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New study finds that structural racism and institutional mistrust are the most prevalent factors influencing Covid-19 vaccine hesitancy

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Professor  Peter A. Newman at the University of Toronto’s Factor-Inwentash Faculty of Social Work and his research team have revealed groundbreaking findings in a scoping review titled “Understanding Covid-19 Vaccine Hesitancy and Undervaccination among Marginalized Populations in the US and Canada”, published in the Journal of Racial and Ethnic Health Disparities.

Amidst ongoing disparities in Covid-19 vaccination rates, and the proliferation of research that unilaterally attributes low vaccination to vaccine hesitancy, this comprehensive review aimed to uncover the multilevel determinants of vaccine hesitancy and undervaccination among marginalized communities.

Conducted using the rigorous scoping review methodology developed by the Joanna Briggs Institute, the research team explored 7 databases yielding 5,897 abstracts, with 103 peer-reviewed articles published from January 1, 2020, to October 25, 2022 included in the review.

Key findings indicate that among 14 marginalized populations, including African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved individuals, structural racism and institutional mistrust emerged as the most prevalent factors influencing Covid-19 vaccine hesitancy (n=71). The review highlighted 32 influencing factors, with structural barriers, vaccine safety concerns, and social/community factors significantly impacting Covid-19 vaccination.

“This study sheds light on the multilayered drivers of undervaccination among marginalized populations,” said Professor Newman. “It is imperative to distinguish systemic barriers like structural racism and limited access to Covid-19 vaccination from vaccine-specific concerns that may constitute vaccine hesitancy, in order to promote equitable vaccine distribution along with informed decision-making among marginalized communities.”

The research underscores the urgent need for evidence-informed interventions to address the multifaceted challenges underlying Covid-19 undervaccination. Rather than placing the onus of undervaccination on marginalized communities themselves, it is critical to advance equity in vaccine access and to combat structural racism and other forms of structural stigma in healthcare and government, along with historically justified institutional mistrust.

For further information, read the full study available online or contact Prof. Peter A. Newman at

Other FIFSW-related researchers listed as co-authors on this study include Professor Charmaine Williams, former postdoc Thabani Nyoni and FIFSW PhD graduate, now postdoc at U of T’s Dalla Lana School of Public Health, Kate Allan.

About Peter A. Newman

formal head shot of Peter A. Newman

Peter A. Newman is a full professor and affiliate of the Joint Centre for Bioethics. He is co-founder, VOICES-Thailand Foundation, and a standing member of the Health Sciences Research Ethics Board.

Dr. Newman has been awarded over 11 million dollars in continuous, external PI-research funding. With over 165 peer-reviewed publications, he has been recognized as among the most highly cited social work scholars in North America. His research program addresses global health and human rights, with a focus on HIV and sexual health among sexual and gender minorities, and racialized populations. He currently leads an international, multisite RCT of a community-based eHealth intervention (#SafeHandsSafeHearts) to support LGBTQ+ and racialized communities in the COVID-19 pandemic, as well as Project VOICES, a study of COVID-19 vaccine hesitancy. Newman’s global SSHRC Partnership grant, MFARR, engages an 8-country multidisciplinary team—from social sciences, fine arts, and medicine—to gather and mobilize evidence to advance LGBTIQ inclusion and human rights in India, Thailand, Bangladesh, Hong Kong, and Canada. His research also promotes culturally grounded understanding of risk and enabling environments for HIV and bullying victimization with LGBTQ+ and other vulnerable youth.

Currently, Dr. Newman is the PI on six externally funded grants, from the International Development Research Centre (IDRC), SSHRC, CIHR, and the Canada Foundation for Innovation. He serves on the Editorial Boards for PLOS Global Public Health, Culture, Health & Sexuality, PLOS ONE, Journal of the Society for Social Work & Research, and the Journal of Gay & Lesbian Social Services.