"They Using Us As Guinea Pigs Again": Resistance to Vaccination Among Criminal Justice-Involved Black Men

Background and Purpose: Current Covid-19-related death rates in the U.S. (0.08 per 100,000) are eight times that of global rates, with Philadelphia’s rates (0.11 per 100,000) being 38% higher than U.S. rates. Compared to Whites, Blacks have a higher prevalence of the underlying risk factors for Covid-19 related mortality, and lower rates of vaccination. At a recent peak of the pandemic, death rates among Blacks in the U.S. were 60% higher than whites. Disparities in Philadelphia are even greater, with Black mortality rates reaching six times that of Whites. Despite Blacks outnumbering Whites in Philadelphia by 5%, those receiving three vaccination doses are 25% less than Whites who are similarly vaccinated. The high incarceration rates among Blacks in Philadelphia place them at greater social precarity, putting them at higher risk of being unvaccinated. This study examines the vaccination rate and its correlates in a sample of Blacks with a recent felon-related arrest, or incarceration episode.

Methods: Utilizing a mixed methods approach, we conducted survey (n=120) and semi-structured qualitative interviews (n=35) from 2022 to 2023 among participants who had been diverted to a Philadelphia diversion program on a felony charge in the past year. All consented program participants were included in the survey sample, while snowball sampling helped to recruit participants for qualitative interviews. We used logistic models regressing vaccination on correlates, and used a grounded theory approach employing sensitizing concepts to code the qualitative data.

Results: On average, participants were 29 years old, with 97% identifying as Black, and 98% as male. Education levels were generally low among participants: 18% had not completed high school, 56% had completed high school with no college, and 19% had completed some years of college without getting a degree. Unvaccinated rates were very high with 65% completely unvaccinated, and only 3 receiving three vaccination shots. Regression analyses indicate that after controlling for correlates, an increase in level of education (some years of high school to completing high school, for instance) decreased the risk of remaining unvaccinated by 50% (OR=0.50, 95% CI=0.28,0.92), while every year increase in age decreased unvaccinated risk by 10% (OR=0.90, 95% CI=0.84,0.97). Conceptually, resistance to vaccination was enunciated through: 1) conspiracy theories about “big pharma” and the State targeting Black bodies, 2) anecdotal narratives about adverse vaccine effects, and 3) linking pro-vaccination pressures to oppressive directive regimes experienced in carceral systems.

Conclusions and Implications: Pandemics amplify the effects of structural racism on Black communities. The large effect size of graduating from one education level to the next highlights the risk of low educational levels for vaccination among poor Black men. Moreover, lack of education and being incarcerated, especially for young Black men, crystallize into subjective opposition to vaccination. Vaccination initiatives become markers of structural racism and anti-Black pogroms. The extremely low rates of vaccination in the sample might explain the enduring high death rates among Black communities. Our results suggest that efforts to contain this and future pandemics need to focus on meaningful educational advancement for young Black men.