Bin early July 2021, almost two-thirds of all U.S. residents 12 years of age or older had received at least one dose of a COVID-19 vaccine; 55% were completely vaccinated. But uptake varies drastically by region, and it does lower than average among people who are not white.
Many blame it relatively lower vaccination rates in communities of color on “vacant hesitation.” But this label overlooks persistent barriers to access and groups together the various reasons why people abstain from vaccination. It also puts all the responsibility on getting vaccinated on people. Ultimately, the reasons for homogenizing people not to get vaccinated divert attention social factors that research shows plays a critical role in health status and outcomes.
As a doctor anthropologists, we took a more nuanced view. Working together as principal investigators of the site CommuniVax, a national initiative to improve vaccine equity, we and our teams in Alabama, California, and Idaho, along with CommuniVax teams in any other part of the country, have documented several positions toward vaccination that simply cannot be considered “hesitant”.
Limited access makes vaccination rates difficult
People of color have long suffered one a number of health inequalities. Consequently, due to a combination of factors, these communities have experienced higher hospitalization due to higher COVID-19 severity of the disease after admission, there is a greater chance of receiving respiratory support and progression to the intensive care unit and higher mortality rates.
CommuniVax data, including some 200 in-depth interviews within these communities, confirm that, in general, those who have directly experienced this type of Trauma related to COVID-19, do not hesitate. They want vaccines a lot. For example, in the very Latin and heavily affected “Southern Region” of San Diego, the uptake of the COVID-19 vaccine is remarkably high, approx. 84% as of July 6, 2021.
However, vaccine uptake is not universal in these communities. This is due in part to access issues that go beyond the file well-documented challenges transportation, Internet access and skills shortages, and lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident white people usurping doses intended for communities of color. African American participants, in particular, reported that they felt that Johnson & Johnson vaccines are promoted in their communities they were the least safe and effective.
Our testimony from participants shows that many unvaccinated people do not “hesitate,” but are “prevented by the vaccine.” And exclusion can happen not only in a physical sense; providers’ attitudes towards vaccines are also important.
For example, Donna, an Idaho health worker, said, “I chose not to get it because if I got sick, I think I would recover mostly or faster.” This type of attitude on the part of health care providers may have downstream effects. For example, Donna may not encourage vaccination when she is on duty or people she knows; some, just by watching their decisions, can follow the same. Here, what appears to be the hesitation of a community to be vaccinated is, instead, a reflection of the hesitation within its health care system.
Members of the community who are most directly prevented, such as Angela in Idaho, skipped the vaccination because they could not risk having a negative reaction that might require intervention. While a trip to the doctor is a very unlikely outcome after a vaccine, it remains a concern for some. “My insurance doesn’t cover as much as possibly, you know, it should be,” he noted. And we have come across many reports of undocumented people who fear deportation though, according to current laws, immigration status should not be questioned in relation to the vaccine.
Christina, in San Diego, illustrates another type of practical barrier. You can’t get vaccinated, he said, because you don’t have anyone to take care of your babies in case you get sick with side effects. Her husband, similarly, can’t take time off from her job: “It doesn’t work that way.” Similarly, Carlos, who made sure his centenarian father was vaccinated, says he can’t get the vaccine himself because of his father’s deep dementia: “If I got the vaccine and got sick , would be fucked “.
Indifference, resistance and ambivalence
Another segment of unvaccinated people hidden by the “hesitant” label is the “indifferent vaccines.” For various reasons, they they will remain relatively intact by the pandemic: COVID-19 is not on its radar. This can include people who are self-employed or working under the table, people who live in rural and remote places, and those whose children are not part of the public school system.
Therefore, these people are not constantly connected to the information related to COVID-19. This is particularly true if they give up social or news media and relate to others who do the same and if there are significant language barriers.
We also learned that, among some of our participants, the initial messages about give priority to high-risk groups, leaving some under 65 and in relatively good health with the impression that they did not need to be vaccinated. Without incentives (travel plans, acceptance into a university, or having an employer require vaccination), inertia takes over the day.
The indifferent are not against vaccination. Rather, “if it doesn’t break, don’t fix it” and “you do” tend to typify their opinions. As Jose of Idaho reported, “I’m not worried because I’ve always taken care of myself.”
We also saw a modified form of indifference in those who believed that the protective steps they were already taking would be enough to keep them free of COVID-19. A caretaker said: “I am an essential worker … So from the beginning we took … all the precautions … [social] distance [and using] natural medicines and vitamins for the immune system. ”In fact, he had so far avoided taking COVID-19.
The view of vaccines as unnecessary immediately spread among some Latinos because of the cultural value given to the need to endure, to “endure” in Spanish, to endure, to move forward and to avoid complaining about daily struggles. This perspective can be seen in many immigrant or impoverished populations, where they get sick or injured it can be a precursor to the ruin of the home for loss of employment and exorbitant and unpayable medical bills.
Another dynamic we have learned is what we call “vaccine ambivalence”. Some participants who consider COVID-19 to be a significant health threat believe that the vaccine poses an equivalent risk. We saw it especially among African Americans in Alabama, not necessarily surprising, as the health care system has not always had these communities higher interest In the heart. The enigma that is perceived leaves people trapped in the fence. Given the legacy of unequal treatment in communities of color, when balancing the “known” of COVID-19 with the unknown of vaccination, its inaction may seem reasonable, especially when combined with masking and social distancing.
Attention to blind spots
At this time of the pandemic, those who have the means and the will to get vaccinated have done so. Provide viable contraindications to misinformation it can help incorporate more people. But continuing to focus solely on individual distrust of vaccines or so-called hesitation overshadows the other complex reasons people have for distrusting the system and avoiding vaccination.
In addition, an overly narrow focus on the vaccine leaves much out of the box. A broader view reveals that the problems leading to inequitable vaccine coverage are the same structural problems that have historically prevented people of color. have a fair shot for good economic and health results, problems that even a 100% vaccination rate cannot solve.
Elisa J. Sobo, Professor and Chair of Anthropology, San Diego State University; Diana Show, Visiting Assistant Professor of Public and Community Health; Executive Director of the Southeast Idaho Area Health Education Center, Idaho State University Institute of Rural Health, Idaho State University, i Stephanie McClure, Assistant Professor of Biocultural Medical Anthropology, University of Alabama