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

ABSTRACT

ObjectiveTo examine whether racial/ethnic discrimination predicts future COVID-19 vaccine refusal, and whether this association is explained by trust in government and the health system. DesignLongitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status. SettingUK (England, Scotland, Wales, and Northern Ireland) Participants633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study. Main outcome measureCOVID-19 vaccine refusal (vs accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021. ResultsNearly one in ten (6.7%) who had refused a COVID-19 vaccine had 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. Structural equation modelling results indicated a nearly 4-fold (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.4 to 10.9) total effect of racial/ethnic discrimination on refusing the vaccine was which was mediated by low trust in the health system to handle the pandemic (OR = 2.5, 95% CI = 1.1 to 5.4). Analyses adjusted for a range of demographic and COVID-19 related factors. ConclusionsFindings underscore the importance of addressing racial/ethnic discrimination and the role the National Health Service in regaining trust from ethnic minority groups to increase COVID-19 vaccine uptake amongst ethnic minority adults.