with a 1-standard deviation increase in Black share of county population; 2.3-1.1 times higher mortality in the average Black plurality county]. For AIANs, it was largely unaffected or even increased [44-10% higher mortality associated with a 1-standard deviation increase in AIAN share; 6.2-1.8 times higher mortality in AIAN plurality county). For all groups, the race/ethnicity effect generally decreased as the pandemic wore on during the first year.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44155-022-00019-9.

Strategic COVID-19 vaccine distribution can simultaneously elevate social utility and equity

Balancing social utility and equity in distributing limited vaccines is a critical policy concern for protecting against the prolonged COVID-19 pandemic and future health emergencies. What is the nature of the trade-off between maximizing collective welfare and minimizing disparities between more and less privileged communities? To evaluate vaccination strategies, we propose an epidemic model that explicitly accounts for both demographic and mobility differences among communities and their associations with heterogeneous COVID-19 risks, then calibrate it with large-scale data. Using this model, we find that social utility and equity can be simultaneously improved when vaccine access is prioritized for the most disadvantaged communities, which holds even when such communities manifest considerable vaccine reluctance. Nevertheless, equity among distinct demographic features may conflict; for example, low-income neighbourhoods might have fewer elder citizens. We design two behaviour-and-demography-aware indices, community risk and societal risk, which capture the risks communities face and those they impose on society from not being vaccinated, to inform the design of comprehensive vaccine distribution strategies. Our study provides a framework for uniting utility and equity-based considerations in vaccine distribution and sheds light on how to balance multiple ethical values in complex settings for epidemic control.

The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination

This study explored intersecting concerns about COVID-19 and racial injustice against Black people in the United States using a syndemic perspective. Findings from a multistate COVID-19 needs assessment project examined the association of general and race-related concerns about COVID-19 and concerns about police violence against Black people with mental health symptoms in a sample of 2480 Black Americans. The role of cultural mistrust in vaccination status was also examined. Concerns about COVID-19 were positively associated with concerns about police violence and associated with worse mental health. Nonvaccinated individuals were higher in cultural mistrust but lower in perceived discrimination than vaccinated individuals. Perceived discrimination partially mediated the relationship between race-related concerns about COVID-19 and mental health symptoms. Findings can inform the development of culturally responsive strategies to address the syndemic effects of COVID-19 and racial injustice.

Quantifying Utilitarian Outcomes to Inform Triage Ethics: Simulated Performance of a Ventilator Triage Protocol under Sars-CoV-2 Pandemic Surge Conditions

BACKGROUND

Equitable protocols to triage life-saving resources must be specified prior to shortages in order to promote transparency, trust and consistency. How well proposed utilitarian protocols perform to maximize lives saved is unknown. We aimed to estimate the survival rates that would be associated with implementation of the New York State 2015 guidelines for ventilator triage, and to compare them to a first-come-first-served triage method.

METHODS

We constructed a simulation model based on a modified version of the New York State 2015 guidelines compared to a first-come-first-served method under various hypothetical ventilator shortages. We included patients with SARs-CoV-2 infection admitted with respiratory failure requiring mechanical ventilation to three acute care hospitals in New York from 3/01/2020 and 5/27/2020. We estimated (1) survival rates, (2) number of excess deaths, (3) number of patients extubated early or not allocated a ventilator due to capacity constraints, (4) survival rates among patients not allocated a ventilator at triage or extubated early due to capacity constraints.

RESULTS

807 patients were included in the study. The simulation model based on a modified New York State policy did not decrease mortality, excess death or exclusion from ventilators compared to the first-come-first-served policy at every ventilator capacity we tested using COVID-19 surge cohort patients. Survival rates were similar at all the survival probabilities estimated. At the lowest ventilator capacity, the modified New York State policy has an estimated survival of 28.5% (CI: 28.4-28.6), compared to 28.1% (CI: 27.7-28.5) for the first-come-first-served policy.

CONCLUSIONS

This simulation of a modified New York State guideline-based triage protocol revealed limitations in achieving the utilitarian goals these protocols are designed to fulfill. Quantifying these outcomes can inform a better balance among competing moral aims.

Acceptance and side effects of COVID-19 vaccination among private dental practitioners and their staffs in Belagavi city

Background: In January 2021, India launched its largest COVID-19 vaccination campaign. Vaccines were distributed at 3,006 locations across India. The health-care workers were given first preference for vaccination. Vaccines are intended to provide immunity without the risk of disease transmission. Methods: A survey was conducted among private dental practitioners and their staff to inquire about their vaccination status, symptoms experienced, post-vaccination dental practice, and out-patient care. A complete list of registered dentists was compiled. A total of 315 participants were interviewed, including both private dental practitioners and their staffs, and data collected via phone call. Results: A total of 315 participants from 120 Dental Clinics in Belgaum City were included in the current study. 84.1% of the population were immunized. The majority of them (80.38%) were vaccinated with Covishield, and (69.06%) received two doses. In addition, 90.57% of participants experienced one or more symptoms following vaccination. The main symptoms reported were Fever/Chills (50.19%), Fatigue (27.12%), Headache (22.26%). Only 0.75% had diarrhea. None of the symptoms were life-threatening or necessitated hospitalization. Conclusion: The vaccine acceptance rate was 84.1% in the study. Mild and short post-vaccination symptoms was reported in more than two-thirds of healthcare professionals.

Communications to Promote Interest and Confidence in COVID-19 Vaccines

PURPOSE

Communicating about COVID-19 vaccine side effects and efficacy is crucial for promoting transparency and informed decision-making, but there is limited evidence on how to do so effectively.

DESIGN

A within-subjects experiment.

SETTING

Online survey from January 21 to February 6, 2021.

SUBJECTS

596 US Veterans and 447 non-Veterans.

INTERVENTION

5 messages about COVID-19 vaccine side effects and 4 messages about COVID-19 vaccine efficacy.

MEASURES

COVID-19 vaccine interest (1 = "I definitely do NOT want the vaccine" to 7 = "I definitely WANT the vaccine" with the midpoint 4 = "Unsure"). Confidence about COVID-19 vaccine efficacy (1= "Not at all confident," 2 = "Slightly confident," 3 = "Somewhat confident," 4 = "Moderately confident," 5 = "Extremely confident").

RESULTS

Compared to providing information about side effects alone (M = 5.62 [1.87]), messages with additional information on the benefits of vaccination (M = 5.77 [1.82], P < .001, d_z = .25), reframing the likelihood of side effects (M = 5.74 [1.84], P < .001, d_z = .23), and emphasizing that post-vaccine symptoms indicate the vaccine is working (M = 5.72 [1.84], P < .001, d_z = .17) increased vaccine interest. Compared to a vaccine efficacy message containing verbal uncertainty and an efficacy range (M = 3.97 [1.25]), messages conveying verbal certainty with an efficacy range (M = 4.00 [1.24], P = .042, d_z=.08), verbal uncertainty focused on the upper efficacy limit (M = 4.03 [1.26], P < .001, d_z = .13), and communicating the point estimate with certainty (M = 4.02 [1.25], P < .001, d_z = .11) increased confidence. Overall, Veteran respondents were more interested (M_Veterans = 5.87 [1.72] vs M_NonVeterans = 5.45 [2.00], P < .001, d = .22) and confident (M_Veterans = 4.13 [1.19] vs M_NonVeterans = 3.84 [1.32], P < .001, d = .23) about COVID-19 vaccines than non-Veterans.

CONCLUSIONS

These strategies can be implemented in large-scale communications (e.g., webpages, social media, and leaflets/posters) and can help guide healthcare professionals when discussing vaccinations in clinics to promote interest and confidence in COVID-19 vaccines.

Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake

INTRODUCTION

Equitable COVID-19 vaccine access is imperative to mitigating negative COVID-19 impacts among racial/ethnic minorities. U.S. racial/ethnic minorities have lower COVID-19 vaccination rates than Whites despite higher COVID-19 death/case rates. The Veterans Health Administration provides the unique context of a managed care system with few access barriers. This study evaluates race/ethnicity as a predictor of Veterans Health Administration COVID-19 vaccination.

METHODS

The cohort was composed of Veterans Health Administration outpatient users aged ≥65 years (N=3,474,874). COVID-19 vaccination was assessed between December 14, 2020 and February 23, 2021. Multivariable logistic regressions were conducted, controlling for demographics, medical comorbidity, and influenza vaccination history. Proximity to Indian Health Service Contract Health Service Delivery Areas was tested as a moderator. Data analyses were conducted during 2021.

RESULTS

Blacks (OR=1.28, 95% CI=1.17, 1.40), Hispanics (OR=1.15, 95% CI=1.05, 1.25), and Asians (OR=1.21, 95% CI=1.02, 1.43) were more likely than Whites to receive Veterans Health Administration COVID-19 vaccinations. American Indian/Alaska Natives were less likely than Whites to receive Veterans Health Administration COVID-19 vaccinations, but only those residing in Contract Health Service Delivery Area counties (OR= 0.58, 95% CI= 0.47, 0.72). Influenza vaccine history positively predicted COVID-19 vaccine uptake (OR= 2.28, 95% CI=2.22, 2.34).

CONCLUSIONS

In the Veterans Health Administration, compared with the general U.S. population, COVID-19 vaccine receipt is higher among most racial/ethnic minority groups than Whites, suggesting reduced vaccination barriers . The Indian Health Service may provide a safety net for American Indian/Alaska Native populations. Addressing vaccination access barriers in non-Veterans Health Administration settings can potentially reduce racial/ethnic disparities.

Vaccine Hesitancy

Purpose of Review

Recent Findings

Summary

Therapist disclosure to combat COVID-19 vaccine hesitancy: a narrative review

With the onset of the COVID-19 pandemic in 2019–2020 and the rapid development of vaccines to prevent this disease came a rise in interest around vaccine hesitancy. Naturally, methods of combatting vaccine hesitancy and increasing vaccination rates are of paramount importance. One such method is building upon the trust and openness of one’s relationship with their healthcare provider. Specifically, this paper examines how psychotherapist self-disclosure could facilitate effective health behaviors in patients, focusing on vaccines. Traditionally, mental health therapists have been encouraged to avoid self-disclosure of personal information due to the possibility of unbalancing or damaging the therapeutic relationship. However, research from medicine and other disciplines suggests that personal recommendation, self-disclosure of vaccination status, and expert encouragement may be effective methods of addressing vaccine hesitancy. In addition, recommendations for therapists in discussing vaccination and in working with vaccine-hesitant patients are provided.

Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Vaccine Attitudes and COVID-19 Vaccine Intentions and Prevention Behaviors among Young People At-Risk for and Living with HIV in Los Angeles and New Orleans

Sexual and gender minority (SGM) and racial or ethnic minority youth at-risk for or living with HIV may have higher risk of SARS-CoV-2 infection. However, there are few data on vaccine hesitancy/acceptance and COVID-19 self-protective behaviors among this population. Youth aged 15-24 years (n = 440), predominantly African American and Latine (73%, n = 320) SGM, from Los Angeles and New Orleans reported their vaccine attitudes and COVID-19 and HIV preventive behaviors in October 2020. Latent class analyses categorized individuals into groups based on their vaccine attitudes and preventive behaviors. Relationships between these groups and other factors were analyzed using Fisher's exact tests, ANOVA, and logistic regression. Most youth had accepting vaccine attitudes (70.2%, n = 309), with 20.7% hesitant (n = 91), and 9.1% resistant (n = 40). SGM and African Americans were significantly less accepting than their cis-gender and heterosexual peers. About two-thirds (63.2%, n = 278) of the respondents reported consistent COVID-19 self-protective behaviors. Youth with pro-vaccine attitudes were most consistently self-protective; however, only 54.4% (n= 168/309) intended to take a COVID-19 vaccine. Homelessness history, race, and sexual orientation were associated with vaccine attitudes. Accepting vaccine attitudes and consistent COVID-19 self-protective behaviors were closely related. COVID-19 attitudes/behaviors were not associated with HIV risk and only loosely associated with SARS-CoV-2 vaccine intentions.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

Confidence and Hesitancy During the Early Roll-out of COVID-19 Vaccines Among Black, Hispanic, and Undocumented Immigrant Communities: a Review

Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development ("warp speed"), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person's decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.

Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers

OBJECTIVES

To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination.

DESIGN

Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers.

SETTING

Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine.

PARTICIPANTS

1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff.

PRIMARY OUTCOME MEASURES

The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers.

RESULTS

Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients.

CONCLUSIONS

Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers' decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

Changes in COVID-19 Vaccine Hesitancy Among Black and White Individuals in the US

Importance

COVID-19 has disproportionately affected Black individuals in the US; however, vaccination rates among Black individuals trail those among other racial groups. This disparity is often attributed to a high level of vaccine hesitancy among Black individuals, but few studies have examined changes in vaccine hesitancy over time.

Objectives

To compare changes in vaccine hesitancy between Black and White individuals in the US and to examine mechanisms that might help explain the observed differences.

Design, Setting, and Participants

This survey study used 7 waves of data collected using a panel design. A total of 1200 English-speaking adults in the US were recruited from a nonprobability online panel to construct a census-matched sample. Participants were contacted monthly between December 9, 2020, and June 16, 2021.

Main Outcomes and Measures

The main outcome of interest was self-reported vaccination intention, measured on a 6-point scale (where 1 indicates extremely unlikely and 6 indicates extremely likely). Beliefs about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores denoting greater agreement.

Results

The baseline data included 1200 participants (693 women [52.0%; weighted]; 921 White individuals [64.0%; weighted], 107 Black individuals [12.2%; weighted]; weighted mean [SD] age, 49.5 [17.6] years). The survey participation rate was 57.0% (1264 of 2218). Black and White individuals had comparable vaccination intentions in December 2020, but Black individuals experienced larger increases in vaccination intention than White individuals relative to baseline in March 2021 (b = 0.666; P < .001), April 2021 (b = 0.890; P < .001), May 2021 (b = 0.695; P < .001), and June 2021 (b = 0.709; P < .001). The belief that the vaccines are necessary for protection also increased more among Black than White individuals in March 2021 (b = 0.221; P = .01) and April 2021 (b = 0.187; P = .04). Beliefs that the vaccines are safe and effective (b = 0.125; P < .001) and necessary (b = 0.405; P < .001) were positively associated with vaccination intention. There was no evidence that these associations varied by race.

Conclusions and Relevance

This survey study suggests that the intention of Black individuals to be vaccinated was initially comparable to that of White individuals but increased more rapidly. There is some evidence that this increase is associated with changes in beliefs about the vaccine. Vaccination rates continue to be lower among Black individuals than White individuals, but these results suggest that this might be less likely the result of vaccine hesitancy than other factors.

Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates

The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.

Diversity's Pandemic Distractions

Pandemic diseases have a nasty history of racialization. COVID-19 is no exception. Beyond the obvious racist invocations of the "China virus" or the "Wuhan Flu" are subtler racializing dynamics that are often veiled in more benign motives but are nonetheless deeply problematic. The racialization of COVID-19 proceeded along two distinct trajectories each of which threatened to reinforce inaccurate biologized conceptions of race while diverting attention from the social, legal, and political forces historically structuring race-based health disparities. First, early on as significant racial disparities in disease incidence and mortality became evident, a frame of race-based genetic difference came to the fore as a possible explanation. Second, as vaccine development ramped up there came widespread calls for racially "diversifying" clinical trials for the vaccines being tested. The rationales for such diversification were varied but tended to reinforce genetic frames of racial difference. Most common was the assertion (without substantial evidence) that vaccines might work differently in Black or Brown bodies and so racial diversity in trials was imperative for reasons of safety and efficacy. Derrick Bell cautioned 20 years ago that "the concept of diversity … is a serious distraction in the ongoing efforts to achieve racial justice." (Derrick Bell, Diversity's Distractions, 103 Colum. L. Rev. 1622, 1622 (2003).) This article explores the dynamics of how the concept of "diversity" racialized responses to COVID-19 and considers their broader implications for understanding and responding to racial disparities in the face of pandemic emergencies and beyond. In the short term, vaccine developers did a decent job of enrolling minorities in their clinical trials and the vaccines have proven to have the same safety and efficacy across races. In the long term, diversity in the biomedical context of pandemic response not only distracts attention from important structural causes of health injustice, but it also focuses attention on the genetics of disparities in a manner that has the potential to reinforce pernicious and false ideas of essential biological difference among racial groups. This article argues that an uncritical embrace of the idea of diversity in analyzing and responding to emergent health crises has the potential to distract us from considering deeper historical and structural formations contributing to racial health disparities. It proceeds first by exploring the dynamics through which initial responses to racial disparities in COVID-19 became geneticized. It will then move on to unpack the rationales for such racialization, examine their merits (or lack thereof), and consider their implications for developing an equitable response to pandemic emergencies. The next section will examine the subsequent racialization of clinical trials for COVID-19 vaccines through the concept of "diversity." It then moves on to explore how the geneticization of COVID-19 racial disparities laid the foundations for a similar geneticization of race in vaccine development. It will argue that in failing to clearly distinguish social and biological rationales for diversity, such framings, while generally well-intentioned, are poorly supported and work in tandem with the geneticization of racial disparities in COVID-19 morbidity and mortality to locate the causes of disparities in the minds and bodies of minoritized populations; again this distracts attention from the historical and structural forces contributing to such disparities. The article concludes by recognizing a certain intractability to the problems of using race in biomedical research and practice, particularly in the context of public health emergencies. It offers modest suggestions for improvement that could have significant practical effects if taken to heart by researchers, clinicians, and policy makers.

Factors Associated with COVID-19 Vaccine Hesitancy among Visible Minority Groups from a Global Context: A Scoping Review

Vaccine hesitancy is one of the top ten greatest threats to global health. During the COVID-19 era, vaccine hesitancy poses substantial risks, especially in visible minorities, who are disproportionately affected by the pandemic. Although evidence of vaccine hesitancy exists, there is minimal focus on visible minorities and the reasons for hesitancy in this group are unclear. Identifying these populations and their reasons for vaccine hesitancy is crucial in improving vaccine uptake and curbing the spread of COVID-19. This scoping review follows a modified version of the Arksey and O'Malley strategy. Using comprehensive search strategies, advanced searches were conducted on Medline, CINAHL, and PubMed databases to acquire relevant articles. Full-text reviews using inclusion and exclusion criteria were performed to extract themes of vaccine hesitancy. Themes were grouped into factors using thematic qualitative analysis and were objectively confirmed by principal component analysis (PCA). To complement both analyses, a word cloud of titles and abstracts for the final articles was generated. This study included 71 articles. Themes were grouped into 8 factors and the top 3 recurring factors were safety and effectiveness of the vaccine, mistrust, and socioeconomic characteristics. Shedding light on these factors could help mitigate health inequities and increase overall vaccine uptake worldwide through interventions and policies targeted at these factors. Ultimately, this would help achieve global herd immunity.

COVID-19 Vaccine Hesitancy in the United States: A Systematic Review

Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

Christian nationalism and COVID-19 vaccine hesitancy and uptake

Understanding COVID-19 vaccine hesitancy and uptake is vital for informing public health interventions. Prior U.S. research has found that religious conservatism is positively associated with anti-vaccine attitudes. One of the strongest predictors of anti-vaccine attitudes in the U.S. is Christian nationalism—a U.S. cultural ideology that wants civic life to be permeated by their particular form of nationalist Christianity. However, there are no studies examining the relationship between Christian nationalism and COVID-19 vaccine hesitancy and uptake. Using a new nationally representative sample of U.S. adults, we find that Christian nationalism is one of the strongest predictors of COVID-19 vaccine hesitancy and is negatively associated with having received or planning to receive a COVID-19 vaccine. Since Christian nationalists make up approximately 20 percent of the population, these findings could have important implications for achieving herd immunity.

Psychosocial Determinants of COVID-19 Vaccination Intention Among White, Black, and Hispanic Adults in the US

BACKGROUND

COVID-19 vaccine uptake is an urgent public health priority.

PURPOSE

To identify psychosocial determinants (attitudes, normative pressure, and perceived behavioral control) of COVID-19 vaccination intentions for U.S. White, Black, and Hispanic adults, and how COVID-19 misperceptions, beliefs about the value of science, and perceived media bias relate to these determinants.

METHODS

Longitudinal online survey using two national samples (18-49 years old/50 years and older), each stratified by racial/ethnic group (n = 3,190). Data were collected in October/November 2020 and were weighted by race group to be representative.

RESULTS

Path analyses showed that more positive attitudes about getting vaccinated predict intention across age and racial/ethnic groups, but normative pressure is relevant among older adults only. Belief in the value of science was positively associated with most determinants across all groups, however the association of COVID-19 misperceptions and perceived media bias with the determinants varied by age group.

CONCLUSIONS

Messages that emphasize attitudes toward vaccination can be targeted to all age and racial/ethnic groups, and positive attitudes are universally related to a belief in the value of science. The varying role of normative pressure poses messages design challenges to increase vaccination acceptance.

The effect of unobserved preferences and race on vaccination hesitancy for COVID-19 vaccines: implications for health disparities

BACKGROUND: Reducing the extra burden COVID-19 has on people already facing disparities is among the main national priorities for the COVID-19 vaccine rollout. Early reports from states releasing vaccination data by race show that White residents are being vaccinated at significantly higher rates than Black residents. Public health efforts are being targeted to address vaccine hesitancy among Black and other minority populations. However, health care interventions intended to reduce health disparities that do not reflect the underlying values of individuals in underrepresented populations are unlikely to be successful. OBJECTIVE: To identify key factors underlying the disparities in COVID-19 vaccination. METHODS: Primary data were collected from an online survey of a representative sample of the populations of the 4 largest US states (New York, California, Texas, and Florida) between August 10 and September 3, 2020. Using latent class analysis, we built a model identifying key factors underlying the disparities in COVID-19 vaccination. RESULTS: We found that individuals who identify as Black had lower rates of vaccine hesitancy than those who identify as White. This was true overall, by latent class and within latent class. This suggests that, contrary to what is currently being reported, Black individuals are not universally more vaccine hesitant. Combining the respondents who would not consider a vaccine (17%) with those who would consider one but ultimately choose not to vaccinate (11%), our findings indicate that more than 1 in 4 (28%) persons will not be willing to vaccinate. The no-vaccine rate is highest in White individuals and lowest in Black individuals. CONCLUSIONS: Results suggest that other factors, potentially institutional, are driving the vaccination rates for these groups. Our model results help point the way to more effective differentiated policies. DISCLOSURES: No funding was received for this study. The authors have nothing to disclose.

Valuing diversity in value assessment: introducing the PhRMA Foundation Health Disparities Challenge Award

DISCLOSURES:: No funding supported the writing of this article. The author has received grants from BeiGene, Ltd., and Pfizer, Inc., and advisory board fees from PhRMA Foundation.

COVID-19 vaccine trust among clients in a sample of California residential substance use treatment programs

BACKGROUND

Individuals with a substance use disorder (SUD) are at a significantly higher risk for coronavirus disease-19 (COVID-19) and have higher rates of COVID-19 related hospitalization and death than those without SUD. This study assessed COVID-19 vaccine trust, transmission awareness, risk and protective behaviors, and effects of COVID-19 on mental health and smoking among a sample of clients in California residential SUD treatment programs and identified factors associated with vaccine trust.

METHODS

A multi-site sample of SUD treatment clients (n = 265) completed a cross-sectional survey. Multivariable logistic regression was used to identify factors associated with COVID-19 vaccine trust.

RESULTS

Participants were predominantly male (82.3 %) and racially/ethnically diverse (33.3 % Non-Hispanic White). Most participants were aware of COVID-19 modes of transmission, however, only 39.5 % trusted a COVID-19 vaccine would be safe and effective. Factors independently associated with trust in a COVID-19 vaccine included age (AOR = 1.03, 95 % CI = 1.02, 1.05, p = 0.0001) and wearing a mask all the time (AOR = 2.48, 95 % CI = 1.86, 3.31, p = 0.0001). African Americans were less likely than White participants to trust that a COVID-19 vaccine is safe and effective (AOR = 0.41, 95 % CI = 0.23, 0.70, p = 0.001).

CONCLUSION

SUD treatment clients were aware of COVID-19 modes of transmission; however, fewer than half trusted that a COVID-19 vaccine would be safe and effective. Health communication about COVID-19 for people with SUD should use a multipronged approach to address COVID-19 vaccine mistrust and transmission risk behaviors.