STRUCTURED ABSTRACTO_ST_ABSBackgroundC_ST_ABSThe global morbidity and mortality burden of COVID-19 has been substantial, often widening pre-existing inequalities. The approved COVID-19 vaccines have shown great promise in reducing disease transmission and severity of outcomes. However, the success of the COVID-19 vaccine rollout is dependent on public acceptance and willingness to be vaccinated. In this study, we aim to examine how the attitude towards public sector officials and the government impact vaccine willingness with a secondary aim to understand the impact of ethnicity on this relationship. MethodsThis cross-sectional study used data from a UK population based longitudinal household survey (Understanding Society COVID-19 study, Understanding Society: the UK Household Longitudinal Study) between April 2020-January 2021. Data from 22421 participants in Waves 6 and 7 of the study were included after excluding missing data. Demographic details in addition to previous survey responses relating to public sector/governmental trust were included in as covariates in the main analyses. A logit model was produced to describe the association between public sector/governmental mistrust and the willingness for vaccination with interaction terms included to account for ethnicity/socio-economic status. FindingsIn support of existing literature, we identified those from BAME groups were more likely to be unwilling to take the COVID-19 vaccine. We found that positive opinions towards public sector officials (OR 2.680: 95% CI 1.888 - 3.805) and the UK government (OR 3.400; 95% CI 2.454 - 4.712) led to substantive increase in vaccine willingness. Most notably we identified this effect to be vary across ethnicity and socio-economic status with those from South Asian background (OR 4.513; 95% CI 1.012 - 20.123) the most unwilling to be vaccinated when their trust in public sector officials were affected. InterpretationThese findings suggests that trust in public sector officials may play a key factor in the low vaccination rates particularly seen in at risk groups. Given the additional morbidity/mortality risk posed by COVID-19 to those from lower socio-economic or ethnic minority backgrounds, there needs to be urgent public health action to review how to tailor health promotion advice given to these groups and examine methods to improve trust in public sector officials and the Government. FundingNo funding RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSA systematic literature search on Pubmed and MedRxiv from database inception to 2nd July 2021 was conducted. The broad terms included were "COVID" OR "SARS-CoV-2*" AND "hesitancy" OR "willingness." There were no age or language restrictions. We identified numerous observational studies examining prevalence of willingness and hesitancy towards taking the vaccine in a variety of global settings. However, there were fewer studies which examined the reasons behind decisions relating to vaccine hesitancy and in particular in communities relevant to those most at risk in the United Kingdom. Added value of this studyTo our knowledge, this is the first attempt to exploring the role of trust in the public sector officials and in the Government with UK COVID-19 vaccination willingness. We found that negative pre-existing opinions around public sector/Government significantly reduced vaccine willingness with an increased effect size noted in those from lower socio-economic and BAME backgrounds. Implications of all the available evidenceOur findings support pre-existing prevalence data suggesting a reduced willingness for vaccination in lower socio-economic/BAME communities. However, our findings build on existing literature by suggesting that trust in public sector officials may play a key factor in the low vaccination rates. Given the additional morbidity/mortality risk posed by COVID-19 to those from lower socio-economic or ethnic minority backgrounds there needs to be urgent public health action to review how to tailor health promotion advice given to these groups and examine methods to improve trust in public sector officials and the Government.
COVID-19 vaccine hesitancy in the UK: A longitudinal household cross-sectional study