What we know about likely COVID-19 vaccine uptake by race and ethnicity
Photo by Myriam Zilles on Unsplash.
What we know about likely COVID-19 vaccine uptake by race and ethnicity
by CRAIG HELMSTETTER | Dec. 8, 2020
COVID-19 mortality rates are higher for nearly every community of color in nearly every state, as thoroughly documented in our Color of Coronavirus project. With the advent of COVID-19 vaccines, the question has become: how likely are different racial and ethnic groups to get vaccinated?
As detailed below:
Recent public opinion data suggests that only about 3 in 5 American adults are readily interested in receiving a COVID-19 vaccine, including only about 2 in 5 of Black Americans.
More comprehensive self-reported seasonal flu vaccination data shows that just under half of American adults received a flu shot in the 2019-20 season, including roughly 2 in 5 of Black, Latino, and Indigenous adults.
Note that this summary of existing data is not intended to scapegoat any particular group. Among many Black Americans, the painful histories of the Tuskegee Syphilis study and HeLa cell line have created distrust of the medical establishment and the pharmaceutical industry. The continued, well-documented mistreatment of communities of color within the health care industry also factors into both the skepticism expressed in the public opinion data and the lower seasonal flu vaccine rates discussed below.
Findings from recent surveys about interest in COVID-19 vaccines
Public opinion surveys have found that Black Americans, the racial group with the highest COVID-19 mortality rate, have higher levels of hesitancy about getting a COVID-19 vaccine than is the case for Asian, Latino, and White Americans. To date, surveys have not generated a clear understanding of other groups with high mortality rates, including Pacific Islanders and Indigenous Americans.
A Pew Research survey released last week found that Black Americans are less likely than Asians, Whites, and Latinos to say they would get a COVID-19 vaccine. Asian Americans are the racial group most likely to say they would get vaccinated.
Interest in getting vaccinated has climbed roughly 10 percentage points for all groups since Pew’s September survey, but is still roughly 10 percentage points lower than Pew’s initial survey on the topic, in May. (To see these changes, click on ‘September 2020 survey’ and ‘May 2020 survey’ the in the graph above.)
The November survey also shows a continued political difference in vaccine interest; 69% of Democrats intend to get vaccinated compared to 50% of Republicans.
Older, more educated, and higher income adults consistently say they are more likely to get a COVID-19 vaccine according to the Pew Research surveys.
A Franklin Templeton—Gallup survey conducted in early October also found that Asians are most receptive to getting a COVID-19 vaccine (56%), followed by Latinos (48%), Whites (46%), and Black Americans (31%).
Around 20% of those surveyed who were reluctant to get a COVID-19 vaccine would consider getting vaccinated under specific circumstances, including if their doctor were to recommend it or if it were available for free.
Similarly, a KFF/The Undefeated survey in August and September found that Black Americans are more hesitant than either Whites or Hispanics to get a COVID-19 vaccine “determined to be safe by scientists and available for free to everyone who wanted it.”
Only 9% of Black adults surveyed were “very confident” that “when a coronavirus vaccine becomes available, it will be distributed in a way that is fair.” More than three times that number of Black Americans are “not at all confident” that this will be the case.
A COVID Collaborative survey specifically on “Coronavirus Vaccination Hesitancy in the Black and Latinx Communities” conducted in September found that Latinos say they are more likely to definitely get vaccinated (31%) than is the case among Black Americans (18%) if it were available for free.
According to this study, “trust in in the safety of the vaccine is by far the strongest predictor” of vaccine uptake, and that confidence in vaccine production and delivery is built on “trust in the government to look out for the interests of Black or Latinx people.” Notably, two-thirds of Black adults believe that the government can only rarely or never be trusted to look out for the interests of the Black community.
Findings from large-scale federal health monitoring
Another clue into how different racial and ethnic groups will access forthcoming coronavirus vaccines may be the coverage rates for seasonal flu vaccines that have been available for several years. The Centers for Disease Control and Prevention (CDC) regularly monitors flu vaccine coverage as a part of its on-going Behavioral Risk Factor Surveillance System (BRFSS) survey, which annually interviews more than 400,000 American adults. This large sample size allows the CDC to obtain a better understanding of smaller racial and ethnic groups than is possible through most public opinion surveys (which typically include around 1,000 respondents).
The CDC’s most recent analysis of the flu coverage data aligns with some of the patterns shown in recent public opinion surveys about the coronavirus vaccination, namely that White and Asian adults are more likely to get vaccinated than are Black adults. In contrast to recent public opinion surveys, however, the CDC shows that during the 2019-20 flu season Latinos were less likely than Black Americans to receive a flu shot.
In addition, the BRFSS shows that only about 2 in 5 of Indigenous adults received a flu shot or nasal spray during the 2019-20 flu season. Similarly, the CDC presented a catchall “other or multiple race” category, which includes Native Hawaiians and Pacific Islanders, and reports that only 2 in 5 adults in that category received a flu vaccine.
Older adults are also much more likely to receive a flu shot than younger adults. Since the White population is considerably older than most populations of color, the CDC also compared flu shot coverage by race and ethnicity separately for various age groups.
Among those age 18 to 64, the highest reported vaccination rate is among Asian Americans (50%), although that rate is statistically tied with that of Whites (46%). For this “typical working-age” group, vaccination coverage rates fall just below 40% among Indigenous, Black, Latino, and “other or multiple race” Americans.
Flu shot uptake is notably higher among those age 65 or older for all racial and ethnic groups. But once again, Asian Americans lead the vaccination rates among older adults, followed by Whites. Two-thirds of Indigenous Americans age 65 or older received the flu vaccine, with even lower rates among the nation’s Black, Latino, and “other or multiple race” older adults.
Conclusions
The racial group with the highest COVID-19 mortality rate, Black Americans, are those that have expressed the greatest skepticism in recent public opinion surveys about getting a COVID-19 vaccine once available. This is the case even when surveys specifically pose a scenario where the vaccine is scientifically proven and cost-free. Some survey data, as noted above, suggests that this skepticism may be rooted in historically-based distrust of the medical system.
A similar pattern shows up in the more comprehensive federal data that tracks seasonal flu vaccine coverage rates. The seasonal flu vaccine data also shows relatively low vaccination coverage among Indigenous, Latino, and other populations. These groups—especially Indigenous Americans—also have disproportionately high rates of COVID-19 mortality.
As plans related to the COVID-19 vaccination’s roll-out emerge, including the federal government’s establishment of phased prioritization, increasing the interest in receiving vaccination and lowering barriers that might prevent access to vaccination will be a key to achieving the much-desired herd immunity to the coronavirus.
Among racial and ethnic populations that have been disproportionately impacted by COVID-19, vaccination efforts must confront cost and convenience, as well as differential treatment in—and distrust of—the medical system. A recent article in the New England Journal of Medicine proposes some ideas about how these barriers to trust may be overcome, as powerful institutional players demonstrate their trustworthiness. Additionally, efforts to work with historically marginalized communities about the importance of vaccination have already begun to emerge.
-Craig (On Twitter: @c_helmstetter)