COVID-19 exposes deep-rooted structural inequities affecting vaccine uptake among ACB groups

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In a recent review published in Vaccines, researchers explored the influence of poor vaccination uptake among African, Caribbean, and Black (ACB) communities on public health in high-income nations.

Study: Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review. Image Credit: SeventyFour/Shutterstock.comStudy: Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review. Image Credit: SeventyFour/


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a massive vaccination drive; however, ACB communities have experienced significant adverse consequences and are unwilling to get the vaccine.

These communities are at risk due to health disparities, such as the greater prevalence of SARS-CoV-2 infections and hospitalizations. These imbalances significantly impact the social determinants of health (SDOH), and vaccine hesitancy can lead to delayed or uncertain immunization.

Global vaccination uptake has fallen; therefore, public health initiatives must adapt to present conditions and plan for future epidemics.

About the review

In the present review, researchers explored the variables contributing to poor vaccination uptake by ACB individuals, emphasizing healthcare in developed nations.

They sought to find current data sources, map the evidence, identify research gaps, and identify existing treatments for increasing vaccination uptake in the study population.

The team searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, APA PsycInfo, CINAHL, Web of Science, Open Science Framework, and the Allied and Complimentary Medicine databases.

They followed the Joanna Briggs Institute (JBI) model, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping literature reviews (PRISMA-ScR). They included articles published in English or French between 2020 and July 19, 2022.

The researchers performed the data search using the population, concept, and context (PCC) model to identify records discussing vaccine uptake among ACB residents of high-income nations, as defined by the World Bank.

Evidence sources included primary studies, secondary research, abstracts, posters, conference proceedings, reports, and commentaries.

Two researchers screened the data independently, and a third researcher resolved disagreements. The team used the social determinants of health (SDOH) method, the socioeconomic model (SEM), and thematic mapping (TM) to analyze and interpret the data.

TM phases included individual-level, intra- and inter-group analyses to generate descriptive, analytical, and primary themes.


Initially, the team identified 9,378 records, from which they removed 4246 duplicates. After title and abstract screening, they excluded 2,746 records.

Of the remaining 2,386 records undergoing full-text screening, 60 eligible records were analyzed, including 24 quantitative, ten qualitative, 19 commentary records, and seven mixed-method records. Most records were from the United Kingdom, Canada, and the United States.

Analysis performed via thematic mapping highlighted four primary themes: (i) inequities and racism, (ii) behaviors and sentiments, (iii) communication and knowledge, and (iv) influence and engagement.

Inequities and racism in the healthcare system originate from mistrust, racial burden, and institutional impediments to access. Vaccine hesitancy (VH) is associated with increased rates of unwillingness to receive vaccinations, thereby perpetuating health inequities in black communities.

The demographics of individuals exhibiting vaccine hesitancy reflect societal determinants of health, such as age, housing instability, poor income, and low education.

Black vaccination starting in the United States is lower among immigrants from other countries, with the Americas and Caribbean Islands having a lower incidence than Africa.

Factors like willingness, vaccination views, life events, and vaccine confidence determine vaccine uptake. Key causes include a lack of vaccination requirements, religious and political opinions, abuse, mortality exposure, and prior diseases.

Mistreatment, exposure to mortality, and past diseases exemplify lived experiences. Vaccine confidence encompasses skepticism, timeliness, novelty, side effects, effectiveness, and safety.

Black individuals are more likely to be vaccinated because of their existing health or their view that immunizations are the incorrect strategy.

Vaccine hesitation might be due to a desire to protect oneself, a need for school or a job, or a desire to avoid infection. To lower vaccination uptake and COVID-19 infections, the government and healthcare institutions must address these variables.

The lack of knowledge, disinformation, and misunderstandings in black communities all contribute to vaccination hesitation. Black parents are actively looking for information about kid vaccines, but the highest barrier is a lack of research on the short- and long-term impacts.

Education, confidence in vaccine information, and open communication are critical for increasing immunization. Addressing distrust can boost vaccine confidence and intentions, while customizing messages to target populations can encourage immunization. Racism and prejudice, which serve as structural impediments to fair health care, must be addressed through culturally responsive techniques.


The review findings showed that ACB populations had lower vaccination uptake than high-income nations. Complacency, discomfort, and a lack of confidence are factors that contribute to vaccination reluctance, which past and contemporary racism and prejudice cannot entirely explain.

The issue is complicated, encompassing knowledge and psychological, economic, and organizational constraints contributing to structural injustices. High-income nations should collect race-specific data for targeted treatments and increase the number of ACB participants in vaccine studies to boost vaccination trust.

Journal reference:
Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.


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