Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study

Woolf, K ORCID: 0000-0003-4915-0715, McManus, IC ORCID: 0000-0003-3510-4814, Martin, CA ORCID: 0000-0002-2337-4799, Nellums, LB ORCID: 0000-0002-2534-6951, Guyatt, AL ORCID: 0000-0003-1860-6337, Melbourne, C ORCID: 0000-0001-7216-4547, Bryant, L ORCID: 0000-0001-5231-4851, Gogoi, M ORCID: 0000-0002-9946-2509, Wobi, F, Al-Oraibi, A, Hassan, O, Gupta, A, John, C ORCID: 0000-0002-6057-2073, Tobin, MD ORCID: 0000-0002-3596-7874, Carr, S ORCID: 0000-0003-3726-3560, Simpson, S, Gregary, B, Aujayeb, A ORCID: 0000-0002-0859-5550, Zingwe, S, Reza, R ORCID: 0000-0003-3257-807X et al (2021) Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study. The Lancet regional health. Europe, 9. p. 100180. ISSN 2666-7762

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Abstract

Background In most countries, healthcare workers (HCWs) represent a priority group for vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) due to their elevated risk of COVID-19 and potential contribution to nosocomial SARS-CoV-2 transmission. Concerns have been raised that HCWs from ethnic minority groups are more likely to be vaccine hesitant (defined by the World Health Organisation as refusing or delaying a vaccination) than those of White ethnicity, but there are limited data on SARS-CoV-2 vaccine hesitancy and its predictors in UK HCWs. Methods Nationwide prospective cohort study and qualitative study in a multi-ethnic cohort of clinical and non-clinical UK HCWs. We analysed ethnic differences in SARS-CoV-2 vaccine hesitancy adjusting for demographics, vaccine trust, and perceived risk of COVID-19. We explored reasons for hesitancy in qualitative data using a framework analysis. Findings11,584 HCWs were included in the cohort analysis. 23% (2704) reported vaccine hesitancy. Compared to White British HCWs (21.3% hesitant), HCWs from Black Caribbean (54.2%), Mixed White and Black Caribbean (38.1%), Black African (34.4%), Chinese (33.1%), Pakistani (30.4%), and White Other (28.7%) ethnic groups were significantly more likely to be hesitant. In adjusted analysis, Black Caribbean (aOR 3.37, 95% CI 2.11 - 5.37), Black African (aOR 2.05, 95% CI 1.49 - 2.82), White Other ethnic groups (aOR 1.48, 95% CI 1.19 - 1.84) were significantly more likely to be hesitant. Other independent predictors of hesitancy were younger age, female sex, higher score on a COVID-19 conspiracy beliefs scale, lower trust in employer, lack of influenza vaccine uptake in the previous season, previous COVID-19, and pregnancy. Qualitative data from 99 participants identified the following contributors to hesitancy: lack of trust in government and employers, safety concerns due to the speed of vaccine development, lack of ethnic diversity in vaccine studies, and confusing and conflicting information. Participants felt uptake in ethnic minority communities might be improved through inclusive communication, involving HCWs in the vaccine rollout, and promoting vaccination through trusted networks. Interpretation Despite increased risk of COVID-19, HCWs from some ethnic minority groups are more likely to be vaccine hesitant than their White British colleagues. Strategies to build trust and dispel myths surrounding the COVID-19 vaccine in these communities are urgently required. Emphasis should be placed on the safety and benefit of SARS-CoV-2 vaccination in pregnancy and in those with previous COVID-19. Public health communications should be inclusive, non-stigmatising and utilise trusted networks. Funding UKRI-MRC and NIHR.

Item Type:	Article
Uncontrolled Keywords:	UK-REACH Study Collaborative Group; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; 42 Health Sciences; Immunization; Biotechnology; Coronaviruses; Coronaviruses Disparities and At-Risk Populations; Social Determinants of Health; Coronaviruses Vaccines; Vaccine Related; Prevention; Infectious Diseases; Emerging Infectious Diseases; 3 Good Health and Well Being
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Public and Allied Health
Publisher:	Elsevier
Date of acceptance:	2 July 2021
Date of first compliant Open Access:	21 October 2025
Date Deposited:	21 Oct 2025 15:24
Last Modified:	21 Oct 2025 15:30
DOI or ID number:	10.1016/j.lanepe.2021.100180
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27395

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