The COVID-19 pandemic has brought racial health disparities to the forefront of public discourse. Data has consistently revealed across the country that African Americans are at an increased risk of contracting the illness and dying from it, including in Philadelphia, where African Americans account for 46.5% of all cases and 51.2% of deaths.
These disparities, which result from centuries of institutional racism, have now also been exemplified through attitudes towards a COVID-19 vaccine. Recent data from Pew has uncovered that African Americans are significantly less likely to get a COVID-19 vaccine when it becomes available. While 74% of both white and Hispanic adults reported intentions to get vaccinated, only 54% of African Americans stated the same.
This hesitancy raises concerns for public health that the population with the greatest need will underutilize the vaccine the most. Structural barriers to vaccination, like lack of health insurance coverage and insufficient healthcare facilities in a geographic area, are important. But the recent reports about attitudes suggest that getting people the COVID-19 vaccine will be more complex than providing physical access.
Although the seasonal flu and COVID-19 are strikingly different illnesses, people’s past responses to the flu vaccine can help us plan for their responses to the COVID vaccine. African Americans are significantly less likely than whites to be vaccinated against the flu each year. While access is an important determinant, African Americans have different experiences with the healthcare system, depending on gender, age, education, and income, each of which informs their vaccine-related attitudes.
In addition, trust is crucial. African Americans are more likely to be skeptical of and express concern about the influenza vaccine than whites. The Tuskegee Syphilis Study — a 40 year-long government study where African American men with syphilis were intentionally left untreated in order to observe the natural progression of the disease — often gets mentioned as an explanation for some of this apprehension, per various studies. Personal experiences with discrimination in health care settings, as well as experiences of others in the same social networks, compound the problem.
To counter these attitudes toward vaccination, a concerted public health messaging effort must be made. Public health agencies and other organizations at the local, state, and national levels must address two elements of communication: first, who is speaking, and second, the content of their message.
The speaker delivering a health message plays an integral role in the audience’s willingness to receive it. Characteristics such as their trustworthiness and expertise have proven to be influential elements of message persuasiveness. Assessments of trustworthiness are often based on perceptions of whether speakers share identities and experiences with their audience. Consequently, public health studies have indicated that messages from black health professionals tend to be more influential for black audiences.
In addition to carefully selecting a spokesperson, the health message should be just as deliberately crafted. Narrative messages have demonstrated efficacy in getting people to take action that prevents harmful health outcomes. For instance, prior work on breast cancer screening targeting black women shows that narratives consisting of other black women sharing their experiences had greater effects on changing attitudes and behaviors than more basic “information only” messages.
These health messages should also convey positive outcomes associated with the behavior in question, rather than just focusing on negative consequences of not vaccinating. Specifically, they can amplify the behavior of those who have been vaccinated. In this same vein, research suggests that appealing to altruism—like highlighting family and community values—can be persuasive. Such appeals are especially relevant to COVID-19 because the majority of the vaccine-hesitant are likely not among the most high-risk (i.e. the elderly, immunocompromised). They will be asked to get the vaccine largely for the greater good.
The concerns, fears, and experiences influencing African Americans’ attitudes toward the awaited vaccine should not be discounted. Rather, they should be considered as another important part of Philadelphia’s and the U.S. efforts to mitigate the disparate impacts of the COVID-19 pandemic, and thus accounted for in health messages.
Last but not least is the importance of a message’s visibility. The very best communication efforts are useless unless the audience sees them. Substantial resources, starting from the City’s public health department, must be allocated to ensure these messages are widely seen on appropriate platforms, from local TV network PSAs to social media posts. Repeated exposure to a message makes people remember it, enabling them to retrieve that information when making related decisions.
The consequences of COVID-19 vaccine hesitancy will be dire if action isn’t taken quickly, especially in cities like Philadelphia where so many African Americans are suffering from the effects of racial health and economic disparities. Efforts to mitigate refusal of the anticipated vaccine must take sociocultural and historical influences, in addition to structural barriers, into consideration.
Meanwhile, more data needs to be collected to understand who exactly among African Americans is most likely to refuse a vaccine, as we are not a monolith. Ultimately, I predict that using trustworthy spokespersons to appeal to crucial community values offers an effective route to changing African Americans’ hesitant attitudes towards a COVID-19 vaccine, and so better serving those communities.