VACCINE SOCIAL PSYCHOLOGY UPDATES
US Black and Latino communities often have low vaccination rates – but blaming vaccine hesitancy misses the mark
Sat, October 9, 2021
With many vaccine-eligible people in the U.S. staying away, some vaccine sites have no lines. Mario Tama/Getty Images
By early July 2021, nearly two-thirds of all U.S. residents 12 years and older had received at least one dose of a COVID-19 vaccine; 55% were fully vaccinated. But uptake varies drastically by region – and it is lower on average among non-white people.
Many blame the relatively lower vaccination rates in communities of color on “vaccine hesitancy.” But this label overlooks persistent barriers to access and lumps together the varied reasons people have for refraining from vaccination. It also places all the responsibility for getting vaccinated on individuals. Ultimately, homogenizing peoples’ reasons for not getting vaccinated diverts attention away from social factors that research shows play a critical role in health status and outcomes.
As medical anthropologists, we take a more nuanced view. Working together as lead site investigators for CommuniVax, a national initiative to improve vaccine equity, we and our teams in Alabama, California and Idaho, along with CommuniVax teams elsewhere in the nation, have documented a variety of stances toward vaccination that simply can’t be cast as “hesitant.”
Limited access hampers vaccination rates
People of color have long suffered an array of health inequities. Accordingly, due to a combination of factors, these communities have experienced higher hospitalization due to COVID-19, higher disease severity upon admission, higher chances for being placed on breathing support and progression to the intensive care unit, and higher rates of death.
CommuniVax data, including some 200 in-depth interviews within such communities, confirm that overall, those who have directly experienced this kind of COVID-19-related trauma, are not hesitant. They dearly want vaccinations. For example, in San Diego’s heavily Latino and very hard-hit “South Region,” COVID-19 vaccine uptake is remarkably high – about 84% as of July 6, 2021.
However, vaccine uptake is far from universal in these communities. This is in part due to access issues that go beyond the well documented challenges of transportation, internet access and skills gaps, and a lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident white people usurping doses that were meant for communities of color. African American participants, in particular, reported feeling that the Johnson & Johnson vaccines promoted in their communities were the least safe and effective.
U.S. First Lady Jill Biden gives comfort to a patient at a vaccination clinic
Our participant testimony shows that many unvaccinated people are not “vaccine hesitant” but rather “vaccine impeded.” And exclusion can happen not just in a physical sense; providers’ attitudes towards vaccines matter too.
For instance, Donna, a health care worker in Idaho, said, “I chose not to get it because if I were to get sick, I think I would recover mostly or more rapidly.” This kind of attitude by health care providers can have downstream effects. For example, Donna may not encourage vaccination when on duty or to people she knows; some, just observing her choices, may follow suit. Here, what appears as a community’s hesitancy to vaccinate is instead a reflection of vaccine hesitancy within its health care system.
More directly impeded are community members who, like Angela in Idaho, skipped vaccination because she couldn’t risk having a negative reaction that might require intervention. Although a trip to the doctor is a highly unlikely outcome after a vaccine, it remains a concern for some. “My insurance doesn’t cover as much as it possibly, you know, should,” she noted. And we have encountered many reports of undocumented individuals who fear deportation although, 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. She cannot get vaccinated, she said, because she has no one to care for her babies should she fall ill with side effects. Her husband, similarly, can’t take time off from his job – “It doesn’t work that way.” Likewise, Carlos – who made sure that his centenarian father got vaccinated – says he can’t take the vaccine himself due to his dad’s deep dementia: “If I took my vaccine and I got sick, he’d be screwed.”
With many vaccine-eligible people in the U.S. staying away, some vaccine sites have no lines. Mario Tama/Getty Images
By early July 2021, nearly two-thirds of all U.S. residents 12 years and older had received at least one dose of a COVID-19 vaccine; 55% were fully vaccinated. But uptake varies drastically by region – and it is lower on average among non-white people.
Many blame the relatively lower vaccination rates in communities of color on “vaccine hesitancy.” But this label overlooks persistent barriers to access and lumps together the varied reasons people have for refraining from vaccination. It also places all the responsibility for getting vaccinated on individuals. Ultimately, homogenizing peoples’ reasons for not getting vaccinated diverts attention away from social factors that research shows play a critical role in health status and outcomes.
As medical anthropologists, we take a more nuanced view. Working together as lead site investigators for CommuniVax, a national initiative to improve vaccine equity, we and our teams in Alabama, California and Idaho, along with CommuniVax teams elsewhere in the nation, have documented a variety of stances toward vaccination that simply can’t be cast as “hesitant.”
Limited access hampers vaccination rates
People of color have long suffered an array of health inequities. Accordingly, due to a combination of factors, these communities have experienced higher hospitalization due to COVID-19, higher disease severity upon admission, higher chances for being placed on breathing support and progression to the intensive care unit, and higher rates of death.
CommuniVax data, including some 200 in-depth interviews within such communities, confirm that overall, those who have directly experienced this kind of COVID-19-related trauma, are not hesitant. They dearly want vaccinations. For example, in San Diego’s heavily Latino and very hard-hit “South Region,” COVID-19 vaccine uptake is remarkably high – about 84% as of July 6, 2021.
However, vaccine uptake is far from universal in these communities. This is in part due to access issues that go beyond the well documented challenges of transportation, internet access and skills gaps, and a lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident white people usurping doses that were meant for communities of color. African American participants, in particular, reported feeling that the Johnson & Johnson vaccines promoted in their communities were the least safe and effective.
U.S. First Lady Jill Biden gives comfort to a patient at a vaccination clinic
Our participant testimony shows that many unvaccinated people are not “vaccine hesitant” but rather “vaccine impeded.” And exclusion can happen not just in a physical sense; providers’ attitudes towards vaccines matter too.
For instance, Donna, a health care worker in Idaho, said, “I chose not to get it because if I were to get sick, I think I would recover mostly or more rapidly.” This kind of attitude by health care providers can have downstream effects. For example, Donna may not encourage vaccination when on duty or to people she knows; some, just observing her choices, may follow suit. Here, what appears as a community’s hesitancy to vaccinate is instead a reflection of vaccine hesitancy within its health care system.
More directly impeded are community members who, like Angela in Idaho, skipped vaccination because she couldn’t risk having a negative reaction that might require intervention. Although a trip to the doctor is a highly unlikely outcome after a vaccine, it remains a concern for some. “My insurance doesn’t cover as much as it possibly, you know, should,” she noted. And we have encountered many reports of undocumented individuals who fear deportation although, 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. She cannot get vaccinated, she said, because she has no one to care for her babies should she fall ill with side effects. Her husband, similarly, can’t take time off from his job – “It doesn’t work that way.” Likewise, Carlos – who made sure that his centenarian father got vaccinated – says he can’t take the vaccine himself due to his dad’s deep dementia: “If I took my vaccine and I got sick, he’d be screwed.”
Indifference, resilience and ambivalence
Another segment of unvaccinated people obscured by the “hesitant” label are the “vaccine indifferent.” For various reasons, they remain relatively untouched by the pandemic: COVID-19 just isn’t on their radar. This might include people who are self-employed or working under the table, people living in rural and remote places, and those whose children are not in the public school system.
Such people thus are not consistently connected to COVID-19-related information. This is particularly true if they forego social or news media and socialize with others who do the same, and if there are significant language barriers.
vaccine recruitment effort by CommuniVax in June
We also learned that, among some of our participants, the initial messaging about prioritizing high-risk groups backfired, leaving some under 65 and in relatively good health with the impression it wasn’t necessary for them to get the vaccine. Without incentives – travel plans, being accepted to a college or having an employer that mandates vaccination – inertia carries the day.
The indifferent are not against vaccination. Rather, “if it ain’t broke, don’t fix it” and “you do you” tend to typify their views. As Jose from 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 already were taking would be enough to keep them COVID-19-free. A janitor said, “I am an essential worker… So from the beginning we took … all the precautions … face masks, taking [social] distance [and using] natural medicines and vitamins for the immune system.” He had, indeed, so far avoided contracting COVID-19.
The view of vaccines as not immediately necessary is magnified among some Latino people by the cultural value placed on the need to endure – “aguantar” in Spanish — to bear up, push through and avoid complaining about daily struggles. This perspective can be seen in many immigrant or impoverished populations, where getting sick or injured can be a precursor to household ruin through job loss and exorbitant, unpayable medical bills.
Yet another dynamic we learned of is what we term “vaccine ambivalence.” Some participants who view COVID-19 as a significant health threat believe the vaccine poses an equivalent risk. We saw this particularly among African Americans in Alabama – not necessarily surprising given that the health care system has not always had these communities’ best interests at heart. The perceived conundrum leaves people stuck on the fence. Given the legacy of unequal treatment in communities of color, when balancing the “known” of COVID-19 against the unknown of vaccination, their inaction may seem reasonable – especially when coupled with mask-wearing and social distancing.
Attending to blind spots
At this point in the pandemic, those with the means and will to get vaccinated have done so. Providing viable counternarratives to misinformation can help bring more people on board. But continuing to focus solely on individual mistrustfulness toward vaccines or so-called hesitancy obscures the other complex reasons people have for being wary of the system and bypassing vaccination.
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Moreover, an overly narrow focus on the vaccine leaves a lot outside the frame. A wider view reveals that the problems leading to inequitable vaccination coverage are the same structural problems that have, historically, prevented people of color from having a fair shot at good health and economic outcomes to begin with – problems that even a 100% vaccination rate cannot resolve.
This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts.
It was written by:
Professor and Chair of Anthropology
Visiting Assistant Professor of Community and Public Health; Executive Director, Southeast Idaho Area Health Education Center, Institute of Rural Health
Assistant Professor of Biocultural Medical Anthropology
Covid vaccine: Why these US workers won't get jabbed
Aleem Maqbool - BBC News
Sat, October 9, 2021
Demonstrations have taken place in cities around the US against mandatory vaccination
Joe Biden has been urging US employers to issue ultimatums to their staff: get vaccinated, or lose your job.
The president says he will soon bring in a mandate that requires all healthcare workers to have had the jab, and has urged states to do the same with teachers.
In Concord, New Hampshire, it is striking to see some of those attending a large protest against vaccine mandates wearing hospital scrubs.
Leah Cushman is prepared to lose her nursing job rather than get vaccinated.
"My beliefs are religious. I believe that my creator endowed me with an immune system that protects me, and if I get sick, that's an act of God. I would not take a medicine that affects the immune system," said Ms Cushman. She denies there is any conflict between these beliefs and the responsibilities of her job.
Ms Cushman argues that the Covid vaccines remain "experimental", despite the Pfizer vaccine having full Food and Drug Administration approval in the US - meaning the FDA considers that enough data has been gathered to indicate the drug is safe and effective. But she says she no longer takes any vaccines at all in any case.
Leah Cushman says she no longer takes any vaccines
Managers who have already decided to impose vaccine mandates at their hospitals say it is primarily about making patients feel safe.
But Scott Colby, CEO of the Upper Connecticut Valley Hospital, acknowledges that he has lost several medical staff over the issue of the vaccine mandate, in a period made busier by the Delta variant and the backlog of non-Covid-related procedures.
The hospital manager says that on balance it is still the right decision to require vaccination, partly because serious coronavirus-related sickness among staff - more likely among the unvaccinated - is an avoidable drain on resources.
But Mr Colby also says he finds some of the opposition does not appear to have a purely medical or religious basis.
"It's not just Covid. There are other vaccines that employees are required to have, like MMR or hepatitis. So to say this is not political would be disingenuous," says Mr Colby.
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Back at the rally Leah Cushman, who as well as being a registered nurse is also a state representative for the Republican Party, says that her stance is also about freedom.
"The Biden administration is targeting our sovereign rights. We're medical professionals, but we still need the ability to choose what happens to our bodies," she says.
Some of the nurses at the demonstration felt that it was the hospitals playing politics, and that if this was really about patient confidence, the onus would be on weekly testing rather than on getting vaccinated, given that even those who have had the jab can pass on the virus.
However even the option of regular testing is unacceptable to many of those Americans who refuse to get vaccinated.
Kahseim Outlaw has just lost his job in Wallingford, Connecticut for that very reason. He was named Teacher of the Year at his high school last year, but felt the mandate to get vaccinated introduced by the state authorities was something he could not comply with.
"I do not use any kind of synthetic ingredients in my life, whether that be for medicinal purposes, supplementation or food. So the idea of becoming inoculated is something that goes directly against the way that I live my life," he said.
Kahseim Outlaw lost his job for refusing to get vaccinated
Like all teachers in the state, Mr Outlaw was offered an alternative of weekly testing but said he viewed that as an "unnecessary medical procedure" that was uncomfortable.
"The way that our soul speaks to us, that little voice that tells us when something is in alignment or not, that voice is telling me that I need to make this particular decision right now."
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One thing Mr Outlaw said he was prepared to undertake was an antibody test to show he had contracted Covid in the past, as he believes he did, and so has the body's natural immunity to the virus. He accepts that there is no telling how long a natural immune response will last.
But this is not an option being offered to him by his employer.
In the classroom, Kahseim Outlaw would of course be in close contact with students, but what of employees who work entirely in isolation at home? Do their employers have the right to require that they are vaccinated?
Rob Segrin lives close to Mount Monadnock in a remote part of rural New Hampshire, but has been told he will lose his IT job if he has not had his first Covid shot by the end of this month.
"I never go into an office, I never interact with people," Rob Segrin says
"My job is a 100% remote, work-from-home type of job for a federal contractor. I never go into an office, I never interact with people. I object to the vaccine because in my opinion there have not been enough years of study into it, but I protect my family in the ways I can," says Mr Segrin.
"It felt like this 'do this or you will lose your job' order was a personal attack against me and my family. Like they are coming after my livelihood," he continues.
Mr Segrin says his discussions with his employer have so far been unfruitful and as things stand, he will lose his full-time job, and as a result his health insurance and his family's health benefits too.
Across the US, there have been huge inconsistencies in public policy relating to the vaccine, just as there have been inconsistencies at every turn during this pandemic, and Republican states continue to fight vaccine mandates.
But as the US grapples with the arguments over personal freedoms and public health, figures show the virus is still claiming nearly 1,500 American lives a day.
NIH Director Dr. Francis Collins
says it's 'truly heartbreaking'
to see fellow evangelicals refuse
the COVID-19 vaccine because
of misinformation, urges them
to 'look at the evidence'
NIH Director Dr. Francis Collins said each day over 1,000 people die from COVID-19.
In an interview with CNN's Jim Acosta, Collins said most of those deaths are among the unvaccinated.
Collins called on fellow evangelicals to look at the evidence and get vaccinated.
Dr. Francis Collins, the director of the National Institutes of Health, is urging fellow evangelicals to get vaccinated.
In an interview with CNN's Jim Acosta on Saturday, Collins said misinformation is causing evangelicals to be hesitant about getting vaccinated. Calling it "truly heartbreaking," he urged people to look at the "evidence."
"Let me make a plea right here that if you are a Christian, or if you're anybody who has not yet gotten vaccinated, hit the reset button on whatever information you have that's causing you to be doubtful or hesitant or fearful and look at the evidence," Collins said. "The evidence is overwhelming, the vaccines are safe, they're effective, they can save your life."
A June survey from the Kaiser Family Foundation found that 22% of Evangelicals said they will definitely not get vaccinated.
Collins told Acosta there are still more than 1,000 people dying every day because of COVID-19, almost all of them unvaccinated and "therefore didn't have to happen."
"Christians of all people are supposed to be particularly worried about their neighbors and this is also a really critical situation where if you're not vaccinated you may be the one spreading this virus to somebody vulnerable who can't necessarily resist it," Collins said.
Some Christians have argued that they can't get the vaccine because fetal cell lines played some role in the development of the vaccine, the Associated Press reported.
The AP reported that the Vatican's doctrine office has said it is "morally acceptable" for Catholics to get the vaccine even if it was based on research on fetal cells. Pope Francis said not getting the vaccine was "suicide."
Collins, who has served as the NIH director for more than 12 years announced last week that he was stepping down at the end of the year.
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