The focus on “hesitancy” as the driver of lower Covid-19 vaccination rates misses the real problem, and opportunity.
Despite having one of the highest risks of dying from Covid-19, about twice that of white Americans, Black Americans remain one of the least vaccinated racial or ethnic groups, with data showing that only 5.7 percent have received at least one dose of a Covid-19 vaccine.
Many are quick to blame “vaccine hesitancy” as the reason, putting the onus on Black Americans to develop better attitudes around vaccination. But this hyper-focus on hesitancy implicitly blames Black communities for their undervaccination, and it obscures opportunities to address the primary barrier to Covid-19 vaccination: access.
Access matters. A closer look at the data reveals that when Black people are given the opportunity, they do get vaccinated.
After the federally funded Vaccines for Children program eliminated cost as a barrier to vaccine access for children in the 1990s, racial disparities in vaccination rates narrowed significantly. Since about 2005, Black children are just as likely to have received the recommended M.M.R. and polio vaccines as any other children, according to data from the Centers for Disease Control and Prevention. If the vaccination rates of children are, in part, a reflection of their parents and caregivers’ attitudes about vaccines, then it suggests that Black caregivers generally support vaccination.
Another study looking at flu vaccination in Detroit showed that among Medicare Part B recipients (people who have a health care plan that covers many vaccines) Black adults 65 years and older are just as likely to accept the flu vaccine as white adults, if their health care provider offers it to them.
Even now, during the pandemic, survey data has shown that interest in Covid-19 vaccination is increasing among Black adults. Sixty-one percent of Black Americans say they plan to get a Covid-19 vaccine or have already received one, up from 42 percent who said in November that they planned to get vaccinated, according to new data from Pew Research Center.
As many as 27 percent of Black Americans in a Kaiser Family Foundation survey still say they may decline Covid-19 vaccination or only get it if required, and as many as 37 percent say they will “wait and see.” But those sentiments must be considered alongside evidence of gaps in Black people’s access to information about vaccines. In another recent study, 41 percent of Black adults reported knowing “little or nothing” about how vaccines are created and tested, and 30 percent reported knowing “only a little or nothing” about how vaccines generally work.
To fully expand access to Covid-19 vaccines, health care must name, challenge and eliminate the anti-Black racism that continues to place vital health care services just beyond Black Americans’ reach. This includes access to health insurance, access to a health care provider, access to credible information about vaccines and convenient access to vaccines.
At each of these steps, Black health care workers are leading the way. In Philadelphia, Black health workers are running walk-up vaccine clinics that don’t require appointments made online or over the phone. Health workers in Oakland have built a testing site that doesn’t require any personal documentation to receive a test. Black health workers and I am disseminating credible Covid-19 information online and through social media.
As a Black physician, I know from experience that Black people are some of the most sophisticated and discerning health care consumers in the country. This comes from necessity. Many Black Americans need not resurrect the ghosts of the Tuskegee experiment to recall a moment in which they’ve endured medical mistreatment. As KQED recently reported, researchers say Tuskegee rarely comes up when Black people share concerns about Covid-19 vaccines. Rather, issues like racism in health care and safety concerns are cited much more often.
Ultimately, while the standards of care in the United States are exceptional, and among the highest in the world, it is important to acknowledge that anti-Black racism keeps the health care system from systematically applying that high standard to Black people. For example, just as surgeons don’t prepare patients for surgery by simply saying, “Just trust me, I’ll see you in the operating room,” when it comes to acceptance of Covid-19 vaccination, the U.S. health system should stop engaging Black communities by asking for their blind trust. Black people deserve to make this important medical decision like all other patient populations, equipped with the access they need to insurance coverage, reliable care, credible information and actual vaccines.
You Got Your Covid Vaccine. Now What?
Rhea Boyd, M.D., M.P.H. is a pediatrician, public health advocate and scholar who writes and teaches about the impact of racism and inequity on health. She co-developed a national campaign to provide Black communities with information about Covid-19 vaccines.
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