When Black and Hispanic parents in Chicago sit down to decide whether to vaccinate their school-aged children against COVID-19, they're weighing far more than medical risk—they're measuring safety against trust, knowledge against autonomy, and respect against a long history of inequity in American healthcare.
A new study published in Vaccine: X reveals why vaccination rates remain persistently low in these communities, even when parents themselves have chosen to get vaccinated. The answer lies not in skepticism about science, but in five core values that shape how parents from racially and ethnically minoritized families evaluate the vaccine: safety, knowledge, trust, humanity, and autonomy.
Researchers at Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine interviewed 20 caregivers of children ages 5–11 years old—62% non-Hispanic Black and 29% Hispanic—to understand what drives their vaccination decisions. The findings upend a common assumption: these parents aren't simply refusing the vaccine out of hand. All had received at least one COVID-19 dose themselves, and 62% of their children had been vaccinated.
What distinguishes confident parents from hesitant ones, according to senior author Dr. Andrea Spencer, Vice Chair for Research at Lurie Children's Hospital's Pritzker Department of Psychiatry and Behavioral Health, is whether these core values are respected or threatened. "When these core values were upheld, parents expressed more confidence in the vaccine," Dr. Spencer explained. "If the values were threatened, there was greater skepticism and hesitancy."
Safety, for these families, means more than clinical efficacy—it encompasses worry about adverse effects on themselves and their children. Knowledge isn't passive; it's built through conversations with family members, experiences within their own communities, and information gathered from multiple sources. Trust carries the weight of history: centuries of medical racism and exclusion from healthcare access shape whether parents believe medical research, health systems, and health professionals have their family's best interests at heart.
Humanity emerged as particularly powerful. Parents wanted to feel respected as individuals with unique circumstances, not as members of a demographic category to be convinced or coerced. And autonomy mattered profoundly—the desire to make their own informed choices and to eventually empower their children to decide for themselves.
Dr. Spencer emphasized that these values are "particularly shaped and amplified by experiences of systemic racism among racial and ethnic minoritized families." Historical medical harms, inequitable access to healthcare, and generations of cultural mistrust don't vanish because a vaccine is available. They inform every calculation a parent makes about their child's health.
The implications are both clear and actionable. Public health campaigns designed around these values—rather than talking past them—could be far more effective. Doctors who approach vaccine conversations with genuine curiosity about a parent's specific concerns, rather than scripts, could build the trust that has been systematically eroded. And policymakers who design vaccination initiatives with equity and respect at their center might do something more valuable than increasing uptake: they might begin rebuilding trust in public health systems themselves.
These aren't barriers to overcome through better messaging. They're the foundation for better medicine.