Understanding Vaccine Disparities in the Bronx, New York, Through a Mixed Methods Analysis of Community and Provider Perspectives.

Introduction: COVID-19 exacerbated inequities, impacting Black and Latinx communities in the Bronx, New York. COVID vaccination rates in the Bronx were initially lower, likely owing to vaccine confidence and hesitancy. Despite improved vaccination rates, persistent vaccine nonconfidence poses health equity challenges. The authors explored the factors contributing to vaccine nonconfidence among community members and healthcare providers. Methods: The authors conducted a mixed-methods study with community members and healthcare providers. Thematic analysis was utilized for the conversations and focus groups, and surveys were analyzed quantitatively. Results: Analysis of conversations and focus groups with 43 Bronx community members identified 6 themes: mistrust, autonomy, structural racism, misinformation and disinformation, faith and religion, and social responsibility. Misinformation, disinformation, mistrust, and patient-provider relationship issues significantly influenced vaccine nonconfidence. Structural racism contributed to limited access and racial prejudice. Religious beliefs influenced decision making, highlighting faith-based organizations' importance. Surveys of 48 providers revealed concerns about side effects, rapid vaccine rollout, misinformation, and community influence. Conclusions: This study provides insights into the factors contributing to vaccine nonconfidence in the Bronx. Addressing these issues requires community-centered approaches and interventions that build trust, improve access, and provide accurate information. The authors propose integrating these findings into a novel curriculum to train Bronx medical students to work toward these goals.