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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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Objectives Substantial inequalities in access to healthcare are common in rural and marginalized populations in the Global South, and these inequalities can drive health disparities. Historical mistrust of healthcare institutions can further impact healthcare behaviors, including vaccination. Here, we apply the concept of medical mistrust, which has been widely applied to healthcare decisions in industrialized countries, across a rural–urban spectrum of communities in Namibia, and assess its utility in understanding vaccination decisions. Methods Otjiherero-speaking indigenous communities of Kunene, Namibia, were surveyed to assess medical mistrust. Participants also answered questions about COVID-19 vaccination status, vaccine safety, and interest in a hypothetical malaria vaccine. Bayesian multilevel models were used to compare medical mistrust across communities and its influence on vaccination and vaccine perceptions. Results The level of medical mistrust varied across contexts, with the highest level of mistrust in peri-urban communities. Medical mistrust predicted beliefs about vaccine safety and interest in the malaria vaccine, but not COVID-19 vaccine status, which was largely driven by access to the vaccine. For rural and peri-urban Himba, participants also expressed disinterest in the COVID-19 vaccine and worries about its safety. Conclusion Addressing global health disparities requires understanding how locally contextualized social and ecological experiences shape healthcare and vaccination decisions. Results of this study show fundamental differences in medical mistrust by community, which may be contributing to beliefs about vaccines. Understanding how medical mistrust varies across these contexts, and how it impacts perceptions about vaccination, can inform health communication and public policy in underserved communities.more » « less
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Wardman, Jamie (Ed.)Currently, one of the most pressing public health challenges is encouraging people to get vaccinated against COVID-19. Due to limited supplies, some people have had to wait for the COVID-19 vaccine. Consumer research has suggested that people who are overlooked in initial distribution of desired goods may no longer be interested. Here, we therefore examined people’s preferences for proposed vaccine allocation strategies, as well as their anticipated responses to being overlooked. After health-care workers, most participants preferred prioritizing vaccines for high-risk individuals living in group-settings (49%) or with families (29%). We also found evidence of reluctance if passed over. After random assignment to vaccine allocation strategies that would initially overlook them, 37% of participants indicated that they would refuse the vaccine. The refusal rate rose to 42% when the vaccine allocation strategy prioritized people in areas with more COVID-19 – policies that were implemented in many areas. Even among participants who did not self-identify as vaccine hesitant, 22% said they would not want the vaccine in that case. Logistic regressions confirmed that vaccine refusal would be largest if vaccine allocation strategies targeted people who live in areas with more COVID-19 infections. In sum, once people are overlooked by vaccine allocation, they may no longer want to get vaccinated, even if they were not originally vaccine hesitant. Vaccine allocation strategies that prioritize high-infection areas and high-risk individuals in group-settings may enhance these concerns.more » « less
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The US and the rest of the world have suffered from the COVID-19 pandemic for over a year. The high transmissibility and severity of this virus have provoked governments to adopt a variety of mitigation strategies. Some of these previous measures, such as social distancing and mask mandates, were effective in reducing the case growth rate yet became economically and administratively difficult to enforce as the pandemic continued. In late December 2020, COVID-19 vaccines were first approved in the US and states began a phased implementation of COVID-19 vaccination. However, there is limited quantitative evidence regarding the effectiveness of the phased COVID-19 vaccination. This study aims to provide a rapid assessment of the adoption, reach, and effectiveness of the phased implementation of COVID-19 vaccination. We utilize an event-study analysis to evaluate the effect of vaccination on the state-level daily COVID-19 case growth rate. Through this analysis, we assert that vaccination was effective in reducing the spread of COVID-19 shortly after the first shots were given. Specifically, the case growth rate declined by 0.124, 0.347, 0.345, 0.464, 0.490, and 0.756 percentage points corresponding to the 1–5, 6–10, 11–15, 16–20, 21–25, and 26 or more day periods after the initial shots. The findings could be insightful for policymakers as they work to optimize vaccine distribution in later phases, and also for the public as the COVID-19 related health risk is a contentious issue.more » « less
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null (Ed.)In response to the novel coronavirus (COVID-19) pandemic, public health interventions such as social distancing and stay-at-home orders have widely been implemented, which is anticipated to contribute to reducing the spread of COVID-19. On the contrary, there is a concern that the public health interventions may increase the level of loneliness. Loneliness and social isolation are public health risks, closely associated with serious medical conditions. As COVID-19 is new to us today, little is known about emotional well-being among people with visual impairment during the COVID-19 pandemic. To address the knowledge gap, this study conducted phone interviews with a convenience sample of 31 people with visual impairment. The interview incorporated the University of California, Los Angeles (UCLA) Loneliness Scale (version 3) and the trait meta-mood scale (TMMS) to measure loneliness and emotional intelligence skills, respectively. This study found that people with visual impairment were vulnerable to the feeling of loneliness during the COVID-19 pandemic and showed individual differences in emotional intelligence skills by different degrees of loneliness. Researchers and health professionals should consider offering adequate coping strategies to those with visual impairment amid the COVID-19 pandemic.more » « less
- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1111/bioe.13141
