Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

Peter A Newman; Duy A Dinh; Thabani Nyoni; Kate Allan; Sophia Fantus; Charmaine C Williams; Suchon Tepjan; Luke Reid; Adrian Guta

doi:10.1007/s40615-023-01882-1

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

J Racial Ethn Health Disparities. 2023 Dec 20. doi: 10.1007/s40615-023-01882-1. Online ahead of print.

Authors

Peter A Newman¹, Duy A Dinh^{2

3}, Thabani Nyoni², Kate Allan², Sophia Fantus⁴, Charmaine C Williams², Suchon Tepjan⁵, Luke Reid², Adrian Guta⁶

Affiliations

¹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada. p.newman@utoronto.ca.
² Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
³ Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
⁴ School of Social Work, University of Texas at Arlington, Arlington, TX, USA.
⁵ VOICES-Thailand Foundation, Chiang Mai, Thailand.
⁶ School of Social Work, University of Windsor, Windsor, ON, Canada.

PMID: 38117443
DOI: 10.1007/s40615-023-01882-1

Abstract

Background: Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada.

Methods: Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations.

Results: The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information.

Discussion: We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

Keywords: Access to care; Covid-19 vaccines; Ethnic and racial minorities; Institutional mistrust; Structural racism; Vaccination; Vaccine hesitancy.

Grants and funding

GA3-177731/CAPMC/ CIHR/Canada