Understanding the fundamental role of racism in ethnic inequities in COVID-19 vaccine hesitancy

Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom 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.

In this briefing, we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We discuss how racism at the structural and institutional level has shaped the landscape of risk for the stark ethnic inequities we’ve seen during the coronavirus pandemic, and in relation to COVID-19 vaccine hesitancy.

We empirically examine some of the pathways we propose using data from the UK Household Longitudinal Study. Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesitancy 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 per cent and 15 per cent 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.