Abstract
Objective: The study was designed to compare intentions to receive COVID-19 vaccination by race–ethnicity, to identify beliefs that may mediate the association between race–ethnicity and intention to receive the vaccine and to identify the demographic factors and beliefs most strongly predictive of intention to receive a vaccine. Design: Cross-sectional survey conducted from November 2020 to January 2021, nested within a longitudinal cohort study of the prevalence and incidence of SARS-CoV-2 among a general population-based sample of adults in six San Francisco Bay Area counties (called TrackCOVID). Study Cohort: In total, 3161 participants among the 3935 in the TrackCOVID parent cohort responded. Results: Rates of high vaccine willingness were significantly lower among Black (41%), Latinx (55%), Asian (58%), Multi-racial (59%), and Other race (58%) respondents than among White respondents (72%). Black, Latinx, and Asian respondents were significantly more likely than White respondents to endorse lack of trust of government and health agencies as a reason not to get vaccinated. Participants’ motivations and concerns about COVID-19 vaccination only partially explained racial–ethnic differences in vaccination willingness. Concerns about a rushed government vaccine approval process and potential bad reactions to the vaccine were the two most important factors predicting vaccination intention. Conclusions: Vaccine outreach campaigns must ensure that the disproportionate toll of COVID-19 on historically marginalized racial–ethnic communities is not compounded by inequities in vaccination. Efforts must emphasize messages that speak to the motivations and concerns of groups suffering most from health inequities to earn their trust to support informed decision making.
Highlights
A successful COVID-19 mass vaccination program requires sufficient supply of a safe and effective vaccine and well-organized distribution, and a willingness of people become vaccinated
We considered the above beliefs about COVID vaccines as potential mediators for the association between race–ethnicity and vaccine willingness
Logistic regression was employed to characterize the association between race–ethnicity and each vaccine belief, with calculation of adjusted odds ratios and 95% confidence intervals (CI)
Summary
A successful COVID-19 mass vaccination program requires sufficient supply of a safe and effective vaccine and well-organized distribution, and a willingness of people become vaccinated. National surveys in the United States have found that Black and Latinx individuals have more reservations than their White counterparts about COVID-19 vaccination [2,3,4,5,6]. We previously reported our findings from a survey of a general population-based sample and medical center workers in the San Francisco Bay Area, documenting that in both groups, Black, Latinx, Asian, multi-race and other race respondents had significantly lower intention to get a COVID-19 vaccine than White respondents [9]. We expand our analyses of the general population sample, comparing beliefs about COVID-19 vaccination across racial–ethnic groups and the extent to which these beliefs mediated differences across racial–ethnic groups in intention to get vaccinated. We present data on beliefs and sociodemographic characteristics that were most important in predicting COVID-19 vaccination intention
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