Black Americans who were initially hesitant about receiving a COVID-19 vaccine were more likely than whites to warm up to the idea as the pandemic wore on and to view vaccines as necessary for protection, a new study has found.

The research highlights the importance of not making assumptions about race-based viewpoints regarding health care, and illustrates the likelihood that access — not just distrust or skepticism — is a significant obstacle to higher levels of COVID-19 protection among black Americans, the study authors said.

The study, led by researchers at The Ohio State University, appears today (Jan. 21, 2022) in the journal JAMA Network Open.

Tasleem Padamsee

“From the start of the vaccine rollout, we began to hear about how black Americans were going to resist vaccinations. Our study highlights that any emphasis on hesitance as the primary challenge to vaccination among Black Americans would be a mistake,” said study lead author Tasleem Padamsee of Ohio State’s College of Public Health.

The research suggests the likelihood that access — not just distrust or skepticism — is a significant obstacle to higher levels of COVID-19 protection among black Americans.

“We must not lose sight of the significant access barriers that persist, including distant vaccine sites, lack of transportation and inflexible work hours.”

The study followed the same group of Americans over time, surveying them about their views regarding the pandemic. This approach allowed the researchers to measure how individual and group perspectives shifted during a time when the world was gaining new information about both the virus and the vaccine by the day.

“As availability of the vaccine approached, and then as it became available, we were hearing as part of the national conversation this assumption that black Americans would be less likely to seek vaccines because of well-earned distrust shaped by racism,” Padamsee said.

“But we also know that black Americans are highly motivated to take care of themselves and their communities,” she said.

Data was collected in seven waves from an initial group of 1,200 participants (response numbers decreased modestly as the study progressed). The surveys began before vaccines became available in late 2020, and ended in June 2021. Participants were asked about their likelihood of getting a vaccine and about their beliefs regarding the safety, efficacy and need for the vaccine.

About 38% of black participants and 28% of white participants were hesitant at the start of the study. By June, 26% of black participants and 27% of white participants were hesitant. The data pointed to changes in beliefs about the protections the vaccine offered as a key explanation.

“The data suggest that black communities were particularly focused on ways to protect themselves and their communities as more evidence emerged that vaccines were effective and safe,” said study co-author Kelly Garrett, professor of communication at Ohio State.

COVID-19 has disproportionately affected black Americans, who’ve experienced inequitable rates of illness and death and worse economic impacts. The vaccination rate for black Americans continues to lag behind the rate for white Americans.

“While black Americans’ intention to get vaccinated has gone up, their actual vaccination rates haven’t gone up as quickly. That suggests that there are other obstacles to vaccination. We have good reason to think that has to do with access, something we must continue to work on,” Garrett said.

In their paper, the researchers note that historical traumas such as the Tuskegee Syphilis Study and the unethical use of cancer cells from Henrietta Lacks provide important context for understanding vaccine hesitance in Black communities.

That history, alongside everyday exposures to institutionalized racism within health care, are real obstacles, but they aren’t the whole of the story, said Padamsee, adding that the research findings didn’t surprise her, based on her body of research examining health inequities and race.

“I expected that the same qualities that lead Black communities to be cautious about a new vaccine would lead them to accept the vaccine once they gathered more information. The unifying theme is protection. Black Americans want to protect themselves and their communities,” she said.

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“Any story that sounds like ‘Black people don’t want to take care of themselves as much as white people’ sounds immediately suspicious to me. That story is generally wrong – it’s that something is standing in their way.”

The National Science Foundation supported the study.

Other Ohio State researchers who were part of the study are Robert Bond, Graham Dixon, Shelly Hovick and Duane Wegener. Other co-authors include Erik Nisbet of Northwestern University and Kilhoe Na of Merrimack College.