Black/African American Community Health Workers in HHS Region 4 and COVID-19 Vaccination: Position Perspective and Power

COVID-19 is caused by the novel and highly transmissible SARS-CoV-2 virus. SARS-CoV-2 was first reported in the Chinese province of Hubei in December 2019 and in the United States in January 2020. After nearly 120,000 confirmed global cases and 4,200 deaths in 114 countries, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic in March 2020. By fall 2020, COVID-19 had become the third leading cause of death in the United States. When compared to other populations, Black/African Americans were disproportionately impacted by the COVID-19 pandemic due to long-standing inequities, including higher rates of preexisting chronic illness. Black/African Americans—who were more likely to be exposed—were also more likely to experience severe COVID-19 illness, hospitalization, and death. To mitigate the spread and impact of the virus, the federal government invested unprecedented resources in the development of COVID-19 vaccines. Despite their increased risk, Black/African Americans were more likely to be hesitant and more likely to face barriers to accessing vaccination. The current study examines disparities associated with COVID-19 and vaccination through the perspectives of Black/African American Community Health Workers (CHWs) in HHS Region 4 of the southeastern United States, using Critical Discourse Analysis (CDA) as the analytical lens. Due to the complexities inherent in this topic, an ecological framework was selected to guide the research. Study findings revealed systemic-level disempowerment of Black/African Americans connected to political discourse, limited vaccine choices and access, institutional distrust, and inequities within the healthcare system. Findings also highlighted sources of empowerment at the institutional and community levels of the ecological model, including community-centered partnerships with local health officials, municipal leaders, faith-based institutions (“the church”), and grassroots organizations. Overall, results suggest community-centered practices can help address systemic inequities, build trust, and empower marginalized communities. To further advance these goals, public health practices should prioritize the development of sustainable, community-centered partnerships—especially in preparing for and responding to public health emergencies—and additional work is needed to strengthen future emergency responses.