Behavioral and Social Science Research to Optimize SARS-CoV-2 Protective Vaccine Uptake in Racial Minority Communities with High Rates of COVID-19

ABSTRACT Intensive efforts are underway to develop a vaccine protective against SARS-CoV-2 infection, and hope is high that a safe and effective vaccine will soon be available. However, development of a vaccine does not ensure its uptake on the scale needed to bring COVID-19 under control. In the United States, communities of color are disproportionately burdened by COVID-19 diagnosis, serious illness, and death. However, experience in areas such as influenza vaccination portends that COVID-19 vaccine uptake will be lower in African American communities hard-hit by the disease. Racial disparities in influenza vaccination have been linked to individual factors (including low vaccine awareness, medical mistrust, fears and vaccine skepticism); structural barriers (such as not having an accessible primary health care provider); peer group norms that do not sufficiently support getting vaccinated; and social, economic, and life stressors that contribute to many health inequities. Similar but also unique factors are likely to undermine acceptance of COVID-19 vaccination in racial minority communities. Community-engaged research must be undertaken now-and at a point before a vaccine is widely available-to understand and address community concerns and to develop strategies to prevent racial disparities in COVID-19 vaccination uptake. The planned research will be undertaken in Milwaukee by a team of behavioral and social scientists in a collaboration with an established federally qualified community health center serving low-income inner-city residents. The research will use mixed methods to identify minority community concerns regarding COVID-19 vaccination; to determine factors that influence strength of community members' intentions to vaccinate; and to pilot test and establish the feasibility and acceptability of a virtually-delivered intervention that engages community social influencers to address vaccine concerns and endorse vaccine benefits within their social networks. The work will be undertaken in an accelerated manner in three distinct but interrelated phases, all with samples diverse in age and gender: (1) focus groups conducted with 160 African American inner-city community members to elicit COVID-19 vaccine beliefs; perceived risks, benefits, and norms; and factors that would impede or facilitate vaccination; (2) an online quantitative survey study that will enroll 700 community members from zip codes with greatest SARS-CoV-2 rates and will measure respondents' intentions to vaccinate and test the influence on those intentions of theory-based predictors including perceived COVID-19 threat; perceived vaccination benefits, barriers, and self-efficacy, as well as identifying preferred settings for vaccination; and (3) a feasibility and acceptability pilot test of a virtually-delivered intervention that trains and enlists personally-known and trusted neighborhood social influencers to address the COVID-19 vaccination concerns of their friends, family members, neighbors, coworkers, and social media followers, and that supports informed decisions about vaccination. This research will characterize vaccine concerns and identify strategies that can optimize vaccine uptake in racial minority communities vulnerable to COVID-19.