Historical Mistrust Contributes to Covid-19 Vaccine Hesitancy Among Black Individuals


University of Missouri analyzes social, structural determinants of health that worsen health disparities.

Factors including historical mistrust in government and pharmaceutical companies and personal experiences with racism within the health care system contribute to COVID-19 vaccine hesitancy for Black individuals, according to the results of a study from the University of Missouri published in the Journal of Racial and Ethnic Health Disparities.1

Political affiliation, social media misinformation, and uncertainty about vaccine efficacy, necessity, and safety were found to be additional factors influencing vaccine hesitancy.1

Black individuals have consistently lagged in access to and uptake of COVID-19 vaccinations compared with White Americans.1

“Although efforts continue to be made to close this gap in vaccine distribution and uptake, little is being done to address the underlying causes of vaccine hesitancy,” the authors wrote.1

Investigators conducted a study to explore vaccine attitudes and intentions among program participants, understand the role of a Black American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions to address the causes of vaccine hesitancy.1

Investigators collected data through interviews with individuals involved within Live Well by Faith, a community-based wellness program run by the Boone County Health Department in predominantly Black communities in the Missouri county.2

A total of 21 participants, including church leaders, lifestyle coaches, and program participants, were interviewed via 5 in-person and 16 phone interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed by 3 investigators.1

The majority of participants, or 95%, were Black. Participants had an average age of 62.8 years, and 81% had lived in the community for 11 years or more.1

Investigators categorized the findings by contextual influences, group and individual influences, vaccine and vaccination-specific issues, and the role of the Live Well by Faith program in COVID-19 vaccinations.1

The findings suggested that faith-based health and wellness programs rooted in Black communities have the potential to provide trustworthy information and advocate for resources.1

Live Well by Faith was found to act as a trusted information source for COVID-19 resources for the Black community, providing services, such as enrolling community members for vaccines and negotiating vaccine provision to and facilitating the establishment of vaccine clinics at Black churches. The local presence of Live Well by Faith gave the program a contextual advantage and a nuanced understanding of attitudes and experiences influencing vaccine hesitancy.1

Such community programs can help tailor public health messaging accordingly and partner with local governments to promote health.1

However, vaccine hesitancy is still a concern, despite the role of Live Well by Faith.

Contextual influences included historical influences as a major predictor of vaccine hesitancy. Acts of violence by police against Black individuals was determined to be a source of distrust and tension between Black individuals and the government during the pandemic, as well as other historical injustices, such as a lack of access to preventive medical care and poor education, housing, and working environments.1

“African Americans are more likely to have lower-income, in-person jobs at crowded places that cannot accommodate work-from-home or social distancing, so they are more likely to be exposed to and infected by COVID-19,” Wilson Majee, PhD, MPH, MBA, an associate professor in the University of Missouri School of Health Professions, said in a statement. “Combine that with African Americans already being poorer and less likely to be able to afford quality health insurance, the historical mistrust in government and personal negative experiences with the health care industry, and you quickly see how all these factors start to work together to negatively impact health outcomes for African Americans.”2

Perceptions of the communication and media environment and the pharmaceutical industry also influenced vaccine hesitancy. Excess information created uncertainty and made it difficult for individuals to access reliable information.1

“The Tuskegee Syphilis Study was repeatedly mentioned as a popular example of unethical medical treatment toward African Americans by the federal government, and once that trust is lost, it can be hard to regain even as time goes on,” Majee said.2

Group and individual influences and vaccination issues were determined to be awareness and knowledge of the vaccine, perception of health care providers, and worries about the newness and safety of the vaccine and potential adverse effects.1 Participants reported concerns over how fast the vaccine was developed and a lack of Black physicians providing vaccines.2

Previous negative experiences with care providers degraded trust in the health system, and low health literacy levels worsened vaccine hesitancy. Participants expressed the need for government to commit resources to addressing historical factors and building trust with minority populations.1

Based on these findings, the authors shared multiple recommendations.

They suggested that the federal government maximize collaboration and communication among Black individuals, government, and health care providers. They also highlighted a need for transparency in basic information about how vaccines are developed and work, their effectiveness, and related adverse and long-term effects.1

Programs such as Live Well by Faith and other local, trusted community programs should be funded and expanded to strengthen community trust in the government and affect health behaviors, the investigators said.1

“African American members of the congregation at Black churches believed in the information they were receiving, because it was coming from people they trusted that looked like themselves,” Majee said. “The key about the Live Well by Faith program is that it is rooted in the community, and we saw it was helpful in getting more African Americans to receive the COVID-19 vaccine.”2

Broadly, the investigators said that they encourage local and state governments to engage Black communities to advocate for formulating programs and policies to address the lack of sustainable infrastructure for health equity and justice in these communities.1

The authors also suggest additional research on the intersection of ethnicity and race in vaccine hesitancy, as well as further research on perceptions of the COVID-19 booster vaccines in Black communities.1

“My passion is to empower people in resource-limited communities by listening to their ideas and allocating resources to develop interventions that meet the needs of struggling people,” Majee said. “There is a great need to elevate the health of minorities, as the disparities are huge and will continue to grow if we fail to act now.”2


1. Majee W, Anakwe A, Onyeaka K, et al. The past is so present: understanding COVID-19 vaccine hesitancy among African American adults using qualitative data. J Racial Ethn Health Disparities. 2022;19:1-13. doi:10.1007/s40615-022-01236-3

2. Historical mistrust in government, health care industry contributes to COVID-19 vaccine hesitancy for African Americans. News release. University of Missouri. July 22, 2022. Accessed August 5, 2022. https://showme.missouri.edu/2022/historical-mistrust-in-government-health-care-industry-contributes-to-covid-19-vaccine-hesitancy-for-african-americans/

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