COVID-19 vaccine hesitancy in the UK: a longitudinal household cross-sectional study

Background The approved COVID-19 vaccines have shown great promise in reducing disease transmission and severity of outcomes. However, the success of the COVID-19 vaccine rollout is dependent on public acceptance and willingness to be vaccinated. In this study, we aim to examine how the attitude towards public sector officials and the government impact vaccine willingness. The secondary aim is to understand the impact of ethnicity on vaccine-willingness after we explicitly account for trust in public institutions. Methods This cross-sectional study used data from a UK population based longitudinal household survey (Understanding Society COVID-19 study, Understanding Society: the UK Household Longitudinal Study) between April 2020-January 2021. Data from 22,421 participants in Waves 6 and 7 of the study were included after excluding missing data. Demographic details in addition to previous survey responses relating to public sector/governmental trust were included as covariates in the main analysis. A logit model was produced to describe the association between public sector/governmental mistrust and the willingness for vaccination with interaction terms included to account for ethnicity/socio-economic status. Results In support of existing literature, we identified those from BAME groups were more likely to be unwilling to take the COVID-19 vaccine. We found that positive opinions towards public sector officials (OR 2.680: 95% CI 1.888 - 3.805) and the UK government (OR 3.400; 95% CI 2.454-4.712) led to substantive increase in vaccine willingness. Most notably we identified this effect to vary across ethnicity and socio-economic status with those from South Asian background (OR 4.513; 95% CI 1.012-20.123) and possessing a negative attitude towards public officials and the government being the most unwilling to be vaccinated. Conclusions These findings suggests that trust in public sector officials play a key factor in the low vaccination rates particularly seen in at-risk groups. Given the additional morbidity/mortality risk posed by COVID-19 to those from lower socio-economic or ethnic minority backgrounds, there needs to be urgent public health action to review how to tailor health promotion advice given to these groups and examine methods to improve trust in public sector officials and the government.

Automated summary

This study found that the attitude towards public sector officials and the government has a significant impact on the willingness to receive the COVID-19 vaccine. In the UK, individuals from South Asian backgrounds and those with negative attitudes are the least willing to be vaccinated. Urgent public health actions are needed to improve trust in public sector officials and the government among these groups and to tailor health promotion advice accordingly.