Bécares, L, Shaw, RJ, Katikireddi, SV, Irizar, P, Amele, S, Kapadia, D, Nazroo, J and Taylor, H (2022) Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study. SSM - Population Health, 19.

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Abstract

Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We introduce a theoretical framework detailing the mechanisms by which racism at the structural, institutional, and interpersonal level leads to higher vaccine hesitancy among minoritised ethnic groups. We then use data from Wave 6 of the UK Household Longitudinal Study COVID-19 Survey (November to December 2020) to empirically examine these pathways, operationalised into institutional, community, and individual-level factors. We use the Karlson–Holm–Breen method to formally compare the relationship between ethnicity and vaccine hesitancy once age and gender, sociodemographic variables, and institutional, community, and individual-level factors are accounted for. Based on the Average Partial Effects we calculate the percentage of ethnic inequities explained by each set of factors. Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesistancy for Pakistani or Bangladeshi people, and community-level factors (ethnic density, community cohesion, political efficacy, racism in the area) were the most important factors for Indian and Black groups, explaining 35% and 15% of the inequity, respectively. Our findings suggest that if policy intervened on institutional and community-level factors – shaped by structural and institutional racism - considerable success in reducing ethnic inequities might be achieved.

Item Type:	Article
Uncontrolled Keywords:	COVID-19; Ethnic inequities; Racism; Vaccine hesitancy; 4206 Public Health; 42 Health Sciences; 44 Human Society; Immunization; Prevention; Clinical Research; Coronaviruses Vaccines; Social Determinants of Health; Coronaviruses Disparities and At-Risk Populations; Behavioral and Social Science; Vaccine Related; Emerging Infectious Diseases; Health Disparities; Infectious Diseases; Coronaviruses; 1117 Public Health and Health Services; 4202 Epidemiology; 4206 Public health; 4410 Sociology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Divisions:	Psychology (from Sep 2019)
Publisher:	Elsevier
SWORD Depositor:	A Symplectic
Date Deposited:	19 Feb 2025 10:11
Last Modified:	19 Feb 2025 10:15
DOI or ID number:	10.1016/j.ssmph.2022.101150
URI:	https://researchonline.ljmu.ac.uk/id/eprint/25670

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