Racial discrimination, low trust in the health system and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups

Objectives To 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. Design Longitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status. Setting UK (England, Scotland, Wales and Northern Ireland). Participants A total of 633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study. Main outcome measures COVID-19 vaccine refusal (vs. accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021. Results Nearly 1 in 10 (6.69%) 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 four fold (odds ratio = 3.91, 95% confidence interval = 1.40 to 10.92) total effect of racial/ethnic discrimination on refusing the vaccine which was mediated by low trust in the health system to handle the pandemic (odds ratio = 2.49, 95% confidence interval = 1.12 to 5.39). Analyses adjusted for a range of demographic and COVID-19 related factors. Conclusions Findings 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 among ethnic minority adults.

Automated summary

This study examines the relationship between racial/ethnic discrimination and COVID-19 vaccine refusal, as well as the mediating role of trust in government and the health system. The findings show that individuals who have experienced racial/ethnic discrimination are more likely to refuse the COVID-19 vaccine, and this association is partially explained by lower trust in the health system. Addressing racial/ethnic discrimination and regaining trust from ethnic minority groups are crucial for increasing COVID-19 vaccine uptake among ethnic minority adults.