Over the past year, we witnessed two pandemics—COVID-19 and racism—disproportionately impacting Black and other systematically marginalized communities. The COVID-19 pandemic further shed light on the more significant issue of racial injustice in the United States and its impact on health disparities, with Black patients dying from the disease at 1.7X the rate of White patients.1 Black individuals’ mistrust of the healthcare system is rooted in historical and systemic racism and perpetuated by their experiences when receiving medical care. This mistreatment contributes to greater COVID-19 vaccine deliberation among Black individuals. Although the differences in vaccination rates between White and Black individuals have narrowed, the percentage of White patients who have received at least one COVID-19 vaccine dose remains higher than the rate for Black patients.2 With the racial/ethnic disparities in COVID-19 infection and mortality rates, we sought to better understand Black individuals’ perspectives about the COVID-19 vaccine to guide clinician communication that builds trust.
We conducted 45-minute, semi-structured interviews in November 2020-March 2021 to learn about Black patients’ perceptions about the COVID-19 vaccine and identify clinician communication strategies to support their patients in vaccine deliberation. Since this study occurred before vaccine rollout, we acknowledge patient perceptions may change over time as more information regarding COVID-19 vaccines becomes available. We recruited interviewees from four clinics that primarily serve Black patients in Alabama, California, New York, and Tennessee. We interviewed 37 Black patients with 50% interviewer-interviewee race concordance. Four distinct coders coded transcripts to identify emerging themes. We also mapped clinician practices to the five communication domains in the Presence 5 for Racial Justice (P5RJ) framework.
Our history shows us that we have been experiments in America, and we don’t wanna be the frontline guinea pigs in trying out all that, and turn out disfigured, malformed … We don’t wanna be the test drive. —Black Patient Interviewee
- CDC. Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Updated February 1, 2022. Accessed March 15, 2022.
- Ndugga N, Hill L, Artiga S, et al. Latest data on COVID-19 vaccinations by race/ethnicity. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/. Published February 2, 2022. Accessed March 15, 2022.
COVID-19, Health Equity, Medical Ethics, SGIM, Social Determinants of Health, Social Justice
Ms. Hollis (email@example.com) is a research assistant in the Stanford School of Medicine Division of Primary Care
and Population Health and will be an MD candidate, 2026. Ms. Garcia (firstname.lastname@example.org) is a social science research professional in the Stanford School of Medicine Division of Primary Care and Population Health and will be an MD candidate, 2026. Ms. De Leon (email@example.com) is a pre-health professions post-baccalaureate student at San Francisco State University and preparing to be a physician’s associate. Ms. Baratta (firstname.lastname@example.org) is a project manager for the Presence 5 team in the Stanford School of Medicine Division of Primary Care and Population Health. Dr. Brown-Johnson (email@example.com) is a qualitative researcher in the Stanford School of Medicine Division of Primary Care and Population Health.
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