There are huge racial disparities in vaccination, and we need new solutions to fight "hesitancy." To get there, we have to stop thinking that people are primary driven by their mistrustful emotions. Sure, mistrust plays an important role, but it's not the whole story. Thread.

Here's one theory. Blacks are more likely to know someone who's had COVID (because of high COVID rates and well, socialization). This also means that Blacks have seen most people survive COVID. They're perhaps less likely to know about lingering symptoms. 2/8

All of us weigh competing risks when making decisions. We're less likely to choose uncertain outcomes, particularly when they’re scary. With vaccinations, some might be weighing their experience of knowing people who survived COVID against the uncertainty of vaccination. 3/8

The vaccine option is complicated by mistrust. And, mistrust isn't just about the U.S. Public Health Service Syphilis Study (at Tuskegee). It's mistrust of institutions: academic research, health systems, pharma, state governments, and the recent presidential administration. 4/8

People go with what they know. They've seen COVID, seen most survive, and likely know less about residual symptoms. Toss in some optimism and false-consensus biases and you get to a "no" on vaccination. 5/8

What does this mean for intervention? Here's one idea. Yes, engage community groups to assist in informing messages and dissemination. But talk less about getting COVID and dying from it. Instead talk about the social, familial and professional hit from #longcovid. 6/8

Talk about the potential for lifelong multi-systemic complications. Show narratives of community folks experiencing #longcovid and the implications for families. Have trusted folks pitch vaccination as an option to prevent an uncertain future of diminished function. 7/8

TL; DR: Education isn't enough to battle hesitancy, mistrust isn't the only driver, people are not (only) bundles of emotion, we knew this was coming, this is just one of many ideas, and we need to move fast to fix this. 8/8