Patient Worry, Identity Shape Adults’ Vaccine Perception

To improve adult immunization rates, pharmacists need to target how patients process health information, as new research shows that personal worry and identity significantly distort the perception of vaccine safety, according to Vaccine.¹

“Barriers [in health care] have engendered a sense of distrust in the US health care system and its associated institutions, including hospitals, private health insurance corporations, the pharmaceutical industry, and government institutions charged with regulating and delivering care,” according to a study in the Russell Sage Foundation Journal of the Social Sciences (RSF).² “COVID-19 vaccination efforts in the US and the responses to those efforts have demonstrated the lethal consequences of institutional distrust at a time when individuals are explicitly asked to place their confidence in public health guidance and medical interventions.”

This distortion of reality is driven by a phenomenon known as pluralistic ignorance, a group-level shared misperception of what other group members are thinking or feeling. In the Vaccine study, researchers surveyed a demographically representative panel of 2425 Black and white Americans.¹

Participants were asked about their worry regarding medical racism, HIV misinformation, vaccine safety, and whether vaccines violate individual rights.

READ MORE: The Effects of COVID-19 Influencing the Development of Vaccines

The researchers discovered that Black participants consistently overestimated their racial ingroup’s worry across all issues explored. White participants, in contrast, only exhibited pluralistic ignorance on items directly related to the COVID-19 vaccine’s safety and implications for personal rights, but not on issues of medical racism.¹

For both groups, an individual’s own worry was a strong predictor of these inflated overestimations, suggesting an egocentric bias. Surprisingly, the study found that overestimating group worry was not driven by the quantity of social media exposure but rather by how individuals processed that information, including those exhibiting actively open-minded thinking.

This suggests that rather than merely combating online misinformation, health care providers must address the cognitive processes and misperceived social norms that shape vaccine beliefs.¹

How Vaccine Hesitancy Comes in Different Shapes and Sizes

Understanding these distinct pathways is critical because vaccine hesitancy is not a monolith. A national NPR poll illustrated that vaccine reluctance was nearly equal among Black and white Americans, with roughly a quarter of Black respondents and over a quarter of White respondents stating they did not plan to get a shot. Yet, the root causes of their concerns diverged significantly.^1,3

Although Black Americans’ vaccine hesitancy is uniquely grounded in historical medical exploitation and contemporary experiences of systemic discrimination, white Americans’ hesitancy is more commonly driven by institutional mistrust, social media use, and political reactance. Furthermore, the poll revealed sharp political and geographic divisions, noting that rural residents and political conservatives were significantly more likely to decline vaccination.^1-5

This complexity is further demonstrated in a study of Arkansas adults, a highly vulnerable rural population ranking third in the nation for serious COVID-19 illness risk. The study found that Black respondents had more than double the odds of vaccine hesitancy compared with White respondents.⁵

In that rural cohort, general trust in vaccines was the strongest predictor of hesitancy, with those reporting low trust exhibiting more than 11 times the odds of hesitancy. Conversely, a lack of fear of infection increased the odds of hesitancy by more than 5 times, emphasizing how perceived risk shapes patient decisions.

Pharmacists’ Ability to Turn Hesitancy into Acceptance

This is where the pharmacist’s role as a trusted intermediary becomes paramount. According to the study in RSF, a vast majority of Americans have experienced negative interactions with the health care system, such as high costs and billing opacity, which predate any pandemic and foster deep-seated institutional distrust.²

Despite this systemic skepticism, many patients maintain high levels of interpersonal trust in their individual health care providers. Local pharmacies and community clinics act as crucial tipping-point hubs because they offer convenient vaccine access in familiar settings, allowing pharmacists to cultivate this interpersonal trust and lower barriers to care.

By recognizing that many hesitant patients are in an active, decision-making phase, pharmacists can intervene with targeted, empathetic education.²

A systematic literature review of vaccine hesitancy determinants among Black and African American individuals highlighted that trust in health care providers and clear information on vaccine safety are among the most significant predictors of vaccine acceptance. Researchers identified historical mistrust, contemporary discrimination, and concerns about rushed vaccine development as primary barriers.⁴

Pharmacists can address critical information needs regarding vaccine development, side effects, and dosing schedules, which are frequently cited as key barriers. Collaborating with faith-based organizations and local community leaders can further amplify these efforts.^4,5

To move patients from hesitancy to acceptance, pharmacists must engage in open, transparent dialogues that validate patient concerns, reconcile past medical injustices, and lower structural barriers to care.^2,4

“Our results indicate that Black Americans were more worried than white Americans regarding medical racism, HIV misinformation, COVID-19 vaccine safety, and the COVID-19 vaccine's implications on personal rights,” concluded the authors of the current study.¹ “Given that histories of medical racism and related misinformation susceptibility are specific to Black communities, it is perhaps unsurprising that Black participants overestimated the average worry of Black Americans on all of these dimensions, while white participants only overestimated other white Americans' worry regarding the COVID-19 vaccine—both safety and rights.”

READ MORE: COVID-19 Resource Center

REFERENCES

1. Geiger N, Heiman S L. Overestimation of racial ingroup worry about the COVID-19 vaccine and medical racism. Vaccine. 2026;91:129046. doi:10.1016/j.vaccine.2026.129046

2. Casselman-Hontalas A, Adams-Santos D, Watkins-Hayes C. Discourses of distrust: how lack of trust in the U.S. health-care system shaped COVID-19 vaccine hesitancy. RSF. 2024;10(4):154-172. doi:10.7758/rsf.2024.10.4.07

3. Summers J. Little difference in vaccine hesitancy among White and Black Americans, poll finds. NPR. March 12, 2021. Accessed August 17, 2026. https://www.npr.org/sections/coronavirus-live-updates/2021/03/12/976172586/little-difference-in-vaccine-hesitancy-among-white-and-black-americans-poll-find

4. Savoia E, Masterson E, Olander DR, et al. Determinants of vaccine hesitancy among African American and Black individuals in the United States of America: a systematic literature review. Vaccines (Basel). 2024 Mar 7;12(3):277. doi: 10.3390/vaccines12030277

5. Willis DE, Andersen JA, Bryant-Moore K, et al. COVID-19 vaccine hesitancy: race/ethnicity, trust, and fear. Clin Transl Sci. 2021 Nov;14(6):2200-2207. doi: 10.1111/cts.13077