Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-021-01037-0 Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey Van Ta Park 1,2 Janice Tsoh 2,6 3 4 1 1 1 5 & Marcelle Dougan & Oanh Meyer & Bora Nam & Marian Tzuang & Linda Park & Quyen Vuong & Received: 7 March 2021 / Revised: 30 March 2021 / Accepted: 30 March 2021 # The Author(s) 2021 Abstract Background Understanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI). Methods Data from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a crosssectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns. Results Overall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. <30), females (vs. males), and experienced mild negative impacts from COVID-19 on family income/employment (vs. no change) reported more concerns about the vaccine. Those who had less vaccine concerns were those who reported higher (vs. low) health status, ≥60 years old (vs. <30), and separated/divorced/widowed (vs. single). Discussion AAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake. Keywords COVID-19 . vaccine concerns . Asian Americans . Pacific Islanders Introduction * Van Ta Park 1 School of Nursing, Department of Community Health Systems, University of California, San Francisco (UCSF), San Francisco, CA, USA 2 Asian American Research Center on Health (ARCH), UCSF, San Francisco, CA, USA 3 Department of Public Health and Recreation, San Jose State University, San Jose, CA, USA 4 Department of Neurology, University of California, Davis (UCD), Davis, CA, USA 5 International Children Assistance Network, Milpitas, CA, USA 6 School of Medicine, Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, USA Addressing concerns regarding coronavirus disease 2019 (COVID-19) vaccination is a critical issue affecting the success of vaccination programs and bringing much needed control to the pandemic. Although a recent survey [1] found an increase in the proportion of US adults with greater degree of vaccine acceptance compared to early months of the pandemic [2, 3], a sizeable proportion of the US population is still unsure or do not plan to become vaccinated against COVID-19 [4]. The accelerated pace of vaccine development and the politicization of vaccine approval has heightened public anxieties and could have influenced its acceptance [5, 6]. It is essential that public health messages promoting COVID-19 vaccination target the underlying concerns especially for individuals who are among the vaccine “wait and see” group. This “wait and see group” is particularly important, given that they may be easier to convert from ambivalent J. Racial and Ethnic Health Disparities towards the vaccine to being willing to get it, compared to those who outright rejected to receive the vaccine. A recent poll by the Kaiser Family Foundation survey reported that 31% of the individuals surveyed belong to this group, saying that they will wait until the vaccine is available for a while and see how it is working for others who have taken it [4]. Several US studies have reported on specific concerns regarding the uptake of the COVID-19 vaccine including vaccine safety (i.e., side effects) [1–3, 7–9], vaccine effectiveness (including the need for more information about the vaccine) [2, 7], antivaccine beliefs and attitudes [1, 3], being worried about getting COVID-19 from the vaccine [1, 9], lack of trust [3], and perceived lack of testing [7]. A major gap in our understanding of concerns regarding COVID-19 vaccine is the scarcity of Asian Americans and Pacific Islander (AAPI) participation and thus their perspectives in these studies. To the authors’ knowledge, only two polls have surveyed Asian Americans about vaccine willingness, but the number of survey responses was few, and the respondents were limited to Asian Americans who could complete the surveys in English [10, 11]. Moreover, neither of the surveys were able to provide disaggregated AAPI data, which runs the risk of masking possible disparities across AAPI subgroups. This study aimed to take a deeper dive to understand the different types of concerns related to COVID-19 vaccination and whether such concerns differ by characteristics between and within subgroups of the AAPI population using a large, ongoing multilingual survey called the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS). The authors recognize that surveys such as this one are conducted in the context of a highly dynamic and changing landscape. However, given growing reports of inequalities in COVID-19 infection and mortality among AAPI [12–14], it is important to shed light on COVID-19 vaccine concerns specific to AAPI, especially when these may become barriers and/or facilitators to vaccination efforts that lead to achievement of herd immunity against COVID-19. Methods Study Eligibility, Recruitment, and Procedures COMPASS is a cross-sectional, community-based national survey that assesses the COVID-19 effects on AAPI. To be eligible, participants must self-identify as AAPI alone or in combination with other races/ethnicities; be able to read English/Chinese (traditional or simplified Chinese)/Korean/ Vietnamese; be ≥ 18 years old; and reside in the USA. The survey is available online (https://compass.ucsf.edu/) with as needed survey administration assistance by phone in the above-mentioned languages. COMPASS is an ongoing survey study, and this paper reports on 1646 participants who completed the survey from October 24–December 11, 2020, which was selected as the cutoff date for this analysis since it was the first day that the FDA authorized a COVID-19 vaccine [15]. The mean survey completion time was 21.6 (standard deviation (SD) = 15.5) min. Each participant was provided an option of receiving a $10 gift card (...truncated)