COVID-19 vaccine hesitancy in ethnic minority communities: increasing vaccine confidence is key

Written by Dr Judith Eberhardt, Associate Professor of Psychology, Centre for Applied Psychological Science, Heath and Wellbeing theme. 

The pandemic is over, right? Wrong – around three years since we first went into lockdown, COVID-19 is still a thing. People are still catching, and some are dying, of COVID-19. Most of us have had it – in many cases, more than once. Although it may feel like everything is back to normal, the pandemic isn’t over yet. I’d like to think we’ve learnt something from this pandemic; even if only how important human contact is. Apart from some personal lessons, one of the insights I’ve gained as a result of the pandemic is just how complex the phenomenon of vaccine hesitancy is.

I became interested in COVID-19 vaccine hesitancy in early 2021, when news reports emerged that the uptake of the vaccine, which had only just started to be rolled out, was not as high as expected, particularly among ethnic minority groups. I’m mixed race and therefore have an ethnic minority background myself but could not understand this scepticism at all. On the contrary, I found this puzzling; after all, wasn’t the vaccine our ticket out of this awful pandemic? I had a conversation about this with Professor Jonathan Ling at the University of Sunderland. Jonathan and I have been working together for several years and we’re a great team, as we tend to be interested in the same things. We both agreed that we should investigate COVID-19 vaccine hesitancy further. I began to read scientific literature in relation to this phenomenon. As it was still early days where the vaccine was concerned, not much had been published yet. Most of the studies that I did come across had not used a theoretical framework to examine COVID-19 vaccine hesitancy. Conducting theory-informed research when it comes to health behaviours is important – I say this to my students all the time. After some more digging I discovered that Protection Motivation Theory (PMT) had been used to examine flu vaccine hesitancy but had hardly been applied to COVID-19 vaccine hesitancy. As PMT lends itself to protective health behaviours such as vaccination, it seemed a no-brainer to me to use it in our planned work. At the same time, I noticed that conspiracy beliefs about the vaccine appeared to be gaining ground, with some studies finding a link between such beliefs and vaccine hesitancy.

We were awarded a research grant by the NIHR CRN NENC in April 2021 to conduct a survey investigating PMT, conspiracy beliefs, and COVID-19 vaccination intention in ethnic minority groups (although we ended up broadening our focus and collecting data from the general UK population). Over the next couple of years, we published a number of papers on this and on subsequent work, some of which focused on vaccine hesitancy in ethnic minority individuals, and received some media attention for our work – I was invited for several radio and TV interviews.

Rather than provide an overview of all papers I’ve published on this topic, I’ll focus on one key paper. Working with the founder of Ubuntu Multicultural Centre in Middlesbrough, John Kabuye, funded by Middlesbrough Council, we conducted a mixed-methods study examining COVID-19 booster vaccine hesitancy in minority ethnic individuals. The qualitative portion of the work was recently published in the Journal of Public Health. For this work, John conducted 16 interviews with ethnic minority community members in Middlesbrough, eliciting their views on and experiences of the booster. Some of the themes arising from our participants’ responses were in line with our previous research focusing on ethnic minority individuals; for example, some believed they were less vulnerable to suffering negative consequences of COVID-19 due to their ethnicity, and therefore saw no need to get vaccinated, whilst others saw themselves as more vulnerable to COVID-19 due to their ethnicity. Also, many saw the booster vaccine as inconvenient or unnecessary, similar to the general population. But the most striking finding, to me, was that our participants’ lack of trust in the vaccine was at least partly linked to historical events involving medical experimentation with minority ethnic individuals. Indeed, it has been argued that there is structural anti-Blackness in global health. It isn’t difficult to see why there is a lack of confidence in the vaccine, and medical mistrust more generally in many ethnic minority individuals. Crucially, however, our interviewees provided some suggestions for addressing this lack of confidence. The central recommendation arising from this, and some of our previous, work is to enlist community leaders, who play an important role in many ethnic minority communities, in COVID-19 vaccination campaigns. These leaders are probably best placed to talk about vaccination to those in the community who trust and look up to them and could also address vaccine-related myths such as an assumed ethnicity-specific (in)vulnerability to COVID-19. Community leaders can help increase confidence in the vaccine, which is key to increasing uptake.

We’ve since broadened our focus to examine hesitancy towards other vaccines, and have been researching ethnic minority health in other contexts, such as prostate cancer awareness, or sickle cell disease. Yet, COVID-19 vaccine hesitancy needs to remain on our radar. Indeed, we recently applied for a grant from the British Academy to look at COVID-19 vaccine hesitancy in healthcare workers in three G7 countries (the UK, the USA, and Germany). There are lessons to be learned from this pandemic, to better prepare us for future pandemics – but we need to better understand what drives phenomena such as COVID-19 vaccine hesitancy, in order to be able to learn these lessons.


Key references

Eberhardt, J., Kabuye, J. & Ling, J. (2023). A qualitative study exploring attitudes and perceptions of the COVID-19 booster vaccine in minority ethnic individuals in North East England. Journal of Public Health. https://doi.org/10.1007/s10389-023-01858-9

Eberhardt, J., & Ling, J. (2022). A Qualitative Exploration of Perceptions of the COVID-19 Vaccine in the United Kingdom During the Later Stages of the Vaccine Rollout. International Journal of Translational Medical Research and Public Health, 6(1), 1-10. https://doi.org/10.21106/ijtmrph.407

Eberhardt, J., & Ling, J. (2022). Explaining COVID-19 Vaccination Intention in Younger Adults using Protection Motivation Theory. Health Psychology. https://doi.org/10.1037/hea0001231

Eberhardt, J., Ling, J., Horsley, L., Cunnett, J., Fryer-Smith, E., Lant, J., Edwards, S., & Ross, E. (2022). Exploring COVID-19 vaccine confidence with people from Black and Asian backgrounds in England. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-022-01372-w

Eberhardt, J., & Ling, J. (2021). Predicting COVID-19 Vaccination Intention Using Protection Motivation Theory and Conspiracy Beliefs. Vaccine. https://doi.org/10.1016/j.vaccine.2021.09.010