Racially diverse patients exhibit less vaccine hesitancy

Key takeaways:

• Patients for whom English was not a primary language were less hesitant.
• Prior vaccination raised the chance of current vaccination.
• Mistrust of authority was among the most common drivers of hesitancy.

BOSTON — Vaccine hesitancy was less likely to occur in racially diverse vs. white patients, although this hesitancy was not significantly impacted by age, sex or language, according to a poster presentation here.

“In recent years, the influenza and COVID-19 vaccinations have dominated discussions,” Albert G. Wu, MD, of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, told Healio.

Wu presented these study findings at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Influenza is responsible for over 31 million illnesses, over 350,000 hospitalizations and over 20,000 deaths annually in the United States. Many public resources are committed to encourage immunization for both the flu and for COVID-19,” Wu said.

But the United States saw a decrease in influenza vaccination rates for the third year in a row in 2022, he continued.

“As vaccine efficacy aims to achieve herd immunity, it is in the public health interest to increase rates of immunizations,” Wu said.

This study included a diverse patient population from an outpatient allergy and immunology center in Brooklyn, New York, which included the least vaccinated zip code in the city, as well as some of the city’s lowest vaccination rates.

The goal of the study was to boost influenza and COVID-19 vaccination rates for clinic patients. Patients who showed vaccine hesitancy were screened to identify shared characteristics. They were asked about their influenza and COVID-19 vaccination status in 2023 and whether they were vaccinated for influenza prior to 2023.

Among the 338 patients (mean age, 44 years; 73% female) seen between March 2023 and February 2024, 37.2% (n = 126) were white, 31.6% (n = 107) were Hispanic, 18.9% (n = 64) were Asian and 12.1% (n = 41) were Black.

The most common language spoken by patients was English (81%; n = 276) with 19% speaking a 11 non-English primary languages, including Spanish, Chinese, Bengali and Yiddish.

The researchers used the WHO’s definition of vaccine hesitancy, which is a delay in acceptance or refusal of vaccines despite the availability of vaccine services and supporting evidence.

Vaccine hesitancy was reported by 53.6% of patients. Hesitancy of the influenza vaccine was demonstrated by 49.7% of patients, 15.1% for COVID-19 and 11.5% for both. Influenza vaccine hesitancy peaked in March and July, whereas COVID-19 hesitancy remained consistent throughout the year.

Patients above age 60 years showed a lower influenza vaccination hesitancy rate at 29.7%. Patients in other age groups showed a 40% to 50% rate. Some factors were associated with decreased hesitancy such as prior vaccination.

Among patients who received an influenza vaccine in the current year, 87% also received it in years prior. On the other hand, among those who did not receive an influenza vaccine this year, 75.9% also did not receive one last year.

Patients with English as their primary language (51.4%) were more hesitant than non-English-speaking patients (41.9%), although this was not considered a significant finding, as the researchers further said no significant differences were found when considering language, sex or age.

Patients who identified as Asian showed a below-average hesitancy for the influenza vaccine (30.4%) and COVID-19 vaccine (2.2%). Other hesitancy rates by race/ethnicity for the flu vaccine included 55.6% for white patients, 53.7% for Black patients and 49.6% for Hispanic patients. These rates included 23% for white patients, 9.8% for Black patients and 13.6% for Hispanic patients for the COVID-19 vaccine.

“Vaccine hesitancy is due to several intrinsic and contextual factors, including individual beliefs and trust of the health care system,” Wu said. “Addressing hesitancy at the individual and governmental level increases uptake of immunizations. Mistrust of authority is among the most cited reasons by patients for vaccination hesitancy, including decreased confidence in the health care system and the government, as well as reservations regarding the safety and efficacy of vaccinations.”

Wu further explained that having translators on hand at the clinic would be a helpful tool in dispelling vaccine hesitancy as well as making sure patients are coming in for follow-ups.

“While public health campaigns are very effective, the crux of a lot of these patients is that they don’t trust authority or they have some sort of mistrust of institutions,” Wu said. “There’s really no substitution for the patient-physician relationship where you’re able to build that trust over a period of time and then be able to just talk to them about their fears, concerns and questions. And it’s not a guarantee,” he continued.

Misinformation about vaccines also plays a role, according to Wu. However, patients might not be willing to change their minds, and trying different approaches could be necessary.

“We recommend going at it gently over a period of time,” he said. “After the first few visits, when they’ve come to trust you and you trust them, you can make gentle recommendations towards more reliable information.”