Broadening the Lens on COVID-19 Vaccine Uncertainty Among UK Minority Ethnic Groups: Understanding the Role of Institutions

Literature Review

This paper aimed to systematically review existing qualitative research exploring hesitancy and barriers to COVID-19 vaccination for UK racial and ethnic minority groups across the vaccine-rollout. Literature searches across five databases identified fourteen eligible studies. Papers were critically appraised and data synthesised via thematic synthesis. Four overarching themes were generated: ‘Challenges in accessing and utilising healthcare services’, ‘lack of trust and confidence in institutions’, ‘the impact of negative messages in social spaces’, and ‘perceived low risk of COVID-19’. Our findings highlight vaccine hesitancy was mostly associated with aspects of ‘motivation’ when mapped onto the ‘Behaviour Change Wheel’ model. The review also sheds light on various contextual factors reinforcing hesitancy at latter stages of the pandemic, such as perceived institutional errors in COVID-19 management, fluctuating local infection rates, and reports of adverse side effects. Future research exploring nuances influencing vaccine decision-making between specific minority groups, and collaboration with community and religious leaders are recommended.

Empirical Project

This study aimed to explore the role of institutional mistrust in COVID-19 vaccine decision-making for individuals from Black African and Black Caribbean backgrounds across the rollout. A focus group and individual interviews were conducted with participants who had expressed initial uncertainty about one or more of the COVID-19 vaccinations. Thematic analysis resulted in three overarching themes and constituent sub-themes, mapping onto the chronological sequence of the pandemic and vaccination rollout: ‘Mistrust during initial vaccine decision-making’, ‘negative experiences of institutions during the pandemic’, and ‘vaccination attitudes post-pandemic’. Results suggest current and historical racial inequities played a crucial role in decision-making and were reinforced through management of the pandemic and vaccine-rollout. Our findings highlight initial adherence through coercive strategies was counterproductive for ongoing willingness to vaccinate. Instead, we recommend co-producing campaigns and providing opportunities to discuss concerns with trusted healthcare professionals in the community.