How vaccine hesitancy intersects with social inequalities and community mistrust: emerging findings from a UK-US comparison

Ozge Ozduzen, Billur Ozgul, Bogdan Ianosev, Matthew Adams and Monika E. Fratczak

Vaccine hesitancy is a multifaceted issue, sparking a lot of debates involving health, illness, religious beliefs, social inequalities, and misinformation. For example, data in both the UK and US points to sizable disparities in vaccination uptake between ethnic groups. The UK Office for National Statistics Public Health Data Asset (by 31 December 2021), on the proportion of people aged 18 and over who received three vaccinations by ethnic group, showed that white British (68.4%), Indian (65.3%) and Chinese (64%) were more likely to receive three vaccinations than Black Caribbean (33.9%), Pakistani (37.8%) and Black African (37.9%) ethnic groups. This proportion is also lower among Muslims compared to other religions. In the US, COVID-19 vaccine mistrust is widespread among American Blacks and Hispanics while Black Americans are more hesitant about receiving the COVID-19 vaccine than non-Blacks. However, ethnicity and religion are not the only differences in vaccine uptake. The ONS (UK) data (2022) shows that UK pupils in state-funded schools who speak English as an additional language were less likely to have been vaccinated against COVID-19 (38.2%) than pupils who speak English as their first language (55.5%). These differences, and the health inequalities that may potentially result from them, shows the necessity of understanding the diverse motivations and reasons that impact vaccine willingness of the minority communities in the US and UK. 

Our British Academy funded project (funded £111,230 under “COVID-19 Recovery: building future pandemic preparedness and understanding citizen engagement in the USA and UK” programme) examines the motivations and reasoning of vaccine hesitant communities and especially those of racially, ethnically, or religiously minoritised individuals and immigrants in the UK and US. We are an international project team: Ozge Ozduzen, Bogdan Ianosev and Monika E. Fratczak from the University of Sheffield, Billur Ozgul, Nelli Ferenczi and Matthew Adams from Brunel University London, and Wenwen Dou and Alireza Karduni from the University of North Carolina at Charlotte. Together, we are taking an interdisciplinary approach combining media studies, political communication, the sociology of health, cross-cultural psychology, and computer and data science to trace the relationship between historical legacies, social inequalities, cognitive processes, social media interaction, and vaccine-hesitancy. 

We investigate social, cultural, and political factors underpinning vaccine hesitancy through interviews with minoritised communities whilst also studying the topics and social networks of vaccine hesitant and anti-vaccination groups on Twitter and Telegram. To this end, we also highlight historically inherited biases and assumptions within medical communities about minority groups. Only by identifying these, will we be able to recommend a truly practical guidance for policymakers. One of the challenges our project faces is to avoid imagining a homogeneous community of anti-vaccine groups with unitary beliefs (e.g., anti vaxxers), as this reflects how vaccine hesitant populations are commonly portrayed in the media. Instead, we want to consider each communities’ distinctive characteristics and backgrounds feeding into their vaccine beliefs. In other words, we do not assume that the causes for vaccine hesitancy reside solely with the minoritised patient population. Our team rather adopts a ‘symmetrical’ research design to uncover the systemic prejudices of both medical communities and vaccine hesitant populations. 

Our research provides empirical evidence for social, cultural, and political factors underpinning vaccine-hesitancy through the deployment of a mixed-method perspective intended to provide an understanding of the impact of social inequalities and mistrust of institutions on perceptions of vaccines. We do this by examining individuals’ voices and testimonies, communities/networks in online and protest spaces, and undertaking big data analysis on social media platforms. Some of the interviews were conducted at the Freedom protests in London with vaccine hesitant protesters who belong to racially or religiously minoritised communities (see Images I and II). So far, we have also collected and analysed big data related to vaccines on Telegram, a crucial platform for the social media conversations of anti-vaccine and vaccine hesitant communities today. While analysing our data from Telegram and interviews, we have been careful to adopt an intersectional perspective that acknowledges how vaccine hesitancy may stem, for instance, from people’s mistrust of medical practises on the basis of historic systems of oppression and lived experiences of institutional racism.

Image I was taken by Ozge Ozduzen in London protests, the 24th of April 2021.

Through our research approach, we have been able to identify multiple reasons for vaccine hesitancy provided by different communities. As a result, a preliminary distinction we may draw with respect to our findings is that, at this point, vaccine hesitancy can be viewed as an encompassing concept containing several more or less radical attitudes. Vaccine hesitancy seems to incorporate attitudes ranging from cautious or suspicious to radical anti-Covid-19 vaccine attitudes, and we are in the process of determining the socio-cultural aspects of each of these attitudes.

Image II taken by Ozge Ozduzen in London protests on 22 January 2022.

Our interviews minoritised communities helped us to expose what is behind the vaccine hesitant views and attitudes of the different minoritised communities. For instance, our early findings suggest that an important reason Black, Black Caribbean, African American, and African research informants may not trust the vaccine roll-out is historical medical and pharmaceutical malpractice. While this may be considered as an issue peculiar to the US, it reflects and represents the patterns of global historical medical malpractice and social injustice towards Black people. This leads to a fear of experimentation within minoritised communities, stemming not only from historical malpractice but also from current racist practices, such as ‘stop and search’ policy. Other global inequalities have also fed into the mistrust of ethnic minorities relating to healthcare advice, such as the UK and US Governments’ unpromising participation in the global vaccine roll-out, particularly in African countries.

As for other minoritised groups (such as second-generation Hispanics, Middle Easterners, Eastern Europeans etc.), their or their parents’ lived experiences of discrimination within healthcare institutions in the UK or US, such as hospitals, play a role in their susceptibility to newer medical procedures. For these communities, mistrust towards the UK and US Governments (e.g. governments’ breaches of social distancing measures) and a perceived systemic exclusion from governmental communication also stimulates hesitancy towards medical procedures, such as the COVID-19 vaccination programme. So far, a shared characteristic of our data collected through social media and interviews points to a grievance against the COVID-19 vaccine mandate in workplaces, schools, and borders (see Image II), which bolster everyday experience of exclusion and marginalisation of minoritised communities. It is thus important for authorities in political, medical and media institutions to better understand the specific reservations of different communities about the COVID-19 vaccine and to address them. The team is currently conducting interviews and focus groups with racially and religiously minoritised communities that are vaccine hesitant as well as medical practitioners in the UK and US, whilst collecting and analysing visual and textual social media conversations on the COVID-19 vaccines. Our research project aims for a symmetrical dialogue between minoritised communities that are vaccine-hesitant and healthcare professionals, whilst offering policy-recommendations for media and political institutions. More information about the research and the team could be accessed on this website.