Black and Latino American communities often have low vaccination rates, but blaming vaccine reluctance misses target

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With many vaccine-eligible people in the United States staying away, some vaccination sites do not have lines. Mario Tama | Getty Images / The conversation

By early July 2021, nearly two-thirds of all U.S. residents aged 12 and over had received at least one dose of a COVID-19 vaccine; 55% were fully vaccinated. But adoption varies considerably from region to region, and is lower on average among non-white people.

Many attribute the relatively lower vaccination rates in communities of color to reluctance to vaccinate. But this label overlooks persistent barriers to access and bundles together the various reasons people do not get vaccinated. It also places all of the responsibility for getting vaccinated on individuals. Ultimately, homogenizing the reasons why people don’t get vaccinated distracts attention from social factors that research shows play a critical role in health status and outcomes.

As medical anthropologists, we take a more nuanced point of view. Working together as lead investigators on the CommuniVax site, a national initiative to improve vaccine equity, we and our teams in Alabama, California and Idaho, as well as CommuniVax teams elsewhere in the country, have documented a variety of positions towards vaccination that simply cannot be expressed. as hesitant.

Limited access hinders immunization rates

People of color have long suffered from a host of health inequities. As a result, due to a combination of factors, these communities experienced higher hospitalization due to COVID-19, higher illness severity on admission, higher chances of being placed on life support and progression to the intensive care unit, and higher death rates.

CommuniVax data, including some 200 in-depth interviews within these communities, confirms that on the whole, those who have directly experienced this type of trauma linked to COVID-19 do not hesitate. They are eager for the vaccines. For example, in the heavily Latin and severely affected southern region of San Diego, uptake of the COVID-19 vaccine is remarkably high, around 84% as of July 6, 2021.

However, vaccination is far from universal in these communities. This is in part due to access issues that go beyond well-documented transportation challenges, internet access and skills gaps, and the lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident whites usurping doses intended for communities of color. African-American participants, in particular, said they felt the Johnson & Johnson vaccines promoted in their communities were the least safe and effective.

The Biden administration failed to meet its July 4 goal of having at least one hit to 70% of adults. Tom Brenner / Pool / AFP via Getty Images

Our participant testimonial shows that many unvaccinated people are not hesitant to be vaccinated but rather hampered by vaccination. And exclusion can occur not only in a physical sense; the attitudes of providers towards vaccines are also important.

For example, Donna, a healthcare worker in Idaho, said: I chose not to have it because if I got sick I think I would recover almost fully or faster. This kind of attitude of health care providers can have downstream effects. For example, Donna may not encourage vaccination when she is on duty or with people she knows; some, just by observing his choices, may follow suit. Here, what appears as a reluctance on the part of the community to vaccinate is rather a reflection of a reluctance to vaccinate within its health system.

More directly hampered are community members who, like Angela in Idaho, skipped the vaccination because she couldn’t risk having a negative reaction that might require intervention. Although a visit to the doctor is a highly unlikely outcome after a vaccine, it remains a concern for some. My insurance doesn’t cover as much as it should, you know, should, she noted. And we have come across many reports of undocumented people who fear deportation although, according to current laws, immigration status should not be questioned in relation to the vaccine.

Christina, in San Diego, illustrates another type of practical barrier. She can’t get the vaccine, she said, because she doesn’t have anyone to take care of her babies in case she gets sick with side effects. Her husband, likewise, cannot take time off from work. It doesn’t work that way. Likewise, Carlos, who made sure his 100-year-old father gets vaccinated, says he can’t get the shot himself because of his father’s profound dementia: If I took my shot and fell sick he would be screwed.

Indifference, resilience and ambivalence

Another segment of unvaccinated people obscured by the hesitant label is the indifferent vaccine. For various reasons, they remain relatively untouched by the pandemic: COVID-19 is simply not on their radar. This could include people who are self-employed or moonlighting, people living in rural and remote areas, and those whose children are not in the public school system.

These people are therefore not systematically connected to information related to COVID-19. This is especially true if they forgo social or news media and socialize with others who do the same, and if there are significant language barriers.

CommuniVax researchers Sarah Song and Grecia Guerrero chat with potential attendees outside a grocery store in June. Diego Ceballos / CommuniVax, CC BY-ND

We also learned that, among some of our participants, the initial message about prioritizing high-risk groups backfired, leaving some under 65 and relatively healthy with the impression that they were not. it was not necessary for them to be vaccinated. Without incentive travel plans, being accepted into college or having an employer that enforces the inertia of vaccination wins.

The indifferent are not against vaccination. On the contrary, if it’s not broken, don’t fix it and you tend to characterize their views. As Jose from Idaho pointed out, I’m not worried because I’ve always taken care of myself.

We also saw a modified form of indifference among those who believed that the protective measures they were already taking would be enough to keep them COVID-19 free. A janitor said, I am an essential worker. So from the start, we took all the precautions against face masks, taking (social) distance (and using) natural medicines and vitamins for the immune system. He had, in fact, so far avoided contracting COVID-19.

The view that vaccines are not immediately needed is amplified in some Latin Americans by the cultural value placed on the need to endure aguantar in Spanish to endure, get through and avoid complaining about daily struggles. This prospect can be seen in many immigrant or impoverished populations, where becoming ill or injured can be a precursor to household ruin through job loss and exorbitant and unpayable medical bills.

Another dynamic that we have learned is what we call vaccine ambivalence. Some participants who view COVID-19 as a significant health threat believe the vaccine poses an equivalent risk. We have seen this particularly among African Americans in Alabama, which is not necessarily surprising given that the health care system has not always had the best interests of these communities at heart. The perceived conundrum leaves people stuck on the fence. Given the legacy of unequal treatment in communities of color, when balancing the known of COVID-19 and the unknown of vaccination, their inaction may seem reasonable, especially when associated with wearing mask and social distancing.

Take care of blind spots

At this point in the pandemic, those who have the means and the will to get vaccinated have done so. Providing viable counter-narratives to disinformation can help rally more people. But continuing to focus solely on individual mistrust of vaccines or the so-called hesitation obscures other complex reasons people have for being suspicious of the system and circumventing vaccination.

In addition, too narrow a focus on the vaccine leaves a lot of things out of the picture. A larger view reveals that the problems leading to inequitable immunization coverage are the same structural problems that have, historically, prevented people of color from having a good chance of good health and economic conditions to start with problems that even a 100% vaccination rate can not solve.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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