In a recent study posted to the medRxiv* preprint server, researchers evaluated the characteristics of coronavirus disease 2019 (COVID-19) vaccine uptake in England at a community level.
Study: Community-level characteristics of COVID-19 vaccine hesitancy in England: A nationwide cross-sectional study. annaevlanova / Shutterstock
The COVID-19 vaccination campaign has been implemented globally to immunize populations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In England, the National Health Service (NHS) commenced mass vaccinations in December 2020, and over 43 million individuals had been vaccinated with at least one vaccine dose by the end of 2021. Despite the high vaccination rate, vaccine uptake varies among populations, and vaccine inequality remains a public health concern.
According to one study, income disparity was the principal cause of vaccine inequity between high- and middle-income countries. Other research groups have reported that less-educated people from ethnic minorities with low annual income and low awareness of COVID-19-related health risks had higher distrust towards immunization. Consistent with other reports, South Asians and Black people in the United Kingdom (UK) were less likely to vaccinate than the White population.
The current cross-sectional study assessed vaccine uptake in people aged 12 years or above in England. As of January 1, 2022, the authors retrieved cumulative vaccination data corresponding to the middle layer super output areas (MSOA). Vaccine uptake determinants were evaluated at a high geographical resolution by considering covariates associated with COVID-19 mortality in 2020, political views, socio-demographic characteristics, chronic physical and mental health conditions, and vaccine accessibility.
Socio-demographics were profiled by computing the percentage of Black and minority ethnic (BME), index of multiple deprivations (IMD), percentage of people aged 12 – 24 years, and >65 years in each MSOA. Each MSOA was categorized as predominantly urban (PU) or rural (PR) or urban with significant rural (UR). Political opinion was characterized by computing the percentage of those who voted in favor of the 2016 Brexit referendum and the 2019 general election results. A Bayesian hierarchical model was used to assess the relationship of uptake of COVID-19 vaccines and the community-level characteristics.
Posterior mean of vaccine uptake up until 01-01-2022 in each Middle Layer Super Output Area in England (left) and for the most populated cities accounting for a total 11 212 813 population  (right).
The national posterior mean of COVID-19 vaccine uptake was estimated at 81.1%, ranging from 37.6 % in Leeds city to 93.9% in Northumberland with lower uptake in city centers. The least compliant regions shared some characteristics – more likely to be deprived and situated in urban places, a high proportion of young residents and non-White ethnic groups, voting for the Labor party, and less likely to experience chronic health conditions. Contrastingly, high vaccine coverage regions were characterized by the older population, increased prevalence of chronic health conditions, and politically favoring the Conservative party.
IMD was the covariate strongly associated with low vaccine uptake. For example, people living in the most deprived places were 0.55 times less likely to be vaccinated than those living in the least disadvantaged regions. In the same line, areas with diverse and high BME populations had 38% lower odds of vaccine uptake than least ethnically-diverse places. Moreover, regions with high proportions of 12 – 24-year-olds had lower odds of vaccine uptake; areas that voted for the Conservative party had high vaccine coverage.
There was insufficient evidence for a link between the proportion of people voting for the Labor party and the Brexit referendum. Areas with a high COVID-19 mortality rate in the pre-vaccination period had higher odds of vaccine uptake; similar was the case in areas with a high prevalence of high blood pressure or asthma, and the vaccine uptake improved with the increase in vaccine accessibility.
The study investigated a range of characteristics at the community level and their role in vaccine uptake. The findings suggested that MSOAs with low uptake of vaccines were the most deprived and ethnically diverse with a high percentage of young people. Vaccine uptake was high across areas with awareness of COVID-19-related health risks and increased accessibility to vaccination centers.
Moreover, areas that voted for the Conservatives had higher vaccine uptake. The national and international COVID-19 policies have changed throughout 2021, increasing public awareness that might have influenced general behavior towards vaccination. A notable limiting factor was the consideration of BME proportions based on the 2011 census assuming that ethnic composition was essentially the same throughout the decade in the MSOAs.
In conclusion, the study reported that despite high national vaccine coverage in a year, multiple inequalities, mainly associated with deprivation and ethnicity, were still persistent. The authors suggested that these sections be engaged through suitable means (scientists and role models from the target communities) to lower vaccine skepticism.
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.