Background: Structural racism, the totality of ways that societies foster racial discrimination through mutually reinforcing systems, has increasingly been recognized as a significant contributor to COVID-19 inequities. Yet, much of the research around COVID-19 vaccine receipt focuses on describing racial disparities and individual trust. We developed a conceptual model proposing that factors contributing to structural racism at the policy, community, organization, and interpersonal levels translate into situations of chronic social disinvestment, limited access to COVID-19 resources, and lack of trusted messengers. This leads to limited community-level trustworthiness in vaccine-affiliated institutions and messaging.

Objective: To test associations between community-level trustworthiness and individual COVID-19 vaccine receipt in Chicagoland communities.

Methods: We will use survey data from the Chicagoland CEAL program to test if individual receipt of vaccine is associated with community-level trustworthiness. Vaccine receipt is defined in two ways: self-reported receipt of any vaccine and completion of the primary series. Determinants of community-level trustworthiness include economic indicators, physical environment factors, and healthcare access; these are extracted from public data sources. Individual variables include confidence in vaccine safety, trust in the federal government, trust in doctors, trusted information sources, sources of news, perceived discrimination, self-reported employment, and self-reported economic stability.

Results: 852 surveys were collected between December 2021 and February 2023. The respondent mean age was 46; 56% reported Black race, 19% White race, and 30% Hispanic ethnicity. Participants reported challenges in the past month accessing healthcare (37%), housing (32%), food (35%), medicine (33%), and transportation (36%). Eighty-four percent had received at least one COVID-19 vaccine and 75% had completed the primary series. Among those who received at least one vaccine, the greatest sources of trust were doctors (72%) and faith leaders (42%); 56% fully or mostly trusted the government to ensure the vaccine was safe for children. Of those who hadn’t received any vaccine, only 38% reported high trust in doctors and 20% trusted the government to ensure the vaccine was safe for children. A series of multivariate logistic regression models will determine if community-level trustworthiness determinants are associated with vaccine receipt. The moderating effects of individual perceived factors will be explored.

Conclusions: Centering discussions of COVID-19 vaccination on our system’s trustworthiness, instead of individual trust, may provide a stronger framework for achieving large scale health equity.

Public health implications: This analysis highlights the role of structural forces on equity-oriented interventions and will identify pathways for future system change.