Community-level characteristics of COVID-19 vaccine hesitancy in England: A nationwide cross-sectional study

  1. Georges Bucyibaruta
  2. Marta Blangiardo
  3. Garyfallos Konstantinoudis

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Abstract

One year after the start of the COVID-19 vaccination programme in England, more than 43 million people older than 12 years old had received at least a first dose. Nevertheless, geographical differences persist, and vaccine hesitancy is still a major public health concern; understanding its determinants is crucial to managing the COVID-19 pandemic and preparing for future ones. In this cross-sectional population-based study we used cumulative data on the first dose of vaccine received by 01-01-2022 at Middle Super Output Area level in England. We used Bayesian hierarchical spatial models and investigated if the geographical differences in vaccination uptake can be explained by a range of community-level characteristics covering socio-demographics, political view, COVID-19 health risk awareness and targeting of high risk groups and accessibility. Deprivation is the covariate most strongly associated with vaccine uptake (Odds Ratio 0.55, 95%CI 0.54-0.57; most versus least deprived areas). The most ethnically diverse areas have a 38% (95%CI 36-40%) lower odds of vaccine uptake compared with those least diverse. Areas with the highest proportion of population between 12 and 24 years old had lower odds of vaccination (0.87, 95%CI 0.85-0.89). Finally increase in vaccine accessibility is associated with COVID-19 vaccine coverage (OR 1.07, 95%CI 1.03-1.12). Our results suggest that one year after the start of the vaccination programme, there is still evidence of inequalities in uptake, affecting particularly minorities and marginalised groups. Strategies including prioritising active outreach across communities and removing practical barriers and factors that make vaccines less accessible are needed to level up the differences.

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  1. Version published to 10.1007/s10654-022-00905-1
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    SciScore for 10.1101/2022.03.15.22272362: (What is this?)

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    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations: some of the community-level covariates considered are not up-to-date; for instance information on BME population are related to the 2011 Census, hence we are implicitly assuming that the ethnic composition at MSOA level remains the same in the last decade. Furthermore, some variables are available at a coarser spatial resolution: COVID-19 mortality is at Local Authority districts (LAD), while political views are available at constituency level. In the analysis we assign the same value to all the MSOAs within the same LAD or constituency, leading to an underestimate of the variability at MSOA level and potentially a reduction in the association with those variables. Finally, the ecological nature of the study means that we cannot infer causal links between covariates and vaccination uptake [27]. Despite the good coverage of COVID-19 vaccine uptake at the national level, our results suggest that a year after the start of the vaccination campaign there are still substantial inequalities, most importantly related to deprivation and ethnicity. These have been highlighted from the beginning of the campaign (e.g. [14]) and have been later linked to general distrust in vaccines, low perception of risk as well as cultural/religious barriers [12, 52]. As they persist while the pandemic evolves, it is necessary to prioritise engagement through relevant figures, such as general practitioners, scientists and a wide spectrum of role models coming from these ...

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  3. Version published to 10.1101/2022.03.15.22272362v1 on medRxiv