"They Don't Really Consider Us Essential, But We Are": a Qualitative Investigation of Vaccine Acceptance and Perceived Workplace Safety Among Black Transit Workers During the COVID-19 Pandemic.

Black Americans face a higher risk of coronavirus disease 2019 (COVID-19) morbidity and mortality due to adverse social determinants of health, including their overrepresentation in the frontline workforce. Despite these inequities, increasing vaccine acceptance among this subpopulation has been challenging. We conducted semi-structured qualitative focus groups with Black public transit workers living in the USA to explore behavioral intentions regarding COVID-19 vaccine uptake, occupational health challenges, and the perceived impact of racism on workplace health and safety during the pandemic. A thematic analysis approach was used to analyze the final transcripts. We completed three focus groups (n=10 participants) in October and November of 2021. Enabling factors for vaccination included opportunities for vaccination in the workplace, flexible hours of operation, and walk-in vaccine clinics. Disabling factors included excessive wait times. Some participants also cited lack of cleanliness, inconsistent enforcement of COVID-19 safety protocols, and unclear workplace policies regarding sick and hazard pay as major safety barriers. Perceptions regarding the role of racism in their experiences with COVID-19 as transit workers were mixed. Though occupational health and safety concerns were high, there are opportunities for transit agencies and government officials to improve both vaccine uptake and working conditions for Black transit workers.