More than a month after the first authorized Covid-19 vaccines began rolling out, Americans are feeling increasingly eager to get vaccinated themselves. The latest Kaiser Family Foundation (KFF) survey, for instance, shows that a growing share of Americans want to get a vaccine as soon as possible, rising from 34% of respondents in December to 41% in January.

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However, vaccine enthusiasm is not consistent across racial and ethnic groups. A survey by the Pew Research Center demonstrates that Black adults were the group least inclined to get vaccinated, with only 42% reporting that they would get a vaccine, compared to 83% of Asians, 63% of Hispanics, and 61% of whites.

And while millions of Americans have received at least one dose of the Covid-19 vaccine, we've seen early signs that Black people are getting vaccinated at significantly lower rates than white people,  according to a new KHN analysis.

So why do so many Black Americans distrust Covid-19 vaccines? The reasons are more complicated than you may think.

Black Americans' historical distrust isn't just 'vaccine hesitancy'

It may be tempting to lump in Black Americans' distrust with the broader "vaccine hesitancy" expressed by other groups, such as those who erroneously believe that vaccines cause autism, or those who struggle due to language barriers to understand the vaccine's effects.

But Black Americans' distrust is different.

It stems from a long legacy of abuse and discrimination of Black people that has strained patient relationships with their providers. This abuse includes medical experimentation on slaves, the Tuskegee experiment in 1932, and the forced sterilization of poor and disabled Black women in the 1960s.

These are painful episodes in the history of American medicine, and it's understandable that some providers might not want to think about them—or might want to believe they're irrelevant to how medicine is practiced today.

But these moments in history are far from forgotten by the Black community. And if leaders want to establish more confidence in Covid-19 vaccines, they'll need to recognize that vaccine hesitancy and historical distrust are not interchangeable barriers.

Why the difference between hesitancy and distrust matters

It's important to recognize the difference between vaccine hesitancy and historical distrust for two key reasons:

1. Black patients are likely to express distinctive questions and concerns

   Not all your vaccine-hesitant patients will have the same concerns. Some patients may express concerns regarding the accuracy of an article they've read or might want more clarity on potential side effects.

   But for many Black people, their concerns will be rooted in historical inequities and injustices. They might, for instance, worry that the vaccine was not adequately studied in Black communities—an issue that has commonly arisen in clinical trials of previous drugs. Cardiovascular disease is a good example: Even though heart conditions disproportionately affect Black individuals, for all FDA drug trials completed between 2015 and 2019, only 2% of participants age 65 or older were Black.

   For this reason, it's important for clinicians to know that drugmakers have made considerable efforts to increase participant diversity in Covid-19 vaccine trials. Demographic data shows that Black participant enrollment is comparable to their share of the total U.S. population.

   

   Notes: *Pfizer-BioNTech data are for all participants globally; of which 76.7% are in the United States. Pfizer results provided for Phase 2/3 trial, Moderna results for Phase 3 trial, and interim J&J results provided for Phase 3 trial. The Pfizer trial included those ages 16 and older. The Moderna and J&J trial included those ages 18 and older.

   Sources: Table adapted from Racial Diversity within Covid-19 Vaccine Clinical Trials: Key Questions and Answers, January 23, 2021; Racial/ethnic distribution of total population age 16 or older based on KFF analysis of 2019 American Community Survey data; FDA, Briefing Document: Pfizer-BioNTech Covid-19 Vaccine, December 10, 2020; FDA, Briefing Document: Moderna Covid-19 Vaccine, December 17, 2020; Janssen Phase 3 ENSEMBLE Trial Press Release, January 29, 2021

   Of course, even if a clinician knows this data, that won't guarantee that Black patients feel comfortable receiving the vaccine—especially as they may be reluctant to share their concerns about vaccination in the first place. But this data can help start a conversation about why Black patients can reasonably trust the Covid-19 vaccine.

2. Historical distrust will impact Black patients even after the Covid-19 crisis subsides.
   

   Even if providers are successful at promoting equitable vaccine uptake, the journey to win patient trust doesn't stop there. The work required to rebuild and maintain patient trust isn't something that happens over the course of a few weeks; it's a long-term endeavor.

How you can help overcome historical distrust of the Covid-19 vaccine

Because distrust and vaccine hesitancy impact patients differently, you can't use a one-size-fits-all approach. You need to target and tailor your outreach campaigns.

Depending on the demographic makeup of your local community, you'll need to apply a culturally sensitive and differentiated communication framework to preempt Covid-19 racial and ethnic disparities from worsening.

In particular, leaders should take the following steps:

Create a clear message

• Collaborate with your local community leaders to hear their concerns and identify the root causes of skepticism in your local community.
  
  
• Deliver a clear and concise message that details why the vaccine is safe and what side effects patients can expect.
  
  
• Incorporate a positive narrative that explains the benefits of vaccination, but within a personal and emotional context (for example, "Here's why I chose to get vaccinated").
  
  
• Develop a culturally competent vaccine campaign in patients' preferred language to reduce cultural barriers to care.
  

Select the right messenger 

• Identify a variety of spokespeople including community health workers, religious leaders, pharmacists, and educators to promote an understanding of the Covid-19 vaccine.
  
  
• Do more than post pictures of Black clinicians getting vaccinated; help amplify their perspectives about why they chose to get the vaccine.
  
  
• Listen to your local community leaders, and partner with them to amplify your messaging around the safety and efficacy of the vaccine.

Define patient access

• Offer the vaccine at convenient locations and hours to ensure access is equitable for shift workers and those who rely on public transportation.
  
  
• Simplify the sign-up process and reduce digital barriers by offering patients multiple methods to sign up that don't require an email address or access to a smartphone.
  
  
• Mitigate financial stress around the cost of care by clearly communicating where patients can go for follow-up care, even if they are uninsured or face economic burdens.