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VACCINE HESITANCY
Editor's Column
by T. Jann Caison-Sorey, MD
Vaccine Hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is a complex multifactorial issue with context specific concerns that vary across time, place and type or types of vaccines and more. It is influenced by factors such as personal choice, misinformation, fear, risk, personal or vicarious experiences, perception and level of trust /confidence and accessibility.
For sake of transparency, vaccine hesitancy has another large segment of followers based on mistrust. These followers however, have a general mistrust of government the news and physicians! Those in this category are also far less likely to say they will be vaccinated.
That said, there are large numbers of people who
are mistrustful, fearful and concerned about getting
the COVID 19 vaccine. This is frequently reflected in communities of color, which include both black and brown people but primarily the African American communities. A University of Michigan survey of Detroiters published November 2020 by Jeffrey Morenoff, found that Black residents in the city of Detroit are four times as likely as white residents to say they will not get the COVID 19 vaccine while Hispanic residents were twice as likely as white residents to say they will avoid the vaccine. The survey also found that women were nearly twice as likely as men to say they won’t get the vaccine although, higher levels of income and education tended to increase the likelihood that a resident will seek to receive the vaccine once it can be accessed.
Why is mistrust an issue for African Americans? Some of the roots for this stem from the infamous Tuskegee experiment that was conducted by the U.S. Public Health Service from 1932 to 1972. Other contributors come from the lingering effects of the African American experience in this nation.
The “trust” factor and “faith” in the doctor – patient relationship are pivotal to the work of gaining vaccine
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acceptance among vulnerable populations but while these concepts are critically important cornerstones of the larger discussion, the approach to acceptance requires knowledge of contributing factors for these groups.
In a recent American Medical Association Panel on 12/2020 entitled, Prioritizing Equity: Trustworthiness
and Vaccines, Margaret P. Moss, PhD, JD, RN, Hidatsa/ Dakhóta, director of the First Nations House of Learning and an associate professor at the University of British Columbia School of Nursing among other presenters, shed light on COVID 19 vaccine questions and indigenous people. Surveys reflected COVID 19 vaccine avoidance issues for Indigenous people often stemmed from federal programs which led to forced “relocation, reservations, assimilation, termination,” for many American Indians and Alaskan Natives. Additionally, trusted, culturally relevant communication comes from the voices of community elders. This population has been ravaged by the COVID-19 pandemic. This reality along with the social determinants of health have led to low life expectancy and fewer
people to carry trusted messages as only about 9% of the American Indian Native Alaskan population is 65
or older compared to about 16.5% of the general population, according to the U.S. Census. The panelist stated that well-documented harms that occurred in both of these vulnerable populations have been passed down across generations and is now the presently lived experience/belief ”.
The data shows a wide age divide, among older and younger Hispanic adults. Those under age 50 appear twice as likely to say they “definitely will not” get the vaccine whereas older Hispanic adults > 50 appear more likely to take the advice/recommendations of their physicians as well as accept information from the CDC and agree to receive the COVID 19 vaccine. Overall, about a quarter (26%) of Hispanic adults say they definitely or probably won’t get the vaccine. These findings place the younger population, with tendencies toward vaccine avoidance, at
First Quarter 2021