Racial Disparities in COVID-19 Vaccination: Is It Vaccine Hesitancy or Vaccine Deliberation?

It’s been one year since we learned about SARS-CoV-2, the virus that causes COVID-19. No one could have anticipated the pervasive consequences of the virus. There is reason for hope with the development, authorization and increased availability of safe vaccines, but only if enough people get vaccinated. In this article, physicians discuss racial disparities in vaccination and share how they address mistrust and misinformation with their patients.

Racial disparities persist

Racial disparities in vaccination persist. A December Pew Research Center poll found that a growing number of Black Americans were willing to take a free and safe COVID-19 vaccine. Sixty-one percent of Black respondents indicated they would take the vaccine, compared with 42% in November 2020 and 69% of all survey respondents. While these are positive signs, a recent analysis by Kaiser Health News reveals that disparities remain despite this willingness. In Ohio, for example, 13% of residents are Black, but only 6% of those vaccinated have been Black.

These disparities are particularly concerning because there tends to be more morbidity and mortality from COVID-19 in Black Americans. Specifically, although non-Hispanic Black Americans test positive for COVID-19 at about the same frequency as non-Hispanic white Americans, they are about three times as likely to be hospitalized with COVID-19 and about twice as likely to die of COVID-19 complications, according to the Centers for Disease Control and Prevention (CDC).

Some people blame vaccine hesitancy. But, according to Cleveland Clinic Associate Chief of Staff and family medicine physician Kendalle Cobb, MD, “it’s not ‘vaccine hesitancy’ as much as it is ‘vaccine deliberation.’ People are really weighing the pros and cons of getting vaccinated. They are looking for information they feel they can trust.”

Oluwatosin Goje, MD, an Ob/Gyn in Cleveland Clinic’s Ob/Gyn & Women’s Health Institute, agrees. “Vaccine hesitancy in minority communities should not be confused with being against vaccinations altogether,” she says. “Medical providers should view hesitancy as an opportunity to ask why a patient would decline the vaccine, answer the patient’s questions, and provide education about vaccine safety and effectiveness.”

Cutting through the noise

The onslaught of information about COVID-19 vaccines in the news and on social media has contributed to a cluster of myths about the vaccines that feed skepticism about the purpose and safety of vaccination. When patients raise doubts based on fears or erroneous information, however, physicians should be ready to listen with patience and respond with clear answers that may help build confidence.

“Patients worry that getting a COVID-19 vaccine may impact their fertility and/or have a lasting effect on their DNA,” Dr. Cobb says. “They want to know that it’s safe. My patients often ask if I’ve gotten vaccinated, which I view as an opportunity to tell them about my own experience and the results of the clinical trials. I’m still conducting my normal life and haven’t had any adverse effects. I encourage my patients to go to trustworthy, verified sources for health information, like their physicians, the CDC or the Ohio Department of Health rather than listening to what they might hear on social media or from their acquaintances.”

Addressing concerns about the speed of development

Among the top concerns people have about the COVID-19 vaccines is the short duration of development, according to Dr. Goje. “I’ve had patients ask how these vaccines could be made in less than a year,” she says. “Traditionally, vaccine development has taken about twice as long. It’s our privilege as physicians to discuss the factors that moved these vaccines through development and regulatory authorization so quickly.”

Additionally, because the COVID-19 vaccines were so highly anticipated, for a lot of people it’s the first time they paid attention to how a vaccine is developed and tested. “They’ve had the opportunity to ask a lot of questions,” Dr. Goje adds, “such as ‘How do you make this? What is mRNA? What does this do to my body?’ I tell patients that we have a lot to lose if we do not protect ourselves from COVID-19 and that vaccination is important and needed for protection. There has been a lot of morbidity and mortality. Asking questions is good, but once those questions are answered, we should embrace the opportunity to protect ourselves, our loved ones and our communities.”

A history of mistrust

The history of medical mistrust is a very long one, according to Dr. Goje, predating the Tuskegee experimentation to when Black people were viewed as property. Mistrust still exists today based on the health inequities Black Americans experience, she notes. “There’s a mistrust of the medical community in general, especially when something new is developed. I think people are skeptical and wonder if this is just another experimentation or if they are truly being treated.”

In a recent community program, Cleveland Clinic’s Linda Bradley, MD, Professor of Ob/Gyn and Reproductive Biology, noted a key distinction between the Tuskegee study and the COVID-19 vaccine trials. “In the Tuskegee trial, treatment was withheld, whereas the COVID-19 vaccine trials give hope against illness,” says Dr. Bradley, who serves as Medical Director of the American Association of Gynecologic Laparoscopists.

Building trust through community partnerships

As the COVID-19 pandemic has exacerbated existing racial/ethnic and socioeconomic health disparities, Cleveland Clinic continues to find ways to connect with the community, fostering bidirectional communication with trusted stakeholders, conducting needs assessments and health screenings, and offering vaccinations. Recently, representatives from Cleveland Clinic’s Community Outreach team summarized the team’s efforts in an article published in the Cleveland Clinic Journal of Medicine’s Curbside Consults series.

As of February, Cleveland Clinic had responded to community needs by donating over 335,000 face masks, 62,000 gloves and 4,000 pounds of hygiene products. The health system has also hosted monthly forums with faith leaders on how to safely open sacred spaces and offer support for bereavement and mental health, and it has worked with local schools to provide COVID-19-specific programming. With the availability of COVID-19 vaccines, Cleveland Clinic is using these community networks to educate the public and advance vaccine deployment.