Black and Latino residents in New Jersey dealt with the brunt of the pandemic—outsized severe illness and more lost loved ones. A new study shows that while this collective experience encouraged them to take precautions against the virus, it didn’t dissuade their skepticism toward the COVID-19 vaccines.

The findings add urgency to the state’s vaccination efforts. New COVID-19 cases and hospitalizations are mostly affecting the unvaccinated population, and the delta variant, which spreads twice as fast as the original variant, is now dominant in New Jersey. It makes up 40% of recent cases.

“It's almost like there's this parallel structure that's happening for people who are vaccinated versus people who are not vaccinated in terms of what you can and can't do,” said Shawna Hudson, a professor of family medicine and community health at Rutgers Robert Wood Johnson Medical School who co-authored the study published in the Journal of the American Medical Association. “It actually sets up the system where we're actually now exacerbating the problem for the populations that have the least ability to navigate it.”

The Rutgers study used focus group interviews for more than 100 participants to examine the views of residents living in urban counties with high rates of poverty that were disproportionately affected by COVID-19. The researchers asked about the respondents’ opinions of virus mitigation factors like testing and vaccination. Overall, residents wanted more information on the vaccine ranging from how it was developed so quickly, whether it would work against new variants and how it could impact various groups of people.

Black residents said they distrusted the vaccine due to concerns over past medical experimentation on the Black community and racism. Latinos, particularly undocumented immigrants, were also hesitant toward the vaccine and wanted to see how others would respond first. They additionally cited logistical barriers to accessing testing sites or having to pay for a COVID-19 test ahead of time, which remains a concern, especially among unvaccinated groups.

While New Jersey ranks in the top-10 for vaccine coverage—with nearly 5 million people fully vaccinated—doses among Black and Latino residents are still lagging. Statewide numbers show Black residents have received 7% of doses and Latinos 15% of doses when both groups comprise more than a third of the population. Over the last three weeks, those numbers have remained largely stagnant despite door-knocking efforts by a state-run volunteer community corps.

In June, New Jersey began to supply more vaccines to smaller community sites and pop-up vaccination sites, including to some primary care doctors who have long sought access. The state also deployed mobile vaccine units in May, targeting towns where vaccination rates are lowest.

“There are some legitimate reasons why some folks are not being vaccinated in communities of color, particularly the African-American community,” Governor Phil Murphy said during a press briefing this week. “Our nation's history, particularly as it relates to that community and vaccines, is not pretty. It takes an extra effort using role models, faith leaders, doctors, nurses at the big, deep, robust information campaign to overcome that. That to me is a legitimate challenge.”

Hudson said her team’s study found residents were motivated to seek public health information and stop the spread of the virus by taking certain precautions but stopped short of embracing the vaccine.

“It's very different when you're doing behaviors that don't require any sort of intervention in your body and very different when you're taking a vaccine,” she said.

The study urged state officials to focus on providing more fact-based outreach via trusted community sources instead of general marketing efforts pushing vaccine availability—particularly amid a new warning from the Food and Drug Administration about an extremely rare side effect called Guillain-Barré Syndrome that could be linked to the Johnson & Johnson vaccine.

“New York has done a really nice job with getting both primary care doctors and nurses and others who talked about their family experiences and why they did it themselves,” Hudson said. “Being able to tell those stories and being more transparent about that, that, that was really what people were looking for, as opposed to you should just go and do this because we're telling you to.”

The pandemic’s fatality rate in the U.S. far outweighs the rate of vaccine adverse events.

One study participant said they weren’t comfortable with the vaccine at all, partly due to how officials rolled it out. “They’re talking about lower-income communities getting the vaccines, the first minorities and Black and Latino communities. They want us to get it first, and I’m like no. That just doesn’t seem right,” they said.

Another respondent in the study who had loved ones die from the virus expressed concerns over side effects.

“I have people close to me die, someone very dear, but at the same time, we’re all different [as] far as it’s going to affect us all differently. So with these adverse outcomes, it may … we may react to it differently. So I’m really concerned about that,” the person said in the study.

After more than 330 million doses being delivered to at least 185 million Americans, the vaccines have proven themselves to be overwhelmingly safe. The pandemic’s fatality rate in the U.S. (1,838 deaths per million people) far outweighs the rate of vaccine adverse events, such as severe allergic reactions (2 to 5 people per million vaccine recipients), atypical blood clots (2.9 people per million) or the Guillain-Barré Syndrome (7.8 people per million).

The latter two adverse events are tied only to the Johnson & Johnson vaccine. But the same pattern applies to rare cases of temporary and treatable heart inflammation seen among people younger than 30 who’ve taken Pfizer and Moderna vaccines. COVID-19 itself has caused way more serious disease in this age group (152,000 total hospitalizations since last August) than the vaccine-related cases of this heart issue (633 confirmed since April).

“The remaining unknowns about new vaccines need to be acknowledged and described for these communities to make informed decisions,” co-author Manuel Jimenez, an assistant professor of pediatrics, family medicine and community health at Rutgers Robert Wood Johnson Medical School, said in a statement.