UAMS study cites trust as major factor in COVID-19 vaccine hesitancy among rural, Black populations

August 16-22, 2021

By Daily Record Staff 


As the Delta variant of COVID-19 continues to spread rampantly across Arkansas’ unvaccinated populations, researchers at the University of Arkansas for Medical Sciences (UAMS) have found that trust in vaccines, fear of infection, and race or ethnicity play a large role in whether people will get a COVID-19 vaccine, particularly when looking at socio-demographic factors.


In the study, “COVID-19 Vaccine Hesitancy: Race/Ethnicity, Trust and Fear,” published in Clinical and Translational Science, researchers found that most respondents who were surveyed in July and August of 2020 were not hesitant. Only about one in five (21%) reported vaccine hesitancy.


However, when looking at socio-demographic factors, the findings were much more pronounced across age, sex, race and ethnicity, income and education. Research subjects who were younger, African American, lower income and those who had some college or a technical degree were more likely to report hesitancy as opposed to those who were older, white, higher income and who had a four-year college degree.


Prevalence of COVID-19 vaccine hesitancy was highest among African Americans (50%), respondents with household income less than $25,000 (30.68%), people with some college (32.17%), people with little to no fear of infection from COVID-19 (62.50%), and people with low trust in vaccines in general (55.84%).


In addition, the odds of COVID-19 vaccine hesitancy were:

• 2.42 greater for African American respondents compared to white respondents

• 1.67 greater for respondents with some college or a technical degree compared to respondents with a four-year degree

• v5.48 greater for respondents with no fear of COVID-19 infection compared to those who fear infection to a great extent

• 11.32 greater for respondents with low trust in vaccines in general


Trust is a major factor in people’s hesitancy to get a COVID-19 vaccine, according to Don Willis, Ph.D., co-principal investigator and lead author on the research study.


“It’s like you’re hanging on to the edge of a cliff and someone throws you a rope,” Willis said in a recent conversation on the ASCPT Podcast Channel. “You’re terrified to fall, but you are also not sure if you can trust the strength of the rope or the person that threw you the rope.”


In this case, Willis was specifically describing those people who are both fearful of infection and hesitant towards the vaccine. He pointed out that most people who had high fear of infection were not hesitant, but this relationship was different specifically for African American respondents who on average had the highest prevalence of both fear and hesitancy.


“Building trust in institutions takes a concerted effort and time,” he added. “Although the urgency of the pandemic is spurring efforts toward trust and transparency, without a sustained effort of community engagement, any gains in trust may be lost.”


The researchers surveyed 1,205 adult Arkansans online in July and August 2020 to determine vaccine hesitancy based on socio-demographics, COVID-19 health literacy, fear of COVID-19 infection and general trust in vaccines.


“Arkansas is an important place to look at this subject,” Willis said. “Arkansas is a very rural state, and there has been earlier research suggesting that rural areas have higher rates of vaccine hesitancy. Arkansas also has a large population of people who are at high risk for serious illness due to COVID-19, a large population of people who are over 65 and suffer from chronic illnesses such as diabetes, heart disease, COPD, asthma and BMI greater than 40.”


The researchers emphasized that understanding and minimizing COVID-19 vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic.


“I think one takeaway is understanding that hesitancy isn’t all about information and facts and education,” Willis said. “It would be nice if it was that way. We could just inform and educate, and everything would be solved. But hesitancy is also about feelings and trust and the social meanings that we attach to vaccines, as well as past experiences and historical legacies of medical racism.”


Joining Willis on this research were Jennifer Andersen, Ph.D.; Keneshia Bryant-Moore, Ph.D.; James Selig, Ph.D.; Christopher Long, Ph.D.; Holly Felix, Ph.D.; Geoffrey Curran, Ph.D.; and Pearl McElfish, Ph.D., vice chancellor of the UAMS Northwest Regional Campus and co-principal investigator.


This project was backed by the UAMS Translational Research Institute, which is funded by a Clinical and Translational Science Award from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS).



Vaccinate Arkansas campaign


The UAMS study comes as the Biden administration and the state of Arkansas are ramping up efforts to reach the nation’s unvaccinated population in rural and African American communities as the Delta variant continues to spread. On Friday, the U.S. Centers for Disease and Control released a study concerning COVID-19 infections in rural Kentucky among people who were previously infected with SAR-CoV-2 shows.


That study showed that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those fully vaccinated after initially contracting the virus. The CDC said the data further indicate that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections.


“If you have had COVID-19 before, please still get vaccinated,” said CDC Director Dr. Rochelle Walensky. “This study shows you are twice as likely to get infected again if you are unvaccinated. Getting the vaccine is the best way to protect yourself and others around you, especially as the more contagious Delta variant spreads around the country.”


Additionally, the U.S. Department of Health and Human Services said a second publication from a weekly CDC epidemiology report shows vaccines prevented COVID-19 related hospitalizations among the highest risk age groups. As cases, hospitalizations, and deaths rise, the report also reinforces vaccines are the best way to prevent COVID-19, said Walensky.


Nationally, the HHS is now spending nearly $250 million to develop a community-based workforce who will serve as trusted voices sharing information about vaccines, increase COVID-19 vaccine confidence, and address any barriers to vaccination for individuals living in vulnerable and medically underserved communities.


This funding, first announced in early May, will help community-based organizations to hire and mobilize community organizers, health workers, social support specialists and others to conduct on-the-ground outreach to educate and assist individuals in getting the information they need about vaccination, help make vaccine appointments, and assist with transportation and other needs to get to individuals to each of their vaccination appointments.


“Increasing public confidence in COVID-19 vaccines and boosting uptake remains a critical part of our fight against this virus,” said HHS Secretary Xavier Becerra. “(This) funding is critically important for connecting vulnerable and underserved communities with trusted health voices who can help deliver vaccinations and information to keep them safe and protect their loved ones.”


In Arkansas, the state American Rescue Plan Act steering committee has been meeting weekly to identify and prioritize COVID-19 emergency relief funding from the $2.2 trillion stimulus package signed into law by President Joe Biden in early March. Gov. Asa Hutchinson created the steering committee to make recommendations on the distribution of $1.57 billion in American Rescue Plan funding in the state.


At the committee’s Aug. 5 meeting, the 15-person task force approved over $250 million in requests from the state Department of Human Services to assist hospitals and nursing homes with costs related to staffing and overtime, bed space, and reimbursements from unanticipated expenses for COVID-19 screening and testing. To date, the committee, chaired by DHS Secretary Larry Walther, has allocated $107 million for COVID-19 related relief.


Gov. Hutchinson created the like-minded CARES Act steering to allocate $1.2 billion in COVID-19 emergency funds for Arkansas from the Coronavirus Aid, Relief and Economic Security Act, signed into law in March 2020 by former President Donald Trump. In June, that committee still had over $60 million in unspent leftover funding.


Also, the “Vaccinate the Natural State” initiative continues across Arkansas with a local COVID-19 vaccination and testing clinic scheduled for Saturday, Aug. 21 at Kelly Smith Funeral & Cremation Services, located at 8434 Kanis Road in Little Rock. That event, sponsored in part by Arkansas Blue Cross, the state Department of Health (ADH) and the Arkansas Minority Commission, aims to educate Arkansans about the benefits of the COVID-19 vaccine and encourage individuals to get the vaccine as soon as possible.


Other organizations participating in the statewide promotional campaign that includes specific promotions and advertising aimed at minority and rural populations include the Arkansas Foundation for Medical Care (AFMC), Arkansas State Chamber of Commerce/Associated Industries of Arkansas, Northwest Arkansas Council, UAMS and Walmart.


In the first week of August, COVID-19 cases topped 3,000 for the first time since early January. According to the state Department of Health’s (ADH) daily COVID-19 dashboard, there were 3,037 new cases reported on Aug. 6, putting the total number of cases to 400,275. As of Aug. 13, that tally had jumped to 411,000, putting the number of fully vaccinated Arkansans at 1,136,668 people, or 37% of the state’s total population.  




Andrews Autosport and the state Department of Health recently unveiled the "Vaccinate Arkansas" race car driven by dirt track driver Peyton Taylor. The race car is part of the Health Department's campaign to spread the word about the COVID-19 vaccine in rural areas.