COVID-19 Vaccine Hesitancy in the Southern U.S.

In the southern United States, systemic racism and economic marginalization have contributed to the disproportionate impact of COVID-19 experienced by African American communities. These and other social determinants of health, including limited health care resources, higher area-level disadvantage, lower socioeconomic status, and a concentration of comorbidities, have limited many communities’ ability to effectively mitigate COVID-19 exposure and mortality, including physical distancing, working from home, and vaccination.

COVID-19 vaccination has also been influenced by the “infodemic” – the ever-growing sources of COVID-19 vaccine misinformation that have shaped public perceptions about the vaccine and hindered vaccination efforts across the country and world. A recent study supported by NIMHD examined social and demographic factors associated with COVID-19 vaccine hesitancy among African Americans living in the southern U.S.

In this study, investigators performed a cross-sectional analysis of survey data from a subsample of participants from the SeroPrevalence And Respiratory Tract Assessment (SPARTA) study. They included 257 community-dwelling members from the Central Savannah River Area who were 18 years of age or older and of which 97% identified as African American. The investigators calculated adjusted odds ratios to determine the association between survey question responses with vaccination hesitancy, assessed by the question: “If given to you for free, how likely are you to take a COVID-19 vaccination?”

Participant responses related to vaccine hesitancy were categorized in three groups:

Acceptant (replying as very likely or likely to take the free vaccine).
Hesitant (replying neutral).
Resistant (replying unlikely or very unlikely).

The models were adjusted for age, gender, employment, health insurance, diabetes, total number of comorbidities, tobacco use, history of receiving the flu shot, and housing insecurity due to COVID-19 (defined as having lost a home or had difficulties paying rent due to the COVID-19 pandemic).

Most survey respondents (68.1%) were acceptant of receiving a free COVID-19 vaccine, followed by resistant (16.3%) or hesitant (15.6%). The authors report that the odds of vaccine resistance were:

20 times more likely in participants 18 to 20 years old than in those 50 years or older.
7 times more likely in participants experiencing housing insecurity due to COVID-19.
4 times more likely in participants 40 to 49 years old than in those 50 years or older.
Almost 3 times more likely in participants with no health insurance compared those with insurance.
82% less likely in individuals with other employment compared to those employed full-time.
61% less likely in individuals having ever receiving the flu shot compared to those who had not.

The authors reported that the odds of vaccine hesitance were:

Almost 7 times more likely in participants 18 to 20 years old than in those 50 years or older.
3 times more likely in participants 40 to 49 years old than in those 50 years or older.
Almost 4 times more likely in women compared to men.
75% less likely in participants with high blood pressure.
56% less likely in individuals having ever receiving the flu shot compared to those who had not.

In summary, several social determinants of health were associated with vaccine resistance and hesitancy in a southern African American community. This included a lack of health insurance, experiencing the loss of a home or difficulty in paying rent, or having never received a flu shot. The study investigators speculated that perceptions of COVID-19 disease severity in youth and limited or unreliable interactions with health care systems, often due to housing insecurity, may influence perceptions about COVID-19 and the vaccine. Additional outreach and greater trust between the community and health care providers will be required to address resistance and hesitancy in African American populations in the southern U.S.

Citation:

Moore, J.X., Gilbert, K.L., Lively, K.L., Laurent, C., Chawla, R., Li, C., … Ledford, C.J.W. (2021). Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States. Vaccines, 9(879), doi:10.3390/vaccines9080879.

Page updated January 14, 2022