It may be hard to rewind your mind six years, but 2020 was a year for the books. We lost Kobe Bryant and George Floyd, wildfires destroyed 8.2 million acres of land in Colorado, California, and Oregon, and the COVID-19 pandemic took the world by storm. In the U.S., as in much of the world, COVID vaccines and later the COVID booster shots were developed quickly, distributed unevenly, and poorly understood by many who took them. In the mad dash to avoid getting the deadly disease, the COVID vaccine controversy was part of the conspiracy theory melee swirling around how the outbreak started, which medications saved lives, who was getting the best care (and not), and the—as of then—unknowns about vaccine side effects.
Fast forward to today, and we know a lot more about the myriad COVID vaccines on the market and how mRNA technology functions in the human body. According to the World Health Organization’s COVID dashboard, over 13.64 billion COVID doses have been administered around the world, and 67% of the global population has taken at least one dose as of December 2023. But only 32% had received a booster, which is recommended for vulnerable populations.
But research has shown that Black patients, especially women, have high hesitancy rates due to historical inequity and medical exploitation. Building trust in public health systems remains a challenge for many, yet research shows high mortality among Black patients.
It’s worth reviewing what we know now about COVID boosters to see if there’s a way to bridge the gap between distrust and disease prevention.
With years of data on who remains most vulnerable to severe COVID outcomes, how long immunity lasts, and how boosters perform in preventing hospitalization and death, healthcare providers can better navigate this complex moment of trust rebuilding. For many Black patients, booster decisions are not about rejecting science outright, but often about weighing personal health risks against historical experience.
Here’s how medical professionals can forge a path forward built on informed dialogue.
Looking Back: What Do We Now Know About COVID?
Years into the pandemic, the risk profile of COVID-19 is clearer. Older adults, people with underlying conditions, such as diabetes, heart disease, obesity, lung disease, and those who are immunocompromised, remain at the highest risk for severe illness, hospitalization, and death.
Unfortunately, these conditions disproportionately affect Black communities, so that reality shapes booster conversations today. With masks and sanitizers less in use, the risk to catch COVID, even from asymptomatic patients, remains a cause for concern. Every country has different guidance on the age groups that should receive the booster and how frequently it is needed, but generally, the booster is recommended for anyone aged 6 months to 65 years with an underlying health condition or weakened immune system.
That said, vulnerability can also be accompanied by vaccine hesitancy, as people consider how the vaccine may interact with other medications, recent procedures, or other health conditions.
What Do We Now Know About COVID Boosters?
Booster guidance has evolved as variants have changed. Current recommendations generally prioritize adults over 65, people with chronic conditions, and those who are immunocompromised. The goal is less about preventing infection and more about reducing severe disease, hospitalizations, and deaths. Depending on the vaccine manufacturer, boosters are recommended every 6-12 months.
Melva Thompson-Robinson, DrPH, professor at the University of Nevada, Las Vegas School of Nursing, emphasizes that conversations about boosters must start by acknowledging the broader information environment patients navigate.
“First and foremost, recognize that misinformation exists about vaccines and their boosters,” Dr. Thompson-Robinson says. “Recognize that contrary to what has been spread across social media and other information channels, vaccines and boosters are effective ways of preventing disease/condition and death or severe illness from disease/condition.”
According to Yale New Haven Health, “common side effects include tiredness, headaches, pain where the shot was given, and chills. Less common but other known side effects are fever, diarrhea, joint aches, vomiting, and swollen lymph nodes in the underarm on the same side as the shot.”
“While someone may have a reaction to the vaccine and/or booster, that reaction is significantly less than the actual disease/condition itself,” Dr. Thompson-Robinson says.
Still, experts note that booster decisions are not one-size-fits-all. Factors such as prior infection, the timing of the last dose, and individual health conditions matter. This is where the right health care practitioner can make all the difference.
How to Bridge the Trust Gap for High-Risk People Who Are Still Skeptical
For many Black patients, hesitancy is not rooted in conspiracy but in recent history. Dr. Thompson-Robinson says providers should start by acknowledging that reality directly. “One of the most effective ways to address historical medical mistrust is to recognize that this mistrust exists and that patients may feel strongly about it,” she explains. “Minimizing and/or ignoring the mistrust only increases it for the patients.”
In practical terms, that means slowing down clinical care and communicating with compassion.
Building and maintaining a trusting relationship with the patient is possible if providers can refocus trust on a bond with the provider and not a blanket acceptance of the entire medical system, she says. “Patients will be more likely to follow providers’ advice if they trust their provider.”
That trust-building often requires more time than standard appointment schedules allow. And it may require multiple visits. “The flip side is that this extra time could increase adherence to treatment protocols, which then minimizes future visits related to non-compliance,” Dr. Thompson-Robinson says.
In other words, trust is not a detour from clinical care. It is a critical foundation for it. When asked about strategies that build vaccine confidence, Dr. Thompson-Robinson points to “consistent and correct messaging about the vaccines as well as building trust with patients.”
What Can People Do If They Don’t Want the Booster but Also Don’t Want COVID?
Some high-risk patients ultimately decide against another booster, but that shouldn’t be the end of their medical care. In fact, these patients likely need to take more long-term precautions.
Healthcare providers should encourage them to stay up to date with other preventive care, test for COVID early when symptomatic, wear masks in high-risk indoor settings, and maintain the COVID lessons learned around social distancing and well-ventilated homes and workplaces.
Declining a booster does not eliminate risk. It simply shifts greater responsibility to other at-home protective measures.
In the end, providers have to know that booster decisions among Black patients are rarely simple or quick. Vaccine hesitancy sits at the intersection of science, lived experience, and personal risk tolerance. The most effective approach hinges less on persuasion and more on partnership.