A vial containing a COVID-19 vaccine with syringes behind.

Vaccine Access, Hesitancy Remain Barriers Among Black Alabamians

Stephanie McClure
Dr. Stephanie McClure

TUSCALOOSA, Ala. – Although hesitancy to get a vaccine for COVID-19 in rural areas continues to hinder pandemic recovery, research from The University of Alabama found that addressing both hesitancy and access at the community level is important to increasing vaccination rates, particularly in African American communities.

In a report issued this week as part of a national effort aimed at strengthening the community’s role in an equitable COVID-19 vaccination campaign, a seven-person team of UA faculty members and graduate students recommend a community-based approach to reducing hesitancy and ensuring vaccine access. This approach involves the encouragement of local leaders and community advocates, familiar messaging modes, opportunities for questioning and respectful dialog, and vaccination opportunities that fit into the course of daily life.

“Hesitancy is the current front in the pandemic battle,” said Dr. Stephanie McClure, assistant professor of anthropology and lead author of the report. “We have learned over the past seven months that movement from hesitancy to vaccination takes time because hesitancy is different for different people. It is magnified by misinformation and poor access to care, and it is best addressed by opportunities for dialog with and information from trusted sources. And once people have been convinced, vaccination should be readily and conveniently available. That’s why we say, ‘fight hesitancy with access.’”

Alabama is one of six sites in the CommuniVax initiative — a rapid ethnographic research project that examined facilitators and barriers to vaccine uptake in historically underserved communities of color in the United States. Local research teams listened to community members in interviews and focus groups.

Based on those exchanges, each team developed recommendations for strengthening COVID-19 vaccine delivery and communication strategies, and for improving public health services. The recommendations in the Alabama report include investing in local public health infrastructure and engaging leaders at the community level to be more prepared and knowledgeable about ways to help their citizens.

The CommuniVax initiative is led by the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health and the Texas State University Department of Anthropology. It is funded by the Chan Zuckerberg Initiative and the Rockefeller Foundation.

“People who work in rural health know about the importance of good community-level service infrastructure, but it seems this knowledge was not employed to best effect in the early days of the vaccine rollout,” said McClure.

For example, the Alabama project team found vaccine access in the Black Belt was initially not adequately addressed by the Federal Retail Pharmacy Program, FRPP. It did not work well in poor and rural areas with sparse retail infrastructure. Additional barriers to use of the FRPP by the rural poor include access to a vehicle, access to the internet to learn about or schedule shots, and daily work and care responsibilities that make driving to a larger town for the vaccine a challenging proposition.

When presented with evidence that the FRPP was not meeting the vaccine access needs of some rural communities, the Alabama Department of Public Health deployed the state National Guard and select Federally Qualified Health Centers to set up mobile health clinics in some of the most underserved communities. These mobile clinics, conducted in the spring, were successful in reaching those who actively sought vaccination or who were persuaded by its availability to take the shot.

“This pandemic, and the hurdles we have faced with vaccine uptake in Alabama illustrate why planning and implementation of public health and health care services should be based on an inclusive assessment of the life circumstances of all Alabama’s citizens, not on what works for well-resourced communities and then retro-fitted for everyone else,” McClure said. “Alabama’s public health ground game is underdeveloped and must be improved if we are to end this pandemic and create a more equitable and effective response to existing and emergent health issues in the future.”

The study was completed at the end of July just as COVID-19 cases began to surge again in Alabama because of spread of the more contagious Delta variant. Vaccinations have increased in the state, bringing up Alabama from the lowest vaccination rate in the country, but Alabama’s rate remains among the lowest.

“The cost of moving up from dead last in terms of lives, livelihoods and the burden on hospital personnel and resources statewide is unacceptably high,” McClure said. “Though some may be tempted to reason that this surge is the price we had to pay for higher vaccination rates, we should strongly resist this reasoning. Vaccination is a preventive measure — it’s about avoiding serious illness and death, not viewing those entirely avoidable circumstances as a stick to compel action.”

Along with McClure, UA researchers involved in CommuniVax_Alabama include Dr. Kathryn Oths, professor emeritus of anthropology; Dr. Levi Ross, associate professor of health sciences; Dr. Pamela Payne-Foster, physician and professor of community medicine and population health; and Dr. Bronwen Lichtenstein, medical sociologist and professor of criminology and criminal justice.

The full report can be found on the CommuniVax website.


Adam Jones, UA Strategic Communications, 205-348-4328, adam.jones@ua.edu


Stephanie McClure, assistant professor of anthropology, smcclur1@ua.edu