Trust and Trustworthiness: Considerations for COVID-19 Vaccine Receipt in the Chicago Metropolitan Area.

Black Americans are disproportionately affected by COVID-19 related disease and mortality due to longstanding social, political, economic, and environmental injustices. Although structural determinants of health have clear links to both COVID-19 disease and vaccine uptake, many public health researchers focus on the contribution of individual level trust in vaccine uptake, obscuring how distrust develops and is reinforced through continued systemic injustice. While much is known about relationship between individual trust and receipt of the COVID-19 vaccine, less is known about how structural racism and exposure to discrimination influence that association. Using survey data collected in the Chicago metropolitan area, we examined associations between structural racism, discrimination, and trust on two measures of vaccine acceptance: self-report receipt of any vaccine and completion of the primary series. Multiple variable logistic regression results suggest that participants who trusted the federal government to ensure a safe pediatric COVID-19 vaccine had higher odds of being vaccinated and completing the primary series. NH Black and Hispanic participants' distrust of their doctor to provide COVID-19 information reduced their odds of vaccine uptake. Trust in medical professionals was linked to higher odds of vaccine receipt for Hispanic participants but not for NH Black participants. Education consistently influenced the likelihood of receiving any vaccine for both NH Black and Hispanic participants, but not completing the primary series. Conversely, employment was strongly related to completing the primary series but not initial vaccine receipt. Measures of structural racism and discrimination had minimal impact on vaccine uptake in this sample.