Research highlights inequalities in England's COVID vaccine coverage

Researchers led by the epidemiologist Elise Tessier, of Public Health England, have been investigating the proportion of unvaccinated individuals against coronavirus disease 2019 (COVID-19) by age, sex, location, vaccine type, ethnicity and poverty level in the United Kingdom.

By examining over 50 million vaccination cases from point-of-care data gathered by Public Health England, these scientists discovered that as of mid-May, Black, African and Caribbean citizens were the ethnic group most likely to be unvaccinated. Outside of ethnicity, the most likely factors to affect vaccination rates were geography – Londoners have consistently lower vaccination rates than the rest of the country – and poverty.

A preprint version of the group’s study is available on the medRxiv* server, while the article undergoes peer review.

Vaccine hesitancy amongst these groups has been recorded before – data from studies examining flu and shingles vaccines show very similar results – and is quickly becoming a political issue. The study emphasizes the ‘utmost importance’ of correcting these unequal vaccination rates.

After examining the gathered information, the researchers used the statistics software Stata to fit univariable logistic regression models to determine the probability of vaccination/lack thereof for each individual factor before creating a multivariable model to adjust for any alternate characteristics. They found that just under 50% of individuals were vaccinated with the first dose, and 28.1% had been vaccinated with the second dose. For over 70s, only ~5% of eligible participants had not received the first dose. However, among Black, African and Caribbean individuals, that number rises starkly to 29% of individuals not receiving their first dose.

Regardless of age and race, Londoners consistently had the highest proportion of unvaccinated individuals – a trend that continued in most urban vs. rural comparisons. This was followed by the Midlands, while the North-East showed the highest proportion of vaccinations. Men were also less likely to have received their vaccine than women. More than one other worrying trend revealed itself: over 70s living in care homes were less likely to have received more than one dose than those outside.

Given the Care Quality Commission revealed in July that over thirty-nine thousand care home residents died from coronavirus, this suggests that further efforts were required to ensure the safety of those within care homes. However, less data is available for residents of care homes, so this information may not reveal the full story. Another important factor in over 70s vaccination coverage was poverty. By comparing postcodes to the IMD Deprivation Deciles released in 2019, the scientists discovered that vaccination rates rose steadily as poverty declined, with 8.7% of those in the most deprived wards not receiving a vaccine, compared to 3.2% in the least deprived areas of the United Kingdom.

Not all of the results are quite as disheartening, however: both the extremely clinically vulnerable and healthcare workers showed higher odds of vaccination than average, with only 4.7% of over 70s who qualify as extremely at risk not having received a vaccine, and 13.4% of over 50 healthcare workers – the average for over 50s falling at 56.5%.

There are some limitations to this study to consider. Only data from individuals with an NHS number could be examined, so the data is likely somewhat incomplete, especially as those suspicious of vaccinations are less likely to register with the NHS in the first place. Other errors may have been introduced due to IT issues with point-of-care apps at vaccinations centres. However, the researchers consider that this factor is likely negligible compared to the amount of data points gathered.

The recommendations given by Elise Tessier and her colleagues at Public Health England concern the expansion of the vaccination program to younger adults. They warn that designs must be put in place to counter the inequalities present in the vaccination scheme to improve coverage before other age groups are covered.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Sam Hancock

Written by

Sam Hancock

Sam completed his MSci in Genetics at the University of Nottingham in 2019, fuelled initially by an interest in genetic ageing. As part of his degree, he also investigated the role of rnh genes in originless replication in archaea.

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