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

Bécares, L., Shaw, R. J. , Katikireddi, S. V. , 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, 101150. (doi: 10.1016/j.ssmph.2022.101150) (PMID:35765366) (PMCID:PMC9225926)

[img] Text
273572.pdf - Published Version
Available under License Creative Commons Attribution.



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:Articles
Keywords:Racism, ethnic inequities, vaccine hesitancy, COVID-19.
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Shaw, Dr Richard and Amele, Ms Sarah
Creator Roles:
Shaw, R. J.Methodology, Software, Formal analysis, Data curation, Writing – original draft, Writing – review and editing
Katikireddi, S. V.Supervision, Writing – review and editing
Amele, S.Writing – review and editing
Authors: Bécares, L., Shaw, R. J., Katikireddi, S. V., Irizar, P., Amele, S., Kapadia, D., Nazroo, J., and Taylor, H.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:SSM - Population Health
ISSN (Online):2352-8273
Published Online:24 June 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in SSM - Population Health 19: 101150
Publisher Policy:Reproduced under a Creative Commons License
Related URLs:

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02SHW - Public Health
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit