Racial discrimination and covid-19 vaccine uptake: is mistrust of the health service behind vaccine refusal?

Abstract

AbstractObjectivesTo assess the role of racial and ethnic discrimination in determining covid-19 vaccine refusal in ethnic minority groups.DesignPopulation based cohort study.SettingSurvey data from the University College London COVID-19 Social Study.ParticipantsData from 633 adults belonging to ethnic minority groups who took part in the study from 23 July 2020 to 14 June 2021 were included. Experiences of racial/ethnic discrimination occurring since the start of the first lockdown were collected in the last week of July 2020. Structural equation modelling was used to model the direct effect of racial/ethnic discrimination on covid-19 vaccine refusal, as well as the indirect effects through low trust in the central UK government and the UK health service to handle the pandemic. The model adjusted for a range of demographic and covid-19-related covariates.Main outcome measuresData on covid-19 vaccination status was collected from 23 December 2020 to 14 June 2021 and operationalised as having had or agreed to have at least one dose versus having been offered but turned it down (refusal).ResultsNearly one in ten (6.7%) who had refused a covid-19 vaccine reported having experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. The total effect of racial/ethnic discrimination on refusing a covid-19 vaccine was nearly 4-fold (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.4 to 10.9) and was mediated by low trust in the health system to handle the pandemic (indirect effect: OR = 2.5, 95% CI = 1.1 to 5.4).ConclusionsFindings underscore the importance of addressing racial/ethnic discrimination in order to increase covid-19 vaccine uptake amongst ethnic minority adults. The results also highlight the crucial role the National Health Service must play in regaining trust from ethnic minority groups in order to overcome vaccine hesitancy.What is already known on this topicCovid-19 vaccine refusal is higher in ethnic minority groups than in white British adults in the UK. Prior research suggests experiences of racial/ethnic discrimination and mistrust of government and the health system are barriers to uptake. However, longitudinal research examining whether the influence of racial/ethnic discrimination on covid-19 vaccine refusal is mediated by government and health system trust is lacking.What this study addsExperiences of racial/ethnic discrimination increased the likelihood of subsequent covid-19 vaccine refusal nearly 4-fold. This effect was mediated by low trust in the healthcare system, but not the government, to handle the pandemic.Findings support addressing issues of mistrust in the healthcare system and discrimination in order to increase vaccine uptake in ethnic minority adults in the UK.