Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Richard Rothenberg, MD, PhD

Second Advisor

Jennifer C. Gander, PhD

Third Advisor

Jessica L. Harding, PhD


BACKGROUND: Despite COVID-19 disproportionality impacting Black communities, vaccine hesitancy may be higher in this group owing to longstanding and enduring systemic racism. In this study, we determined whether Black (vs White) adults within a Georgia (GA) integrated healthcare system, previously infected with COVID-19, were more or less likely to report vaccine hesitancy, report concerns about vaccine safety, and efficacy. We also explored how factors like social determinants of health and hardships faced during the COVID-19 pandemic can affect the impact race has on vaccine outcomes (uptake, safety concerns, efficacy concerns).

METHODS: We invited all adult members age ≥18 years at Kaiser Permanente Georgia, with a positive COVID-19 diagnosis between March 2020 and April 2021 to participate in a cross-sectional COVID-19-specific survey (n=17,608 eligible members) sent between June 2021 and August 2021. Participants self-reported race (White, Black) and were asked their willingness to receive a vaccine, concerns about vaccine efficacy, and vaccine safety. Descriptive statistics and Chi-Square tests were calculated. Multivariable logistic regression models were used to assess the association between race and three vaccine-specific outcomes (uptake, safety concern, efficacy concern), adjusted for age, sex, social determinants of health, chronic conditions and COVID-19 impact. Mediation analysis was used to assess the impact of education and COVID-19 experiences on the relation between race and vaccine outcomes.

RESULTS: In total, 482 adults (response rate 3%) completed the survey, but only 414 were eligible to take part in the analysis: mean age 51.3 years (SD=13.1), 32.6% males, and 38.5% reported Black race. A total of 288 (75.0%) participants reported having received the COVID-19 vaccine. Black adults had higher crude OR to not have received the COVID-19 vaccine (cOR=1.8 ; 95% CI: 1.1-2.9), but this was not significant when adjusted for age, sex, chronic conditions, and COVID-19 experiences. Black adults were more likely to have vaccine safety (aOR=2.3; 95% CI: 1.3-4.0) and vaccine efficacy concerns (aOR=2.3; 95% CI: 1.3-4.1) when compared to White adults. Having everyone with a high level of education would eliminate 37% of the effect of race on vaccine uptake and 12% on the effect of race on vaccine safety concerns. Having no one experience financial hardship would eliminate the effect of race on vaccine uptake (29%), vaccine safety concerns (14%), and vaccine efficacy concerns (12%).

CONCLUSION: Our results show that among adults diagnosed with COVID-19 in Georgia, Black adults were not less likely to have received the vaccine compared to White adults, despite having higher odds of being concerned about the vaccine safety and vaccine efficacy. Education and financial hardship negatively impacted the effect of race on vaccine outcomes.


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Available for download on Thursday, May 02, 2024