How to talk to patients of color about the COVID-19 vaccine amid hesitancy and mistrust

Clinician provides a vaccine to a patient

A new commentary co-authored by a University of Chicago Medicine health disparities researcher offers practical tips for clinicians to discuss the COVID-19 vaccine with patients of color who may be hesitant to get vaccinated.

Monica Peek, MD, MPH, an internist and associate professor of medicine at the University of Chicago, and her co-authors wrote the piece because there are few COVID-19 vaccine resources for physicians that take into account the role systemic racism plays in influencing patients’ health decisions.

"Clinicians may feel ill-equipped to address concerns about the coronavirus … vaccine that are rooted in the sociopolitical mistrust of communities that experience health disparities, discrimination and structural injustice in their everyday lives," the authors wrote in their editorial published February 8. "This mistrust is multifactorial and is not restricted to concerns about COVID-19 vaccine safety and"efficacy. It is rooted in a history of unethical medical and public health experimentation involving communities of color, as well as structural inequities in government institutions."

The article’s advice comes at a critical time in the country’s vaccine rollout. Nationwide, public health officials are working to vaccinate as many people as quickly as possible to limit the spread of the SARS-CoV-2 virus, which causes COVID-19. But vaccine uptake has been particularly low in communities of color, which have also been disproportionately burdened by the pandemic.

A nationally representative survey published in December 2020 showed only 18% of Black Americans and 40% of Latinx Americans report trusting the effectiveness of COVID-19 vaccines, which have been shown to be 94-95% effective. Even fewer say they believe the vaccines are safe, despite large-scale clinical trials that led to Emergency Use Authorization from the U.S. Food & Drug Administration.

Peek and co-authors Douglas Opel, MD, MPH, from University of Washington School of Medicine, and Bernard Lo, MD, from University of California, San Francisco, say physicians of all races and ethnic groups will play an important role in vaccine education and outreach for Black and Latinx patients.

“Addressing COVID-19 vaccine mistrust can be a powerful way for any clinician to convey an openness to discussing patient concerns about COVID-19 vaccination and also an interest in patients’ lived experiences with structural injustice," they wrote.

Among their tips:

  1. Ask open-ended questions, making it clear it’s the patient’s choice to get vaccinated. Listen carefully to answers and avoid making assumptions.
  2. Explore the patient’s concerns in detail. Then tailor specific responses that are both nonjudgmental and collaborative.
  3. Use accessible language when describing the regulatory and development processes surrounding COVID-19 vaccines.
  4. Be transparent and acknowledge the uncertainty around some aspects of the vaccines. This openness builds trust with the patient.

"This past year has laid bare harsh health disparities and structural injustice in the United States, activating and exacerbating mistrust among people of color. Clinicians need to address this mistrust to help patients at highest risk for COVID-19 gain the benefits of COVID-19 vaccines," the trio wrote. "Prioritizing these discussions now in routine clinic visits, even over other health maintenance or stable chronic disease management issues, may help increase the acceptance of COVID-19 vaccinations and improve health outcomes among persons of color."