The first documented COVID-19 death in Miami-Dade County was a 94-year-old Haitian woman, and from that point on, Haitians/Haitian Americans were severely impacted by the pandemic (1). Although COVID-19 negatively affected the entire world, within the United States (U.S.) and Florida (FL), its impact on racial and ethnic minorities was devastating, with those populations having higher than average rates of infection, hospitalization, and mortality (2). Since the pandemic began in 2020, African American/Black individuals have consistently faced a disproportionate burden of COVID-19-related health and socioeconomic risks (3). Unfortunately, state health officials did not always routinely track diagnoses by ethnicity, and Haitian/Haitian Americans, like other Afro-Caribbeans, are often grouped with African Americans in reporting, confounding attempts to parse the experiences of different ethnic groups (1, 4). Haitians reportedly account for about 4% of the population in Miami-Dade County (1). Miami-Dade County has a population of approximately 2.7 million individuals (5). Haitian Americans accounted for at least 5% of those affected by COVID-19. As of the end of August 2020, at least 105 of the more than 2,000 deaths in Miami-Dade County had been members of the Haitian community. This is thought to be an under count (1). Given missing ethnicity data for hospitalizations, it is not possible to discern if Haitians were disproportionately affected (1). Many factors contributed to the disproportionate negative effects of COVID-19 on Black individuals, including linked historical structural inequities (e.g., racism, poverty, food deserts), more crowded and polluted living conditions, a higher likelihood of having public front-facing employment (e.g., service, food, transportation industries), and the population’s likelihood of having more pre-existing comorbidities (e.g., diabetes, cardiovascular disease) (6). Economic instability likely amplified the pandemic’s negative consequences for many Haitians and Haitian Americans (4). The Haitian community is an ethno-racial, linguistic community which also contains individuals with low income. Data from the Thrive305 survey conducted in Miami-Dade County by the government collected data from participants of Haitian descent during the COVID-19 pandemic indicated evidence of discrimination. When answering the question, I think that residents of all backgrounds including my own, are welcomed and respected “by fellow residents of Miami-Dade”, the highest numbers of responses were “disagree.” In addition, when asked “I think that residents of all backgrounds, including my own, have equal employment opportunities in Miami-Dade County,” the highest numbers of responses were “strongly disagree” (7).

The limited current literature suggests that the negative effects of the COVID-19 pandemic were felt disproportionately by Haitian/Haitian Americans in many ways (2, 4). For example, 40% of the Haitian diaspora in the U.S. works in public service-related industries, which were among the first to face major economic loss and unemployment due to social distancing policies (8). In addition, food insecurity for many increased, and Black and Latino households were twice as likely as white households to report that their families did not have enough to eat (9). COVID-19 hurt social relationships and mental health as well (9). In a case study conducted in Miami Gardens, found that Black community members rated their physical and mental health less positively since the pandemic began, reporting increased loneliness (9, 10).

Structural interventions are needed to reduce the pandemic’s harm on this population, including making testing and vaccines free and accessible, improving tracing/reporting data, and continuing economic relief for those affected. In addition, existing prevention methods (such as wearing masks) must be better utilized to reduce morbidity and mortality. Furthermore, although vaccination is known to be the most effective mechanism to prevent COVID morbidity and mortality, vaccination rates remain low among Black communities in the U.S. and in Haiti (10, 11). Chery et al. (12) found that among 1,071 survey respondents in Haiti, only 27% had positive attitudes towards the COVID-19 vaccine and had been vaccinated.

This study aimed to better understand the experiences of Haitians/Haitian Americans, during the COVID-19 pandemic, particularly with regard to (1) thoughts/concerns about the pandemic, (2) thoughts about COVID-19 vaccines, (3) healthcare access during the study period, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with the COVID-19, (6) prevention measures (e.g., wearing masks), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences. A better understanding of Haitians/Haitian Americans’ experiences during the COVID-19 pandemic will allow us to provide guidance on addressing its continued negative consequences and develop more effective mitigation strategies for future pandemics and other public health emergencies. The Health Equity Impact Assessment highlights social determinants of health that are relevant to Haitians/Haitian Americans and COVID-19 (13). The social determinants of health addressed in this manuscript are income/social status, social support networks, employment, social environments, personal health practices, coping skills, health services, and culture.

A qualitative research design was used to collect and analyze data. In partnership with the Family Action Network Movement and Community Health and Empowerment Network, 30 Haitians/Haitian Americans were recruited face-to-face and by phone. Participants included community members and those in community leadership positions (stakeholders) in Miami, FL. The participants did not have a relationship with the study team prior to the study. The study used convenience sampling. Data were collected between February 4, and October 1, 2021, at community-based organizations, churches, and via phone. Participants were recruited using flyers and face-to-face by study team and staff members of community partners at the Family Action Network Movement and Community Health and Empowerment Network, as well as other community-based organizations and churches across Miami-Dade County. Participants who expressed interest and met eligibility criteria were enrolled. The research team consisted of female and male staff experienced in qualitative research and bilingual in Haitian Creole and English. The interview guides were reviewed and modified with feedback from the Family Action Network Movement and Community Health and Empowerment Network. Thirty sociodemographic surveys and semi-structured interviews were conducted with Haitians/Haitian Americans (15 community members and 15 stakeholders). One potential participant was unable to complete the study due to scheduling conflicts. The interviews were conducted by the principal investigator (an MD), a research associate, a community consultant, and three other research team members in person at a private space and/or by the phone. The study team verbally read the consent form to participants and provided a copy of the document in their preferred language. All participants provided verbal informed consent to participate in this study. Interviews were audio recorded and lasted for 30–45 min, during which notes were taken. No interviews were repeated. Interviews conducted in Haitian Creole were later transcribed and translated to English. All participants were given $30 gift cards for their participation. The University of Miami Institutional Review Board (Study #: 20200190) approved this study’s protocol and materials prior to data collection in the field.

Table 1 shows the socio-demographic characteristics of the participants. Of the 30 participants, 15 were community members, and 15 were stakeholders. Participants self-identified as female (15; 50%) and male (14; 46.7%), while one preferred not to answer (1; 3.3%). The average age of the community members was 47.9 (SD = 14.27), while the stakeholders’ average was 39.5 (SD = 10.4). All 15 of the community members were born in Haiti. Of the stakeholders, 6 were born in the U.S., 8 were born in Haiti, and 1 was born elsewhere. Approximately 60% of the community members had not completed high school while 93% of the stakeholders graduated from high school or higher. Of the 30 participants, 86.7% identified as Christian. Over half (66.7%) of the community members and stakeholders reported that they were renting a house or apartment. More than 53% of the community members reported a household income of less than $25,000, and about 67% of them were working full- or part-time. Over half (66.7%) of the stakeholders reported an income of $25,000 or more, with 73.3% working full- or part-time. The community stakeholders represented community-based organizations, were medical professionals, or worked for the government. Twenty interviews were conducted in English and ten were in Haitian Creole.

Both community members and stakeholders provided insightful information regarding (1) thoughts/concerns about the pandemic, (2) thoughts about COVID-19 vaccines, (3) healthcare access during the study period, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with the COVID-19, (6) prevention measures (e.g., wearing masks, hand hygiene, social distancing, and COVID-19 vaccination), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences during the COVID-19 pandemic.

In the U.S., the COVID-19 pandemic disproportionately impacted racial and ethnic minority groups negatively, including Haitians/Haitian Americans (2). Our findings agree with others suggesting that this population experiences similar barriers to healthcare as other immigrant communities in South FL (4). The sociodemographic characteristics of the participants in this study provide a holistic representation of this segment of the Miami community. With nearly three-fourths of the participants having been born in Haiti, the findings of this study offer unique insights that reflect the lived experiences and perceptions of first-generation immigrants, an essential factor when examining their responses to a global health crisis like the COVID-19 pandemic.

One key observation from this study is the prevailing apprehension towards the COVID-19 vaccine. The hesitancy mirrored findings from Chery et al., which also noted reluctance among the Haitian population due to factors such as misinformation, cultural beliefs, and lack of trust in the health system (12). The concerns regarding the rapid development of the COVID-19 vaccine and conspiracy theories seen in this sample suggest that external narratives play a significant role in shaping perceptions of vaccines. Such apprehensions are consistent with the community’s historical marginalization and the resulting mistrust towards medical interventions and historically based mistrust of the medical establishment, which can be linked to earlier health crises (15). Furthermore, studies from the Caribbean have found rural dwelling, lower education, and financial insecurity to be associated with vaccine hesitancy among Haitians/Haitian Americans (4, 16, 17). These barriers prompted Haitian/Haitian Americans to be less likely to be vaccinated against COVID-19 than other racial and ethnic minority groups (16–21). Avoidance of vaccines was also attributed to participants’ preference for traditional, cultural remedies over the use of Western medicine (19, 22–24). The apprehension towards the COVID-19 vaccine observed among Haitians/Haitian Americans parallels concerns seen in other minoritized populations within the US, such as Cubans, other Afro-Caribbean groups, and Latin Americans. These groups similarly grapple with misinformation, cultural beliefs, and a deep-seated mistrust towards the health system. For example, research among Latin American immigrants has highlighted significant hesitancy towards vaccinations, attributed to a combination of misinformation spread through social media and historical distrust in government and healthcare institutions (25–27). Similarly, studies on Black Americans have documented longstanding mistrust in the U.S. healthcare system, which has contributed to vaccine hesitancy, partly stemming from unethical historical medical experiments like the Tuskegee Syphilis Study (28). These patterns underscore a broader theme of mistrust among minoritized populations, stemming from historical injustices and compounded by current systemic barriers in healthcare access and information dissemination.

Our findings on food insecurity draw attention to the cascading effects of economic challenges. The interplay between employment, healthcare access, and food insecurity elucidated by study results is reminiscent of the multifaceted vulnerabilities, such as having jobs affected by economic downturns and healthcare or immigration barriers observed during past crises in the Haitian diaspora (29). The compounded vulnerabilities of Haitians/Haitian Americans are not isolated experiences but are shared across various minoritized communities. For instance, Afro-Caribbean and Latin American immigrants often encounter language barriers, immigration status concerns, and lack of culturally competent care, which exacerbate disparities in healthcare (30). Food insecurity, amplified by the pandemic, has similarly affected Black, Latino, and immigrant households at disproportionately high rates, reflecting broader systemic inequities (31, 32).

This study reveals structural challenges in urban settings like Miami, aligning with literature that delves into the challenges faced by immigrant communities in accessing healthcare (12, 33). The effects of the pandemic on intrapersonal relationships in the community suggest a deeper socio-cultural rift. Cultural congruence in expressing emotions and maintaining relationships is integral to communities with close-knit family and friendship ties, such as those of this community (34, 35). Thus, the reported isolation due to COVID-19 could have potential long-term implications on the community’s mental and emotional well-being.

Preventive measures used by this community reflected an interplay of traditional practices and global health guidelines. The significant role of herbal remedies signifies a blend of ancestral knowledge with contemporary health advice, similar to patterns seen in other minority communities (36). This blending was further echoed in the reliance on prayer and spirituality, aligning with past literature on the Haitian community’s coping mechanisms (37).

While the COVID-19 pandemic has affected communities globally, this study confirms the disproportionate negative experiences faced by members of the Haitian community in Miami, reflecting both universal challenges and unique socio-cultural dynamics. Although the COVID-19 pandemic started over 3 years ago, these data are important for addressing the support needs of this community and for overcoming vaccine hesitancy in future pandemics. Further studies are needed to explore these and other negative health consequences that disproportionately affected this population during COVID and other public health emergencies.

Although those who were interviewed brought up mistrust of the medical community, we were unable to distinguish between mistrust of the medical community and mistrust directed towards the public health community. Future studies should delineate and characterize these differing forms or reasons for mistrust directed at each of these two professional communities.

Finally, to address social determinants of health, structural interventions are needed to improve employment opportunities and other resources for this population to cope with the negative experiences due to the COVID-19 pandemic. Reducing healthcare barriers, building trust within the community, and improving transparency and communication are among the critical actions that can be taken to improve this population’s access and uptake of public health interventions like the COVID-19 vaccines. Addressing these challenges will require an integrated coordinated approach, taking into account the Haitian/Haitian American community’s cultural norms, historical experiences, and structural barriers. All of these lessons learned have practice implications for how medicine and public health should improve to better deal with the COVID-19 crisis and other similar issues that are likely to emerge or reemerge in future public health emergencies. Future work may benefit from comparing the experiences of Haitians and other communities using larger samples. Furthermore, future work on the Haitian community may benefit from a priori use of methodologies such as the Health Equity Impact Assessment.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the University of Miami Institutional Review Board (Study #: 192 20200190). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent from the [patients/participants OR patients/participants legal guardian/next of kin] was not required to participate in this study in accordance with the national legislation and the institutional requirements. Verbal consent from participants was approved by the University of Miami Institutional Review Board.

CS: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Writing – original draft, Writing – review & editing. DR: Data curation, Formal analysis, Writing – original draft, Writing – review & editing. VE: Data curation, Writing – original draft, Writing – review & editing. MC: Writing – original draft, Writing – review & editing. MB: Writing – original draft, Writing – review & editing. DM: Writing – review & editing. AF: Writing – review & editing. MT: Writing – review & editing. AM: Writing – review & editing. MA: Conceptualization, Methodology, Supervision, Writing – review & editing. SD: Conceptualization, Methodology, Supervision, Writing – review & editing.