Abstract
Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.
Highlights
More than 18 months after the first case of the coronavirus disease 2019 (COVID-19) was identified in the U.S, COVID-19 and its variants continue to spike cases and mortality rates across the country and around the globe
We considered mediation in terms of six different measures of the participant’s personal experience with COVID-19, including two of trust: perceived severity of the COVID19 pandemic, if the respondent had friends or family who had become ill with or who died from COVID-19, if the respondent had been diagnosed with COVID-19, the degree of the respondent’s trust in healthcare providers, and the degree of the respondent’s trust in government health officials
NH Black Detroiters expressed the lowest intention to be vaccinated: only 32% of NH Black residents reported being willing to vaccinate in October 2020, compared to 69% of NH white Detroiters, 51% of Hispanic Detroiters, and 45% of other racial/ethnic groups
Summary
More than 18 months after the first case of the coronavirus disease 2019 (COVID-19) was identified in the U.S, COVID-19 and its variants continue to spike cases and mortality rates across the country and around the globe. Research has shown that COVID-19 has disproportionately affected racial and ethnic minority groups [1]. Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. Within the US, Wayne county, Michigan—home to Detroit—ranks 22nd in the number of confirmed COVID-19 cases and 8th in deaths, with a case to fatality ratio of 2.40% [2]. In Detroit, where more than 78% of the population is non-Hispanic (NH) Black and more than one third (36%) living in poverty [3], there have been nearly 52,000 confirmed COVID-19 cases and 2312 deaths. Detroit remains a COVID-19 case and mortality “hot spot”, yet vaccine uptake remains low. As of 28 July 2021, vaccination coverage within Detroit is 33%, compared to 54% for the state as a whole [4]
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