Breaking Barriers: Empowering Black Young Adults to Embrace COVID-19 Vaccination

By Lisa Hightow-Weidman, M.D., M.P.H., and Henna Budhwani, Ph.D., M.P.H.
Florida State University (FSU) College of Nursing
Posted Aug. 15, 2024

The COVID-19 pandemic was a frightening and uncertain time. Schools closed, office work went virtual, and countries shut their borders. In the early days of the pandemic, hospitals were overrun, and over six million people died; of our fallen, 13% were African American or Black. In 2020, the largest increase in deaths was among American Indian and Alaska Native (36.7%) and Black (29.7%) populations. Collectively, we held our breath, waiting for a scientific miracle.

To respond to this global threat, an internationally coordinated effort was made to develop an effective COVID-19 vaccine. In 2020, the United States Food and Drug Administration (FDA) issued emergency use authorizations (EUA) for the Pfizer-BioNTech vaccine and the Moderna vaccine. Both vaccines were mRNA-based. In 2021, the FDA issued an EUA for the Jassen vaccine, which leveraged the adenovirus vector. Historically, the vaccine development process takes about 11 years; thus, the expeditious release of three COVID-19 vaccines built using two different technologies caused skepticism, fueling hesitancy and an unwillingness to accept the vaccine.

Understanding the Assignment

Even before the approval of COVID-19 vaccines, misinformation and false narratives about them flooded social media, leading to widespread hesitancy. Black young adults, especially those in the southern United States, were particularly hesitant, with early estimates showing only 42% were likely to accept the vaccine. This skepticism and rampant misinformation, coupled with systemic health care barriers that harm Black populations, made it imperative to find effective ways to reach and engage Black young adults living in southern states expeditiously.

A screenshot from the Tough Talks COVID-19 mobile application. Credit: Virtually Better, Inc

The National Institute on Minority Health and Health Disparities (NIMHD), as the young people would say, understood the assignment. They released a funding announcement to promote the COVID-19 vaccine to minority populations. We saw this opportunity and knew we had to respond with all we had. Bet! We live in the southern United States, and this was our chance to contribute to the well-being of our communities. We knew time was of the essence, so we developed a proposal to adapt the “Tough Talks” digital health intervention that engaged young adults to promote HIV-related health into Tough Talks for COVID-19 or TT-C.

The Tough Talks for COVID-19 Intervention Study

To build trust, we had to be innovative in our approaches while also being completely real about the quickly changing landscape of COVID-19. And so, we pulled together a team of diverse scholars and community partners to inform the entire project. We took guidance and direction from experts: both leaders at minority-serving institutions and Black young adults living in southern states. We listened, we learned, and then we created the TT-C digital health interventions featuring:

• Testaments: Black young adults living in southern states shared their personal experiences and reasons for getting vaccinated via real-world video-based digital stories.
• Interactive Activities: We included choose-your-own-adventure games and engaging activities that explained complex biomedical concepts in relatable, youth-friendly ways.
• Non-Stigmatizing Messaging: Collaborating with our advisors, we crafted tailored, non-judgmental, and supportive messages that addressed common misconceptions and fears without alienating participants.
• Educational Content: We embedded comprehensive information about COVID-19 vaccines, including their safety and efficacy, and general preventative health tips, like proper handwashing techniques.

To evaluate the TT-C intervention, we conducted a randomized controlled trial (RCT) with 360 Black young adults aged 18-29 from Alabama, Georgia, and North Carolina who were unvaccinated or not fully vaccinated per current recommendations. Participants were recruited via social media. Once enrolled, participants were randomly assigned to either the TT-C or the control group. Self-reported data on vaccination and related constructs were collected at multiple points through 3-months post-randomization. Our primary outcome was COVID-19 vaccine uptake, verified by vaccine cards and survey responses. Secondary outcomes included measures of vaccine hesitancy, confidence, knowledge, and conspiracy beliefs. We tracked paradata to assess intervention engagement and were 100% accessible to our participants and partners.

Vaccine Interventions are Game-Changers

Preliminary observations suggest that TT-C holds significant promise. By using digital storytelling and incorporating valuable insights from young adults and expert advisor boards, TT-C resonated with Black young adults. The mobile app format ensured that participants could access information and support from anywhere using a youth-friendly modality, removing barriers like transportation and the need for clinic visits. The intervention’s culturally relevant content addressed concerns and misconceptions unique to the community’s lived experiences, fostering trust and confidence.

Vaccination saves lives; specifically, since the 1970s, vaccination has saved 154 million lives globally. If TT-C is indeed successful at reducing vaccine hesitancy and improving vaccine knowledge, there will be a strong case for adapting TT-C to promote other vaccines like influenza and HPV to avert preventable diseases, such as cervical cancer. By breaking down structural barriers and giving those we aim to support a true voice in the scientific process, we can foster trust, fight misinformation, and reduce vaccine hesitancy. Together, hand in hand, we can create a healthier future by improving rates of life-saving vaccinations.

Learn More

For more information on this project, visit our website and follow us on social media for updates on TT-C and our other health equity initiatives and success stories.

Lisa Hightow-Weidman, M.D., M.P.H., and Henna Budhwani, Ph.D., M.P.H., are co-principal investigators of the Tough Talks for COVID-19 study.

Dr. Hightow-Weidman is a Distinguished and Endowed McKenzie Professor at the Florida State University (FSU) College of Nursing. She is the founding director of the Institute on Digital Health and Innovation and the contact PI of the Adolescent Medicine Trials Network for HIV/AIDS Intervention (ATN) Scientific Leadership Center.

Dr. Budhwani is a professor at the FSU College of Nursing and leads the Institute on Digital Health and Innovation’s Intervention Research and Implementation Science Hub. A medical sociologist by training, Dr. Budhwani’s research focuses on addressing health inequities among adolescents and young adults via pragmatic clinical trials.