King's College London

Research portal

Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study

Research output: Contribution to journalArticlepeer-review

Laia Bécares, Richard J. Shaw, Srinivasa Vittal Katikireddi, Patricia Irizar, Sarah Amele, Dharmi Kapadia, James Nazroo, Harry Taylor

Original languageEnglish
Article number101150
JournalSSM - Population Health
PublishedSep 2022

Bibliographical note

Funding Information: This study was funded by the Economics and Social Research Council ( ES/W000849/1 ). SVK acknowledges funding from a NRS Senior Clinical Fellowship ( SCAF/15/02 ). RJS, SA and SVK acknowledge funding from the Medical Research Council ( MC_UU_00022/2 ) and the Scottish Government Chief Scientist Office ( SPHSU17 ). Publisher Copyright: © 2022

King's Authors


Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We introduce a theoretical framework detailing the mechanisms by which racism at the structural, institutional, and interpersonal level leads to higher vaccine hesitancy among minoritised ethnic groups. We then use data from Wave 6 of the UK Household Longitudinal Study COVID-19 Survey (November to December 2020) to empirically examine these pathways, operationalised into institutional, community, and individual-level factors. We use the Karlson–Holm–Breen method to formally compare the relationship between ethnicity and vaccine hesitancy once age and gender, sociodemographic variables, and institutional, community, and individual-level factors are accounted for. Based on the Average Partial Effects we calculate the percentage of ethnic inequities explained by each set of factors. Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesistancy for Pakistani or Bangladeshi people, and community-level factors (ethnic density, community cohesion, political efficacy, racism in the area) were the most important factors for Indian and Black groups, explaining 35% and 15% of the inequity, respectively. Our findings suggest that if policy intervened on institutional and community-level factors – shaped by structural and institutional racism - considerable success in reducing ethnic inequities might be achieved.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454