An estimated 132 million COVID vaccines were given to people in Britain in 2021. Yet despite this, over a year into the UK’s vaccination programme, a significant number of people still don’t have any vaccine-based protection against the coronavirus. Around one in ten eligible people in the UK still haven’t had a first COVID vaccine dose.
Who makes up this hesitant group, and what are their reasons for not taking a COVID vaccine? These are questions that our research sought to answer by analysing data from an ongoing survey called the UK Household Longitudinal Study. We found that during the period immediately before Britain’s COVID vaccine rollout began, over 11% of UK adults said they were unwilling to take a COVID vaccine. But this hesitancy wasn’t spread evenly across the population.
It was lowest among white people, with 9% saying they didn’t want a COVID vaccine. In comparison, 50% of Black people said they didn’t want one, and hesitancy was also high in other non-white groups: 28% of South Asian and 17% of other Asian respondents said they were unwilling to be vaccinated. Among people of mixed ethnicity, the hesitancy rate was 22%.
Rates of declared vaccine hesitancy have since fallen, but the general trends we found have been borne out over the past year. Across every age group, COVID vaccine uptake has been highest among white people and lowest among Black people, with the difference often a sizable gap of around 20 percentage points. Among those eligible, the uptake of booster doses has also been lower among non-white groups.
This appears counterintuitive. Research has shown that Black and minority ethnic people face a higher risk from COVID. We might have expected this increased risk to correlate with a higher demand for vaccination in these groups. Instead, there’s greater hesitancy. So what might be driving this?
A deep-seated problem
We believe this hesitancy is at least partly driven by people feeling disenfranchised by the state or not trusting government personnel.
When we analysed data from the UK Household Longitudinal Study, we found that participants who agreed or strongly agreed with the statement that “public officials don’t care”, or who felt that they “don’t have a say in what government does”, were least likely to want to get vaccinated.
Note that the responses to these statements came from an earlier round of questioning in the household study – one that pre-dated the pandemic. Participants’ answers weren’t influenced by how the government had been managing the pandemic. Rather, they can be interpreted as a reflection of people’s overall faith in public institutions, irrespective of COVID.
This appears to be a highly influential factor when it comes to hesitancy. Those who felt they have no say in government were almost twice as likely to be hesitant to a COVID vaccine compared to those who felt otherwise. Similarly, we saw higher vaccine hesitancy in those who don’t trust public officials.
This may explain why ethnic minorities are so hesitant and their vaccine uptake has been lower. In the household study, ethnic minority groups reported, on average, less faith in public officials and were less likely to report that they feel they have a say in government.
Indeed, once we statistically controlled for this “trust” variable, we found that people at higher risk from COVID – including those from ethnic minority backgrounds – were more willing to take a COVID vaccine. For example, South Asian people who felt positively towards public officials were 4.5 times as willing to get vaccinated compared to those from other ethnic groups who had a neutral or negative attitude towards public officials.
What about other influences?
After controlling for many other factors (such as age, gender, marital status, ethnicity, educational qualifications, employment status, household living arrangements, clinical vulnerability, subjective financial condition and geographical region), we found that a number of other things were associated with vaccine willingness, too.
People with lower levels of education were more likely to be unwilling to take a vaccine when other factors were controlled for. Conversely, clinically vulnerable respondents were more willing to take a COVID jab. Self-employed people were less willing to get vaccinated compared to employed people. And respondents who said they felt positive about their financial wellbeing were almost three times as likely to be willing to take a vaccine compared to those felt they were just getting by or struggling.
How to raise trust
Given these overall findings, building trust in the public sector and government could be a way of improving uptake, particularly in groups who are most at risk from COVID. But when it comes to building trust, there’s no silver bullet. It takes time and effort.
Tactics to try could include engaging citizens in consultations and focus groups concerning the topic in question – in this case vaccination – as well as frequent and transparent communication. It’s also important for the scientific community, public figures and public institutions to maintain high ethical standards during times of emergency like the pandemic when there is reduced oversight.
Unfortunately for the UK, reports of corruption in the awarding of PPE contracts, and now the scandal of the Downing Street lockdown parties, will have lowered public trust in officials. Growing inequality is another barrier to trust, with those left behind increasingly believing that institutions are rigged against them.
Thus, open dialogue and transparency will only go so far. Such efforts should be accompanied by policies and actions that seek to address wider issues such economic disparity and unfairness. Doing this might not only make managing future public health emergencies easier by helping to raise vaccine uptake, but could also help create a society that is less polarised and more resilient.
I am a senior lecturer in economics at the University of Leeds, and I also hold visiting appointments at the Indian Institute of Management in Bangalore, India, the University of New South Wales and University of Sydney in Australia, and the Madras School of Economics in Chennai, India. I also hold the position of associate professor at the Indira Gandhi Institute of Development Research in Mumbai, India, and am a consultant economist for the World Bank, specialising in applied econometrics, empirical development economics and political economy.
Anindita Chakrabarti is a teaching fellow in economics at the University of Leeds and a fellow of the Higher Education Academy. Her main research interest is health economics, particularly evaluating the importance of socio-economic factors in explaining utilisation of maternal and child health care services in India. She is also interested in the importance of healthcare financing, particularly the importance of community-based heath insurance services as a source of financing private healthcare services among the rural community in India. Prior to joining Leeds University she worked in the faculty at the Madras School of Economics, Chennai, India, and at the Tata Institute of Social Sciences, Mumbai, India.
Joht Singh Chandan
Dr Chandan is an academic clinical lecturer on the West Midlands public health registrar training scheme. He is based at the University of Birmingham. His primary research focuses on a public health approach to abuse and violence. He has expertise in population health data science, data linkage and medical education. Dr Chandan’s PhD focuses on the outcomes of individuals who have suffered child maltreatment and domestic abuse. He has numerous high impact factor publications in a variety of fields which have been disseminated on BBC News, Sky News and the other leading news outlets. Dr Chandan is also member of HDRUK and is the Midlands theme lead for mental health.
Siddhartha is an internationally recognised economist in the field of political economy and public policy. He was the recipient of the Duncan Black prize awarded by the Public Choice Society for his work on the electoral incentives of prosecutors with Bryan McCannon in 2015. His work on political coalitions has been published in internationally leading journals and has been widely cited by leading scholars in the field. His papers are on the reading list of a number of courses in political economy in reputed universities. He has a particular interest in the economics of crime and economic evaluation of policy. His research interests in this area includes game theoretic modelling of criminal behaviour, econometric (statistical) analysis of factors determining crime, cost benefit analysis of alternate interventions, and the impact of initiatives such as citizen reporting. He has published several papers in reputed journals across several disciplines as well and has been cited in both academic papers as well as policy reports, including the Official National Statistics.