Structural racism ‘fundamental’ to Covid vaccine hesitancy, study argues

Racism has been the “fundamental cause” of Covid-19 vaccination hesitancy among ethnic minority groups, a study from Manchester University has argued.

The briefing paper, published by the university’s Centre on the Dynamics of Ethnicity and the Runnymede Trust, has argued that previous explanations for vaccine hesitancy among these cohorts are flawed.

During the rollout of the Covid-19 vaccination programme in the UK, explanations for the lower vaccination rates in people from ethnic minority groups tended to focus on differences in the level of concern about side-effects and a perceived lack of trust in the development and efficacy of the vaccine.

However, the latest study has argued that, by the time people were deciding whether or not to have the vaccine, the conditions that created lower vaccination uptake among ethnic minority groups were already present.

By ignoring the impact of structural and institutional racism on vaccination rates, vaccine hesitancy is misunderstood, they therefore have argued and, crucially, the opportunity to address inequities is missed.

The briefing analysed data from the UK Household Longitudinal Study to show that institutional and community-level factors, driven by structural and institutional racism, explained the large majority of ethnic inequities in vaccination rates.

Vaccination hesitancy rates vary across ethnic groups, with more than half of the black group reporting hesitance to get the Covid vaccine, compared with just over 10% of the white British group.

When comparing vaccine hesitancy in the ethnic minority groups with the white British group, institutional factors – including financial situation, car use, ability to travel to vaccination centres, housing tenure, and educational attainment – could explain 41.6% of the difference for Pakistani or Bangladeshi people.

Community-level factors including neighbourhood diversity, cohesion, political efficacy and racism, could explain more 30%, the authors argued.

For black people, community-level factors were the biggest impact, with institutional-level factors explaining 12.9% of the difference.

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What these findings suggested was that, if policy intervened on institutional and community-level factors shaped by structural and institutional racism, then considerable success in reducing ethnic inequities might be achieved.

“Vaccine hesitancy puts the blame on individuals, instead of addressing the historical and ongoing racism that has contributed to the societal inequities that lead to ethnic inequalities in the distribution and uptake of vaccines,” said one of the authors of the briefing, Professor Laia Bécares from King’s College, London.