Under-represented groups are rightfully nervous about getting the COVID-19 vaccine

Updated on April 27th, 2021 with summary table on how common COVID-19 vaccine concerns are addressed and their sources at the bottom.

By Michelle Rufrano & Jean-Ezra Yeung

Executive Summary

  • Multiple COVID-19 vaccine surveys show that the plan to get the vaccine is about half of the U.S. population, and Blacks showed the highest level of concern
  • Contemporary racism is compromising vaccine access for communities of color
  • Clinical trials should adapt representation to accommodate the highest burden of disease
    • This includes any under-represented group (e.g. age, gender identity, ability, immigrant status, etc.)
  • The surveys show that the top concern is side effects
    • Some vaccine concerns were unfounded (acquiring infection from vaccine and costs) from mis/dis-information, but others reflect a fundamental mistrust

Many articles have heavily leaned on historic racism as way to explain away the presence of vaccine hesitancy in communities of color, but action can only be taken if we address the ways racism is expressed today. Black and Brown Americans are the most distrustful of the vaccine, yet they are also have the highest mortality and morbidity rates due to the coronavirus itself. Contemporary racism, therefore, manifests in cultivating an environment where communities of color distrust something that they need more than any other group.

This phenomenon is supported across four COVID-19 vaccine surveys (see summary table at the bottom) and clinical trial data. The survey data shows that only about half of the U.S. population is planning on getting vaccinated — Blacks have the strongest level of concern. Across all groups, the top concern is side effects, which have been documented in sizable proportions from clinical trials. Most of the other concerns can be categorized as mis/dis-information, and mistrust in medical research, development and practice. The clinical trials conducted by Pfizer-BioNTech, Moderna, and Johnson & Johnson’s Janssen all mirror lack of representation in recruitment of study participants. Under-represented groups are rightfully nervous about getting a vaccine if people with their specific social identities are not adequately included at the research stage.

This phenomenon is known as the “Tuskegee effect” or the lingering distrust of participation in medical trials aptly named by a one of the most well-known historic disregard for black male health specifically needs to be addressed. Furthermore, acknowledgement of how racism manifests today is tantamount to helping people of all backgrounds access care. The COVID-19 pandemic shows us how a disproportionate impact on a subgroup affects everyone in the (global) community, alongside dire strains on (public) health systems. Consequently, clinical trials and public health efforts should adapt representation to accommodate those with the highest burden of disease.

Dec. 2020
Jan. 2021
Kaiser Family Foundation (KFF)
Feb. 2021
Pew Research Center
Mar. 2021
The decision to get vaccinated or individuals who got vaccinated is split around the middle47% plan to get the vaccine51% plan to get the vaccine if they haven’t yet55% received at least one doseHalf of U.S. plan to get the vaccine, if they haven’t already
There are racial differences, specifically Blacks had a stronger level of concern and there was a lack of confidence that there was adequate testing on their race/ethnicityBlacks (24%) are less likely to plan to get the vaccine than Whites (53%) and Hispanics (34%)Non-Hispanic Blacks (30%) are least likely to plan to get the vaccine compared to Hispanics (47%), Non-Hispanic Whites (56%), and non-Hispanic Asians (66%)Vaccine enthusiasm is higher in Whites (61%) than in Hispanics (52%) and Blacks (41%)

Half of Blacks (50%) and one third of Hispanics (34%) were not confident the vaccine was adequately tested on their race/ethnicity
Blacks (61%) are the least likely to plan to get the vaccine or already did compared to White (69%), Hispanic (70%), and Asians (91%)

Yet Blacks expressed a higher level of concern about the pandemic across six questions, such as getting infected and being hospitalized or knowing someone that did

Blacks expressed less confidence in the vaccine research and development process
There are myriad vaccine concerns and side effects is at the top of the list*The top reason for not getting the vaccine or being unsure are side effects (71%), development/approval process (57%), infection from the vaccine (37%)The top concerns were side effects (51.2%) and plan to wait and see if it is safe (50%)The top concern is side effects (56%), followed by out-of-pocket costs (35%), missed work from side effects (34%), get COVID-19 from vaccine (33%) and won’t be able to get it at a trusted place (30%)The major reason is side effects (72%), vaccine developed too quickly (67%), want to know more how they work (61%), seen too many medical system mistakes in the past (46%), don’t need it (42%), and don’t get vaccines in general (36%)

*Some of the concerns are unfounded, such as out-of-pocket costs (only for the vaccine, not the administration if not the only service in visit) and getting the infection.

Note: I would say the KFF and Pew Center Research surveys were the most comprehensive, if you wanted to look at them in more detail.

Updated on April 27th, 2021 with summary table on how common COVID-19 vaccine concerns are addressed and their sources:

Concern AnswerSource
 Side effectsIn clinical trials, the most common side effects (>50%) were at the injection site (e.g. pain) and others (>~40%) include fatigue, fever, muscle pain, headache. Allergies were reported. Rare events occurred but were not related.FDA, NEJM, NIH clinicaltrials.gov (see bottom of table for links)
Vaccine development and approval processResearch, development and approval were accelerated from: genetic sequencing technology and sharing; existing coronavirus research; no financial risk from US government’s Operation Warp Speed funds; ease of participant recruitment; and Emergency Use AuthorizationNature, Medical News Today, FDA
Infection from vaccinePfizer-BioNTech, Moderna and Johnson & Johnson’s Janssen vaccines (mRNA or viral vector) do not use the COVID-19 virus, but they help generate the spike protein that triggers antibody and immune responses against COVID-19.CDC (mRNA, viral vector)
InconvenienceThe vaccine and its administration in a visit without other services should be covered by insurance (providers can request administration reimbursement from the government for uninsured). Certain states passed law to give employees hours aside from sick time to get the vaccine (e.g. New York State on March 21 for 4 hours per vaccine dose).CDC, New York State
Mistrust of healthcare systemPeople haven’t viewed doctors and medical researchers as trustworthy when it comes to transparency and responsibility. Also for healthcare providers, people felt rushed and confused about instructions.Pew

Side effects sources: