Beyond Information Provision: Analysis of the Roles of Structure and Agency in COVID-19 Vaccine Confidence in Ethnic Minority Communities

Shoba Poduval; Atiya Kamal; Sam Martin; Amin Islam; Chandrika Kaviraj; Paramjit Gill

doi:10.3390/ijerph20217008

Beyond Information Provision: Analysis of the Roles of Structure and Agency in COVID-19 Vaccine Confidence in Ethnic Minority Communities

Int J Environ Res Public Health. 2023 Nov 1;20(21):7008. doi: 10.3390/ijerph20217008.

Authors

Shoba Poduval¹, Atiya Kamal², Sam Martin^{3

4}, Amin Islam⁵, Chandrika Kaviraj⁵, Paramjit Gill⁶

Affiliations

¹ UCL Research Department of Primary Care & Population Health, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
² School of Social Sciences, Birmingham City University, 4 Cardigan Street, Birmingham B4 7BD, UK.
³ Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK.
⁴ Vaccines and Society Unit, Oxford Vaccine Group, Oxford University, Oxford OX3 7LE, UK.
⁵ Patient and Public Involvement Authors, UCL Research Department of Primary Care & Population Health, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
⁶ Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.

Abstract

People from Black and Asian backgrounds are more likely to die from COVID-19 but less likely to be vaccinated, threatening to exacerbate health inequalities already experienced by ethnic minority groups. The literature suggests that mistrust rooted in structural inequality (including socioeconomic position and experience of racism) may be a key barrier to COVID-19 vaccine uptake. Understanding and addressing structural inequality is likely to lead to longer-term impacts than information alone. The aim of this study is to draw on health and sociological theories of structure and agency to inform our understanding of how structural factors influence vaccine confidence. We conducted qualitative interviews and focus groups with 22 people from London and the surrounding areas from December 2021 to March 2022. Fourteen participants were members of the public from ethnic minority backgrounds, and seven were professionals working with the public to address concerns and encourage vaccine uptake. Our findings suggest that people from ethnic minority backgrounds make decisions regarding COVID-19 vaccination based on a combination of how they experience external social structures (including lack of credibility and clarity from political authority, neglect by health services, and structural racism) and internal processes (weighing up COVID-19 vaccine harms and benefits and concerns about vaccine development and deployment). We may be able to support knowledge accumulation through the provision of reliable and accessible information, particularly through primary and community care, but we recommend a number of changes to research, policy and practice that address structural inequalities. These include working with communities to improve ethnicity data collection, increasing funding allocation to health conditions where ethnic minority communities experience poorer outcomes, greater transparency and public engagement in the vaccine development process, and culturally adapted research recruitment processes.

Keywords: COVID-19; COVID-19 vaccines; ethnic and racial minorities; ethnicity; health inequities; health promotion; primary health care; public health; systemic racism; vaccination hesitancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines*
COVID-19* / prevention & control
Ethnic and Racial Minorities
Ethnicity
Humans
Minority Groups
Vaccination

Substances

COVID-19 Vaccines

Grants and funding

This research was funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 571). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Patient and Public Involvement (PPI) funding was supplemented by a UCL Biomedical Research Centre starter grant for PPI (project reference: BRC830).