Black women’s COVID-19 vaccine hesitancy

What Drives COVID-19 Vaccine Hesitancy among Black Women in the United States?

 Brittany C. Slatton, Farrah G. Cambrice, and Serwaa S. Omowale

Black residents in the United States have higher levels of vaccine hesitancy than White residents. Vaccine hesitancy is defined as delaying vaccination or refusing to be vaccinated, even when vaccines are readily available. Vaccine hesitancy exists on a continuum from doubts about specific vaccines to outright refusal of all vaccines. Hesitancy is influenced by emotional, cultural, social, spiritual, and political factors. For Black women and men, vaccine hesitancy stems from medical mistrust, including a distrust of health care systems, practitioners, and treatments. This medical mistrust is rooted in historical medical mistreatment of Black people as well as structural racism—a system of policies, institutions, and social forces that create and maintain racial discrimination and leads to unequal access and outcomes.

Research shows that Black women express more COVID-19 vaccine hesitancy than Black men. In a poll conducted in January 2021, before no-cost vaccines were widely available, 19% of Black women said they would definitely not get the vaccine compared to 7% of Black men [1]. Given that Black women are often the primary healthcare decision makers for their families, it is important to understand their views on vaccine hesitancy because those views not only influence their own decisions but could also influence family members’ decisions on getting vaccinated.

This brief reports on a recent study [2] in which the authors conducted in-depth interviews about vaccine hesitancy with Black women between June and November 2021, when no-cost COVID-19 vaccines were widely available. By conducting in-depth interviews with a large group of Black women during this time, the authors gained a nuanced understanding of the dynamics of vaccine hesitancy among this group. These dynamics continue to shape current attitudes and behaviors. The goal of this research is provide critical insights about vaccine hesitancy among Black women to help develop effective public health strategies to improve vaccine uptake and to address health disparities.

Key Findings

Black women in the US expressed hesitancy toward COVID-19 vaccines for three main reasons:

• Mistrust in healthcare and government, which is rooted in past medical exploitation.
• Concerns over vaccine safety and its long-term effects.
• Ineffective and coercive vaccine communication and promotion.
• See figure for representative quotes

Reasons for COVID-19 vaccine hesitancy among Black women in the U.S.

In interviews with Black women, three primary reasons emerged to explain hesitancy toward COVID-19 vaccines: mistrust in healthcare and the government, which is rooted in a history of medical exploitation of Black people; concerns about the short-term safety and long-term effects of the vaccine; and communication and promotion campaigns that were ineffective and manipulative.

Mistrust in healthcare and government, rooted in past medical exploitation. Participants expressed deep-rooted skepticism about being treated as “expendable” in medical research, with this mistrust further exacerbated by rapidly changing official communications during the pandemic. Their skepticism was particularly evident in responses to changing CDC guidelines about COVID-19 transmission. Participants also questioned the government’s motives, wondering how they could rapidly develop a COVID-19 vaccine while failing to cure longstanding diseases.

Concerns over vaccine safety and long-term effects. Participants expressed significant apprehension about both immediate adverse effects and long-term impacts of the COVID-19 vaccine on their health, particularly regarding reproductive health. Participants doubted the ability of healthcare professionals to accurately attribute adverse reactions to the vaccine, reflecting deeper mistrust in the system’s responsiveness to their health concerns. The rapid development of the vaccine intensified these concerns about safety and long-term effects of the vaccine.

Ineffective and coercive vaccine communication and promotion. Participants strongly criticized promotional tactics, particularly lottery-style financial incentives and celebrity-driven advertisements, viewing them as manipulative and disrespectful. The use of financial incentives was seen as exploitative of vulnerable communities, while celebrity endorsements were viewed as patronizing and dismissive of their desire for factual, scientific information. Participants consistently expressed a preference for comprehensive education about vaccine mechanisms and clear, scientific information rather than promotional gimmicks.

Policy Implications

To effectively address vaccine hesitancy among Black women in the U.S., healthcare institutions and public health officials need to provide scientific information about vaccine safety and mechanisms, rather than use coercive promotional tactics like financial incentives and celebrity endorsements. These communication strategies should prioritize clarity, transparency, and respect for Black women’s ability to make independent decisions.

Policymakers can address vaccine hesitancy by investing in community-based health initiatives that engage trusted community leaders and acknowledge historical medical exploitation. More broadly, public health policies should address the systemic healthcare disparities and discriminatory practices that perpetuate mistrust in government and healthcare institutions.

Data and Methods

The authors conducted in-depth interviews with 54 Black women who they recruited through social media and referrals. They conducted interviews between June and November 2021 during which they asked open-ended questions about COVID-19 and vaccination and followed up with questions to elicit more details (for example, “What factors influence your decision to get vaccinated or not?”). The authors then analyzed transcriptions of the interviews using the Braun and Clarke 6-step thematic analysis approach [3] that allows themes to emerge organically from the data. The women interviewed ranged in age from 21 to 66 years old; most had a bachelor’s degree or higher and resided in the South.

References

[1] Kearney A., Hamel, L., Brodie, M. (2021). Attitudes towards COVID-19 vaccination among Black women and men. KFF. https://www.kff.org/coronavirus-covid-19/poll-finding/attitudes-towards-covid-19-vaccination-among-black-women-and-men

[2] Slatton, B.C., Cambrice, F.G. & Omowale, S.S. (2025). COVID-19 vaccine hesitancy among Black women in the US. JAMA Network Open. doi:10.1001/jamanetworkopen.2024.53511

[2] Braun V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3(2):77-101. doi:10.1191/1478088706qp063oa

Suggested Citation

Slatton, B.C., Cambrice, F.G. & Omowale, S.S. (2025). What drives COVID-19 vaccine hesitancy among Black women in the United States? PRC Research Brief 10(1). https://doi.org/10.26153/tsw/58438

About the Authors

Brittany C. Slatton, Brittany.slatton@tsu.edu, is a professor of sociology at Texas Southern University and an external faculty affiliate at the Population Research Center, The University of Texas at Austin; Farrah G. Cambrice is an associate professor of sociology at Prairie View A&M University and an external faculty affiliate of the PRC; and Serwaa S. Omowale is an assistant professor in the Department of Management, Policy, and Community Health in the School of Public Health at The University of Texas Health Science Center at Houston.

Acknowledgements

The study on which this research brief is based was funded by a grant from the Urban Institute to Dr Slatton. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

This research brief was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Urban Institute or the National Institutes of Health.