ABSTRACTBackgroundVaccination is crucial to address the COVID-19 pandemic but vaccine hesitancy could undermine control efforts. We aimed to investigate the prevalence of COVID-19 vaccine hesitancy in the UK population, identify which population subgroups are more likely to be vaccine hesitant, and report stated reasons for vaccine hesitancy.MethodsNationally representative survey data from 12,035 participants were collected from 24th November to 1st December 2020 for wave 6 of the ‘Understanding Society’ COVID-19 web survey. Participants were asked how likely or unlikely they would be to have a vaccine if offered and their main reason for hesitancy. Cross-sectional analysis assessed prevalence of vaccine hesitancy and logistic regression models conducted.FindingsOverall intention to be vaccinated was high (82% likely/very likely). Vaccine hesitancy was higher in women (21.0% vs 14.7%), younger age groups (26.5% in 16-24 year olds vs 4.5% in 75+) and less educated (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was particularly high in Black (71.8%), Pakistani/Bangladeshi (42.3%), Mixed (32.4%) and non-UK/Irish White (26.4%) ethnic groups. Fully adjusted models showed gender, education and ethnicity were independently associated with vaccine hesitancy. Odds ratios for vaccine hesitancy were 12.96 (95% CI:7.34, 22.89) in the Black/Black British and 2.31 (95% CI:1.55, 3.44) in Pakistani/Bangladeshi ethnic groups (compared to White British/Irish ethnicity) and 3.24 (95%CI:1.93, 5.45) for people with no qualifications compared to degree educated. The main reason for hesitancy was fears over unknown future effects.InterpretationOlder people at greatest COVID-19 mortality risk expressed the greatest willingness to be vaccinated but Black and Pakistani/Bangladeshi ethnic groups had greater vaccine hesitancy. Vaccine programmes should prioritise measures to improve uptake in specific minority ethnic groups.FundingMedical Research CouncilResearch in contextEvidence before this studyWe searched Embase and Medline up to November 16, 2020, using key words “vaccine hesitancy” and “COVID-19” or “SARS-CoV-2”. Vaccine hesitancy is complex but also context specific. Previous research about vaccine hesitancy relates to existing adult and childhood vaccines, with limited evidence currently available on willingness to be vaccinated for newly available COVID-19 vaccines. Existing vaccination programmes often have lower uptake among more socioeconomically disadvantaged groups. Uptake of vaccines has often varied across ethnic groups, but patterns have often varied across different vaccine programmes.Added value of this studyOur study describes the sub-groups of the UK population who are more likely to be hesitant about a COVID-19 vaccine and examines possible explanations for this. We used nationally representative data from the COVID-19 survey element of the UK’s largest household panel study. We asked specifically about vaccine hesitancy in relation to a COVID-19 vaccine at a time when initial results of vaccine trials were being reported in the media. We found willingness to be vaccinated is generally high across the UK population but marked differences exist across population subgroups. Willingness to be vaccinated was greater in older age groups and in men. However, some minority ethnic groups, particularly Black/Black British and Pakistani/Bangladeshi, had high levels of vaccine hesitancy but this was not seen across all minority ethnic groups. People with lower education levels were also more likely to be vaccine hesitant.Implications of all the available evidenceThe current evidence base on vaccine hesitancy in relation to COVID-19 is rapidly emerging but remains limited. Polling data has also found relatively high levels of willingness to take up a COVID-19 vaccine and suggested greater risks of vaccine hesitancy among Black, Asian and Minority Ethnic (BAME) people. Our study suggests that the risk of vaccine hesitancy differs across minority ethnic groups considerably, with Black ethnic groups particularly likely to be vaccine hesitant within the UK. Some White minority ethnic groups are also more likely to be vaccine hesitant than White British/Irish people.Herd immunity may be achievable through vaccination in the UK but a focus on specific ethnic minority and socioeconomic groups is needed to ensure an equitable vaccination programme.
Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities
