Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.
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The ethics of COVID‐19 vaccine mandates for healthcare workers: Public health and clinical perspectives
COVID‐19 vaccine uptake among healthcare workers (HCWs) remains of significant public health concern due to the ongoing COVID‐19 pandemic. As a result, many healthcare institutions are considering or have implemented COVID‐19 vaccine mandates for HCWs. We assess defenses of COVID‐19 vaccine mandates for HCWs from both public health and professional ethics perspectives. We consider public health values, professional obligations of HCWs, and the institutional failures in healthcare throughout the COVID‐19 pandemic which have impacted the lived experiences of HCWs. We argue that, despite the compelling urgency of maximizing COVID‐19 vaccine uptake among HCWs, the ethical case for COVID‐19 vaccine mandates for HCWs in the United States is complex, and, under current circumstances, inconclusive. Nevertheless, we recognize that COVID‐19 vaccine mandates for HCWs have already been and will continue to be implemented across many healthcare institutions. Given such context, we provide suggestions for implementing COVID‐19 vaccine mandates for HCWs.
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- Award ID(s):
- 2122574
- PAR ID:
- 10612844
- Publisher / Repository:
- Wiley
- Date Published:
- Journal Name:
- Bioethics
- Volume:
- 37
- Issue:
- 4
- ISSN:
- 0269-9702
- Page Range / eLocation ID:
- 331 to 342
- Subject(s) / Keyword(s):
- COVID‐19 healthcare workers policy vaccine mandates
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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