Lower COVID-19 vaccine uptake among minority groups in London was driven by mistrust

Lower COVID-19 vaccine uptake among Black ethnic groups in London compared to White British groups was driven by trust, including mistrust in the vaccine itself and in authorities administering it, according to research led by UCL.

The peer-reviewed study, published in the Journal of Public Health, was undertaken by UCL researchers funded by National Institute of Health and Care Research (NIHR) ARC North Thames, in collaboration with the Government's Office for Health Improvement and Disparities, the UK Health Security Agency (UKHSA) as well as other London partners.

Findings showed that among Black ethnic groups vaccine uptake was between 57–65% compared to a 90% uptake in White British groups after the first six months of the vaccine rollout. Mistrust in government institutions and information provided, together with access barriers, were reported to drive such inequalities.

The research team carried out an analysis of first dose vaccine uptake across London between 8 December 2020 and 6 June 2021 by vaccine priority cohorts and ethnicity. This was supplemented by in-depth qualitative data, including a qualitative survey of 27 London local authority representatives, vaccine plans from London's five Integrated Care Systems, and interviews with 38 London system representatives.

Researchers found that one of the barriers to uptake may have been because of the large numbers of people on zero-hour contracts or shift-working and who may have been concerned about losing out on paid work or taking time off for appointments.

Dr. Kristoffer Halvorsrud (UCL Department of Applied Health Research), joint lead author of the study, said: "For vaccinations to work, uptake must be high across the country and amongst all social groups. We know that uptake tends to be lower amongst ethnic minority groups, and on top of that, London has historically lower vaccine uptake than any other English region.

"This can partly be explained by London's diverse population but also due to deprivation levels. Vaccination rates are also lower in deprived areas and London includes seven of the top 10 local authorities for income deprivation in England among older people. High population turnover and outdated general practitioner (GP) lists could also hinder uptake."

The research team say despite the issues encountered in the city, London councils came together in an unprecedented way to document inequalities in uptake and address issues as quickly as possible through the use of intensive, targeted and "hyper-local" initiatives to tackle uptake. These included one-to-one workplace conversations, out-of-hours Question and Answer sessions, support from trusted community champions and newspapers, and pop-up and outreach vaccination models.

Dr. Leonora Weil, Consultant in Public Health at UKHSA London said: "COVID-19 has repeatedly laid bare the ongoing health inequalities experienced by some Londoners, and COVID vaccine uptake is no exception.

"Understanding and addressing communities' concerns whilst sharing best practice to combat vaccine hesitancy and boost confidence has been a crucial part of London's approach to addressing disparities in uptake of the COVID-19 vaccine, but also wider health inequalities.

"The pandemic has allowed the public health system to align approaches to support all Londoners to have their COVID-19 vaccine to protect them from the impacts of the pandemic. Taking these learnings into future vaccine programs will be essential to ensure no Londoner is left behind in being fully protected against any vaccine preventable disease, and to ensure that we learn the lessons from COVID-19 in working with communities to improve their health and well-being more generally."

The study authors say their research provides the most comprehensive quantitative analysis combined with an in-depth exploration of the early stages of COVID-19 vaccination in London, mapping inequalities, probing uptake barriers and identifying interventions to address these. They point out that data was collected from public health staff and not residents themselves, and that the cut-off point of 6 June 2021 meant they cannot provide a full understanding of barriers and successful interventions in younger cohorts.