SGIM Forum

Best Practices

Response to Black Patients’ COVID-19 Vaccination Concerns: Clinician Communication Practices

Ms. Hollis ( is a research assistant in the Stanford School of Medicine Division of Primary Care
and Population Health and will be an MD candidate, 2026. Ms. Garcia ( is a social science research professional in the Stanford School of Medicine Division of Primary Care and Population Health and will be an MD candidate, 2026. Ms. De Leon ( is a pre-health professions post-baccalaureate student at San Francisco State University and preparing to be a physician’s associate. Ms. Baratta ( is a project manager for the Presence 5 team in the Stanford School of Medicine Division of Primary Care and Population Health. Dr. Brown-Johnson ( is a qualitative researcher in the Stanford School of Medicine Division of Primary Care and Population Health.

Over the past year, we witnessed two pandemics—COVID-19 and racism—disproportionately impacting Black and other systematically marginalized communities. The COVID-19 pandemic further shed light on the more significant issue of racial injustice in the United States and its impact on health disparities, with Black patients dying from the disease at 1.7X the rate of White patients.1 Black individuals’ mistrust of the healthcare system is rooted in historical and systemic racism and perpetuated by their experiences when receiving medical care. This mistreatment contributes to greater COVID-19 vaccine deliberation among Black individuals. Although the differences in vaccination rates between White and Black individuals have narrowed, the percentage of White patients who have received at least one COVID-19 vaccine dose remains higher than the rate for Black patients.2 With the racial/ethnic disparities in COVID-19 infection and mortality rates, we sought to better understand Black individuals’ perspectives about the COVID-19 vaccine to guide clinician communication that builds trust.

We conducted 45-minute, semi-structured interviews in November 2020-March 2021 to learn about Black patients’ perceptions about the COVID-19 vaccine and identify clinician communication strategies to support their patients in vaccine deliberation. Since this study occurred before vaccine rollout, we acknowledge patient perceptions may change over time as more information regarding COVID-19 vaccines becomes available. We recruited interviewees from four clinics that primarily serve Black patients in Alabama, California, New York, and Tennessee. We interviewed 37 Black patients with 50% interviewer-interviewee race concordance. Four distinct coders coded transcripts to identify emerging themes. We also mapped clinician practices to the five communication domains in the Presence 5 for Racial Justice (P5RJ) framework.

Our history shows us that we have been experiments in America, and we don’t wanna be the frontline guinea pigs in trying out all that, and turn out disfigured, malformed ... We don’t wanna be the test drive. —Black Patient Interviewee

Black patient interviewees expressed concerns over vaccine safety, side effects, composition, efficacy compared to personal protective behaviors, and a lack of transparency in the media around COVID-19 in Black communities. Interviewees expressed distrust around the intentions of the COVID-19 vaccine compared to existing vaccines. Interviewees shared fears about misinformation and lack of information around the vaccine, current health disparities and racism in medicine, historical instances of racism in medicine (i.e., Tuskegee Syphilis Study), and racially discriminatory treatment in quality or access to the vaccine (see Table).

How Can Clinicians Work with Their Black Patients to Build Trust in the COVID-19 Vaccine?

With a greater understanding of Black individuals’ concerns around the COVID-19 vaccine, specific practices are needed for clinicians to work with their Black patients to promote comfort and confidence in the COVID-19 vaccine. The P5RJ framework provides five anti-racism communication practices for clinicians to build trust with Black patients:

  1. Prepare with Intention
  2. Listen Intently and Completely
  3. Agree on What Matters Most
  4. Connect with the Patient’s Story, and
  5. Explore Emotional Cues.

The following case study illustrates how these practices can guide vaccine conversations.

Case Study

During the height of the pandemic, a 65-year-old Black man comes in for a regular check-up. He has asthma and diabetes, and you are concerned about his increased risk for adverse outcomes if he contracts SARS-CoV-2. You notice that he has not received the COVID-19 vaccine. As the clinician, you say, “I see you haven’t received a COVID-19 vaccine. Would you like me to set up that appointment for you?”

The patient responds, “I don’t want to take the vaccine because I have a few things running through my mind. How do I know the vaccine is safe? I believe that they’ll give one race the real vaccine and give Black people the vaccine that will kill us. I’m worried about side effects. If something happens to me, the media will sweep it under the rug like another Black person who died. I don’t want to be a guinea pig like we were in Tuskegee.”

As his clinician, how do you respond using the P5RJ practices to address all of these concerns?

Prepare with Intention

Greater awareness about current and historical instances of racism will allow for better understanding and empathizing with your patients’ concerns. Staying well informed on the influence of racism on social and environmental factors can increase your ability to engage in transparent and supportive patient discussions.

Physician Preparation: Take time to stay updated on race-related news, media, and historical and current events.

Listen Intently and Completely

Your patient may have experienced racism, stigma, and discrimination in their lives and interactions with the healthcare system. Listen and be mindful of how adverse experiences or historical racism in medicine may contribute to vaccine distrust. Acknowledge these experiences and provide a safe space for patients to share their concerns.

Physician Response: “Thank you for sharing that with me. I can see that this concern is affecting you deeply. I acknowledge there are many faults in the medical system, but I am here for you and want to provide you with the best care.”

Agree on What Matters Most

If a patient deliberates regarding the vaccine, discuss their perceptions and beliefs without judgment. If the patient is not comfortable sharing their concerns, provide reassurance of confidentiality and discuss concerns other patients have shared. Acknowledging that some decisions require multiple conversations, it may be beneficial to schedule a subsequent visit.

Physician Response: “I hear where you are coming from with your concerns. I want to work with you to help keep you as healthy as possible. Other patients have shared similar thoughts about the COVID-19 vaccine, and I went over vaccine information with them in-depth. Is it okay if I share some resources that other patients have found helpful? This may take more than one conversation. We can schedule a time to talk further about this, and I can walk through some of this vaccine information with you.”

Connect with the Patient’s Story

Consider socio-cultural reasons for a patient’s health beliefs and actions. Use humble inquiry to learn about your patient’s life and circumstances.

Physician Response: “Thank you for this opportunity to get to know more about you. I understand why you feel the way you do. Your concerns are valid, and your health and values are important. I want to hear all of your thoughts and support you in making an informed decision that is right for you.”

Explore Emotional Cues

Pay attention to the non-verbal cues from your patient as they discuss emotion-evoking topics. Recognize racial trauma and practice trauma-informed care throughout the visit. Reflect, validate, and confirm your perceptions of your patient’s emotions.

Physician response: “How are you feeling at this moment? I realize that talking about the vaccine or negative and racist experiences with your healthcare can be traumatic or make you feel like you don’t control what happens to you. This decision is yours to make. I am here to support you through this.”


The racial and ethnic disparities highlighted by the COVID-19 pandemic have served as a call to action for clinicians to take on systemic racism in medicine. While the proposed framework is not a fix-all guide to combating racial disparities in COVID-19 and treatment, it offers practical strategies for clinicians to understand Black individuals’ concerns around the vaccine and support them in making informed decisions. Further research is needed to evaluate the efficacy of these practices in increasing vaccination rates in Black communities.


  1. CDC. Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. Updated February 1, 2022. Accessed March 15, 2022.

  2. Ndugga N, Hill L, Artiga S, et al. Latest data on COVID-19 vaccinations by race/ethnicity. Kaiser Family Foundation. Published February 2, 2022. Accessed March 15, 2022.


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