The complexities of ‘trust’ in the context of COVID-19 vaccination choices among Black women in Alameda County, CA

Many academic and media conversations about COVID-19 vaccination center on lower uptake among racially minoritized individuals due to what is characterized as 'mistrust.' In 'Is trust enough? Anti-Black racism and the perception of Black vaccine hesitancy,' Wilson argues that questioning Black people's trust in the COVID-19 vaccine fails to 'understand Black people as rational, complex beings who are fit to make reasonable decisions guided by complex factors.' In this study, we explore what shapes Black women's COVID-19 vaccination choices using data from 20 qualitative interviews conducted March-April 2022 with a sample of predominantly Black women in Alameda County, CA. Findings provide empirical evidence to support Wilson's argument that a narrow view of 'trust' over-simplifies Black women's comprehensive thinking about health decisions. Participants triangulated COVID-19 information sources and vetted this material with specific consideration of factors highly relevant to Black women's day-to-day lives: evidence of systemic or interpersonal racism in healthcare settings, management of chronic health conditions, and the importance of family. Many participants indicated that it was common for people in their networks to hold different perspectives on vaccination and they normalized these differences of opinions, expressing understanding of the socio-structural factors affecting the impact of the COVID-19 pandemic and vaccination choices.