Public mistrust predates the COVID-19 pandemic and was further amplified with the rapidity of the COVID-19 immunization rollout in Canada. Public mistrust within health institutions is deeply rooted in anti-Black violence, racism, experimentation observed among African, Caribbean and Black Canadians (ACB) and other racial groups and a strong predictor for vaccine hesitancy (VH) [1, 2]. VH is a common term that is currently used in the literature to capture the varying reasons for low uptake of COVID-19 vaccine among various populations. Nacimento et al defines it as
VH as existing on a continuum ranging between complete adherence and complete refusal due to doubts
or concerns within a heterogeneous group of individuals who may be influenced by a combination of cognitive, emotional, cultural, social, spiritual, and political factors [3, p. 2]
The key difference with VH during the COVID-19 pandemic was the rapidity of immunization roll-out across Canada and worldwide, politicization of vaccines among major pharmaceutical companies (i.e. Pfizer, Moderna, Astra Zeneca), and racial reckoning in the murders of George Floyd, Breanna Taylor, Ahmaud Ahbery and countless others. The collision of these highly political and racially tense events exacerbated vaccine hesitancy during the pandemic.
High income countries such as the United Kingdom, United States, United Arab Emirates (UAE) ran rapid vaccine rollout programs and encountered low uptake of COVID-19 vaccine among various minority groups (Black, Arabs, Asians, Hispanic/Latino and a small percentage of American Indians and Alaskan natives) [4]. Challenges with vaccine hesitancy among minority groups do not stem from their innate vulnerabilities, instead the key drivers are socio-economic factors such as social status, access to social goods, housing, employment, and healthcare services [4, 5, 6]. Within the Canadian context, one key study found that vaccine hesitancy among Black Canadians primarily stemmed from “the denial of their rights and feeling that decisions were being made for members of the Black community and hesitancy related to medical distrust” [3] (p. 9)
The selection of the most effective vaccine companies, primarily between Pfizer and Moderna, became another source of vaccine hesitancy among minority groups. During the pandemic the World Health Organization recommended a vaccine with 70% effectiveness; Pfizer reported 90% effectiveness in preventing COVID-19, while Moderna reported 94.5% effectiveness [1]. Accompanying these reports were miscommunication lacking in cultural and linguistic approaches from both government and public health agencies on COVID-19 vaccine effectiveness [7]. Additionally, vaccine clinical trials experienced difficulty recruiting Black participants due to the historical dehumanisation and experimentation done withing Black communities, inflexible clinic hours, lack of translation services and transportation costs [1].
The racial tensions during the pandemic that resulted from the murders of George Floyd and others reinforced systemic racism within our social justice, political and healthcare systems. There is a growing body of research to show the linkages between social determinants, COVID-19 infections and racialization. These social determinants places vulnerable ACB individuals a greater risk of disease and psychological stress (3, 5, 8). In Canada, heavy policing and social distancing rules were enforced on minority groups, particularly within Black communities reinforcing the mistrust within our social and health systems [1].
Several studies have highlighted the impact of public mistrust among various racialized populations in Canada and its impact on vaccine uptake. One recent study coined the term vaccine mistrust ( a sub-theme of public mistrust used in reference to Black individuals) defined it as “a lack of confidence in the healthcare system, providers, treatments, and immunizations because of failure to them”[6, p. 1]. The findings showed vaccine mistrust was highest among Black Canadians compared to other racialized groups such as Arab and Indigenous communities due to higher rates of racial discrimination in healthcare services and conspiracy theories [3]. Additionally, Black Francophones tend to have higher rates of vaccine mistrust compared to Black Anglophones due to language barrier impacting access to health services. Another report revealed 57% of ACB individuals were less likely to intend to be vaccinated compared to White individuals due to pre-existing chronic conditions, high level of COVID-19 risk perceptions, skepticism towards COVID-19 vaccination and difficulty identifying trusted sources of information [4] Additional studies have also shown worse outcomes due to the COVID-19 virus for Black communities in both Canada and the US [3, 8]. Large city hubs revealed that ACB people in Ottawa reported 37% of confirmed COVID-19 cases although they represent 7% of the population; while 33% of cases in Toronto although they represent 9% of the population. Additionally, the mortality rate for COVID-19 infection is 2.2 times higher in Black compared to White communities [3]. Similarly in the US, COVID-19 hospitalization rates and death were higher among African Americans due to the linkages between economic factors and physical health [8].
Despite the successful efforts of public health institutions across Canada to achieve high vaccination coverage, there is growing concern among government officials, public health leaders, and policy makers that more targeted approaches are needed to restore public trust with COVID-19 vaccines among racialized communities [7].
Study Aim
The ACB Vaccine Acceptance study (AVA) led by the University of Ottawa and its partners, and funded by Public Health Agency of Canada (PHAC) collaborated to address the unique barriers, and lived experience of ACB communities due to low vaccine uptake. The study aimed to meaningfully engage with ACB community members and service providers to facilitate vaccine uptake and to strengthen communities’ confidence in and acceptance of COVID-19 vaccines in Ottawa and the national capital region. Two main research questions were addressed during this study: How do ACB people understand their vulnerability to COVID-19 infection, especially in relation to vaccination? What are the individual, community and structural barriers/facilitators that promote vaccine uptake and access to inclusive services? This study utilizes the socio-ecological model (SEM) to explore the issues surrounding vaccine uptake including challenges, and provide community-driven evidence-based approaches to rebuild trust among ACB communities within Canadian healthcare institutions.