Black Women in the US Remain Hesitant Regarding Vaccines

Vaccine hesitancy remains a prevalent issue in Black women living in the US according to a new study published in JAMA Network Open.¹ Vaccine hesitancy has root causes in several reasons, which requires education on the topic to be specified for each individual to address improving vaccine uptake in this demographic.

Vaccine hesitancy is a major challenge in public health, highlighted primarily during the COVID-19 pandemic, during which Black communities had higher rates of both infection and mortality.² Vaccine hesitancy can be defined as a person either refusing vaccines or delaying receiving the vaccine even if the vaccine is readily available. Vaccine hesitancy can stem from multiple factors, including emotional, cultural, or political influences. Black residents of the US have been more hesitant of vaccines historically with Black women more hesitant than Black men. The current study aimed to exam the themes surrounding this hesitation, specifically with the COVID-19 vaccine.

Vaccine hesitancy persists in Black women in the US | Image credit: weyo - stock.adobe.com

Participants were included if they were a Black women who lived in the US and were aged 18 years or older. Participants were recruited via social media and interviews were conducted through Zoom between June and November 2021. All participants were asked about vaccine hesitancy and COVID-19 through open-ended questions and follow-up clarification questions. All interviews were recorded and transcribed for use in the study, with all participants being anonymous.

There were 54 women included in the study who were aged between 21 and 66 years. A bachelor’s degree was held by 75.9% of the participants, and 59.3% had no children. Most of the participants lived in the South (75.9%) and identified as Christian (72.2%). There were 3 themes that were associated with hesitancy surrounding the COVID-19 vaccine: mistrust in health care and government, concern over vaccine safety, and ineffective and coercive communications surrounding the vaccine.

Black women primarily spoke about their mistrust in health care, as medical care in the past has treated Black participants poorly during the development of the vaccines. A participant specifically mentioned that the Black community were the “lab experiment, the testing community for these vaccinations,” which has made her against vaccination in general. A participant who works in health care mentioned that changing accounts of how the virus spread made her wary of taking the advice of health care professionals regarding the vaccine. The rapidity of the development of the vaccine was also called into question.

This rapidity of development also made participants question the safety of such a vaccine as well as the effects that it could have on their health in the long term. Participants having fears of a bad reaction to the vaccine, or not being taken seriously if they do have a bad reaction, were primary concerns of the participants. Participants were also concerned about how the vaccine might affect them 10 years after the vaccine was given and how the FDA might have approved it too quickly.

Communications surrounding the vaccine have also been inconsistent and insufficient in the eyes of the participants. Some of the promotions of the vaccine were also met with disapproval due to their being disrespectful of the needs of the community, culturally insensitive, or coercive. The participants felt that more education on the virus was needed, as the way that the vaccine worked wasn’t explained. The lack of unity in messaging and the perceived handouts to entice people to get the vaccine were felt to be both uninformative and insensitive.

There were some limitations to this study. This study may not be generalizable to all Black women living in the US. Participants were more likely to have strong opinions due to self-selection of participants. The participants were also not geographically diverse, with most being from the south, which could eliminate evaluation of different strategies regarding vaccine uptake. Pregnancy status was not collected. There was homogeneity regarding the participants’ education, geography, and religion did not allow for comparison.

“The study provides crucial insights into how Black women’s intersectional experiences with both racial and gender discrimination in health care settings specifically shape their vaccine decisions. Current vaccine promotion strategies—particularly the use of financial incentives and culturally insensitive celebrity endorsements—appear to erode trust among Black women," said Brittany C. Slatton, PhD, coauthor of this study, in a statement to The American Journal of Managed Care^®. "As key health care decision-makers for their families and communities, addressing Black women’s vaccine concerns through transparent communication and culturally respectful approaches could significantly impact community-wide vaccination rates.”

The researchers concluded that the method of approaching Black women who are hesitant about receiving the vaccine should be changed to better address the concerns brought up in this study. “Health care practitioners can use these findings to improve communication with Black women patients, while public health officials can design more respectful outreach programs addressing specific concerns, which may increase vaccine confidence and uptake,” the authors wrote.

References

1. Slatton BC, Cambrice FG, Omowale SS. COVID-19 vaccine hesitancy among black women in the US. JAMA Netw Open. 2025;8(1):e2453511. doi:10.1001/jamanetworkopen.2024.53511
2. Hill L, Artiga S. COVID-19 cases and deaths by race/ethnicity: current data and changes over time. KFF. August 22, 2022. Accessed January 8, 2025. https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/