COVID-19 vaccine hesitancy in underserved communities of North Carolina

  1. Irene A. Doherty
  2. William Pilkington
  3. Laurin Brown
  4. Victoria Billings
  5. Undi Hoffler
  6. Lisa Paulin
  7. K. Sean Kimbro
  8. Brittany Baker
  9. Tianduo Zhang
  10. Tracie Locklear
  11. Seronda Robinson
  12. Deepak Kumar

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Abstract

In the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina.

Methods

We conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 –December 15, 2020. Vaccine hesitancy was defined as the response of “no” or “don’t know/not sure” to whether the participant would get the COVID-19 vaccine as soon as it became available.

Results

The sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]).

Conclusions

This study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.

Article activity feed

  1. Version published to 10.1371/journal.pone.0248542
  2. ScreenIT

    SciScore for 10.1101/2021.02.21.21252163: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Eligibility criteria to participate in the survey included being at least 18 years of age, English or Spanish comprehension and providing informed consent.
    IRB: The Institutional Review Board at NCCU approved the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    ACCORD identified local residents as community facilitators and leveraged existing health resources such as public health departments in each county to garner community support for COVID-19 testing events.
    ACCORD
    suggested: ( ACCORD , RRID:SCR_009015)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are limitations of the ACCORD survey. The data originate from a convenience self-selected sample recruited from COVID-19 testing events who agreed to take the extra time to complete the survey. The extent to which they reflect the experiences of others in their communities is unclear. Because respondents completed paper surveys, we did not have the advantages of electronic data entry including logic checks, skip patterns, and reducing missing data. However, online surveys tended to skip the questions about reasons not to vaccinate. Such questions were administered to all respondents in our paper survey, showing that people who were not vaccinate hesitant, nonetheless, had safety concerns and wanted others to get the vaccine first (Figure 2). Logistical constraints prevented collecting COVID-19 test results from participants. That said, not collecting testing results likely increased participation and preserved community trust. The ACCORD communities were testing deserts and susceptible to becoming vaccination deserts perpetuating health disparities if provision of vaccines fails to address and overcome obstacles. Emerging evidence suggests that navigating the landscape to obtain vaccines requires a combination of information about where to go, health literacy, computer savvy, patience, and persistence.44,45 ACCORD presents an example of a coordinated system, where collected meaningful data for the implementing of evolving COVID-19 management and vaccination strategies o...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.21.21252163 on medRxiv