The COVID-19 pandemic has highlighted existing health disparities in the United States (U.S.), particularly within Black communities, where infection and mortality rates have been much higher. These disparities are intertwined with structural racism and social determinants of health, such as limited access to healthcare, underlying medical conditions, and densely populated living environments. The phenomenon of “weathering,” characterized by prolonged exposure to social, economic, and political stress, leads to physiological wear-and-tear, increasing susceptibility to diseases like COVID-19 by weakening the immune system.
In response to the growing concern over vaccine hesitancy, especially among Black people, this qualitative research was conducted to identify the predictors of vaccination hesitancy among Black women in the US. The survey was conducted during the initial vaccine rollout in 2021, a period marked by heightened vaccine hesitancy. A closer insight into Black women’s experiences and concerns will provide a more refined understanding of the situation in contrast to investigations that consider other races or genders.
The historical mistreatment of Black Americans in medical research and practice, such as the Tuskegee Syphilis Study and forced sterilizations, has fostered deep mistrust in healthcare systems. This mistrust remains a significant driver of vaccine hesitancy in the Black US community; indeed, many remain skeptical about the safety, efficacy, and motivations behind the COVID-19 vaccine.
Vaccine hesitancy, characterized by reluctance or refusal to accept vaccines, among Black Americans, stems from multiple factors, including mistrust in the government, concerns about the rapid development of vaccines, and fears of long-term side effects. These are the existing issues that are worsened by the low involvement of Black people in the clinical trials and the lesser representation of the same in health-related research which made most of them doubt the vaccine effectiveness for their demographic group.
Black women have lower vaccine acceptance than Black men and White women. According to one study in 2021, 19% of Black women firmly refuse the vaccine, a figure that is twice as compared to Black men. As primary healthcare decision-makers in their households, Black women’s vaccine hesitancy often influences their relatives, further reducing vaccination uptake within Black communities.
While vaccine availability has improved since 2021, hesitancy persists, which is influenced by emotions, cultural norms, spirituality, and politics. Misinformation on social media and political affiliations further complicate efforts to increase vaccine acceptance.
This qualitative study was endorsed by the Institutional Review Board at Texas Southern University and adhered to Standards for Reporting Qualitative Research (SRQR) guidelines. The study was carried out between June and November 2021 through in-depth, semi-structured interviews of Black women who are above 18 years old and reside in the U.S. The participants were selected through a purposive sample from social media such as LinkedIn, and word-of-mouth referrals. More than half of the participants were university-educated, with most of them having a bachelor’s degree or above. A majority resided in the Southern U.S., where vaccine acceptance tends to be lower.
The interview lasted for around 75 minutes, where all participants’ opinions and experiences concerning COVID-19 and the vaccine were addressed. All data were collected according to high standards of ethical practice; the participants of this study received a $25 incentive for their time and assistance.
Participants for the study were 54 Black women, between the age of 21 and 66. Participants were well-educated and had a bachelor’s degree or higher. In income distribution, 29.6% earn between $40,000 and $59,999 and 14.8% earn 80,000 or more. As to family distribution, 59.3% of them were childless while 40.7% had one or more children. The majority (75.9%) resided in the Southern U.S. Ethnically, 72.2% were identified as Christians, followed by those adhering to other religions or none.
The study identified three significant themes contributing to vaccine hesitancy among Black women: Participants expressed a deep mistrust in healthcare and government, increased by historical exploitation and concerns about the rapid approval of the COVID-19 vaccine and inconsistent guidelines. Many questioned vaccine safety, expressing doubts about FDA approval and fears of long-term effects. Furthermore, Black women found vaccine communication efforts unclear, culturally insensitive, and coercive, with financial incentives and celebrity endorsements further eroding trust.
This study will be a testament to the urgency of changing public health officials’ and healthcare practitioners’ engagement with Black women regarding vaccination uptake. Addressing vaccine hesitancy requires acknowledging historical mistrust and adopting culturally competent communication strategies that incorporate Black women’s voices and experiences. Clear communication, respectfulness, and making efforts to add the voices of Black women toward vaccine promotion may help in building confidence and increase vaccination rates.
Reference: Slatton BC, Cambrice FG, Omowale SS. COVID-19 vaccine hesitancy among Black women in the US. JAMA Netw Open. 2025;8(1):e2453511. doi:10.1001/jamanetworkopen.2024.53511
