"Black Is Not Monolithic": Complexities in COVID-19 Vaccine Decision-Making

Area of Science:

• Public Health
• Sociology
• Medical Ethics

Background:

• COVID-19 disproportionately affected Black Americans due to longstanding inequities.
• Lower COVID-19 vaccine uptake in Black populations is linked to medical mistrust.

Purpose of the Study:

• To explore Black parents' perspectives on the COVID-19 pandemic and vaccination.
• To understand factors influencing COVID-19 vaccine decisions for themselves and their children.
• To assess trust within the Black community regarding the medical system.

Main Methods:

• Qualitative methodology using in-depth, semi-structured interviews.
• Grounded theory approach and constant comparative method.
• Interviews conducted with 20 Black parents at a tertiary academic medical center.

Main Results:

• Five themes emerged: mixed feelings on vaccine decisions, influence of health concerns and mandates, risk perception affecting uptake, systemic racism fueling institutional mistrust, and conflicted feelings about child vaccination.
• Fifty percent of interviewed parents were vaccinated against COVID-19.
• Key decision-making factors included relief, uncertainty, fear, distrust, and perceived vaccine integrity.

Conclusions:

• Vaccine decision-making among Black families is complex and significantly influenced by institutional mistrust.
• Addressing systemic racism and building trust are essential for effective COVID-19 vaccine counseling.
• Findings highlight the need for culturally sensitive approaches to public health interventions.