Self-reported COVID-19 vaccine hesitancy and uptake among participants from different racial and ethnic groups in the United States and United Kingdom

Abstract

Worldwide, racial and ethnic minorities have been disproportionately impacted by COVID-19 with increased risk of infection, its related complications, and death. In the initial phase of population-based vaccination in the United States (U.S.) and United Kingdom (U.K.), vaccine hesitancy may result in differences in uptake. We performed a cohort study among U.S. and U.K. participants who volunteered to take part in the smartphone-based COVID Symptom Study (March 2020-February 2021) and used logistic regression to estimate odds ratios of vaccine hesitancy and uptake. In the U.S. (n = 87,388), compared to white participants, vaccine hesitancy was greater for Black and Hispanic participants and those reporting more than one or other race. In the U.K. (n = 1,254,294), racial and ethnic minority participants showed similar levels of vaccine hesitancy to the U.S. However, associations between participant race and ethnicity and levels of vaccine uptake were observed to be different in the U.S. and the U.K. studies. Among U.S. participants, vaccine uptake was significantly lower among Black participants, which persisted among participants that self-reported being vaccine-willing. In contrast, statistically significant racial and ethnic disparities in vaccine uptake were not observed in the U.K sample. In this study of self-reported vaccine hesitancy and uptake, lower levels of vaccine uptake in Black participants in the U.S. during the initial vaccine rollout may be attributable to both hesitancy and disparities in access.

Fig. 1. Disparity in vaccine uptake by race and ethnicity according to country of enrollment.

Risk estimates of receiving a vaccine through 1 February 2021 calculated within the country using multivariable logistic regression conditioned upon age, sex, and date of study entry and adjusted for personal history of diabetes, heart disease, lung disease, kidney disease, current smoking status, body mass index, prior reported history of COVID-19 infection, frontline healthcare worker status, and education and income at the community level. Data are presented as multivariable OR estimates ±95% CI. P_interaction was calculated using the Wald test for the cross-product terms between race and ethnicity and country, P_interaction = for Black vs. white and 0.106 for all other races and ethnicities compared with white participants, respectively. N = 1,110,544 for white U.K. participants, 64,144 for white U.S. participants, 8787 for Black U.K. participants, 2179 for Black U.S. participants, 35,657 U.K. participants of other races and ethnicities, and 7327 U.S. participants of other races and ethnicities, respectively. Source data are provided with this paper. CI confidence interval, OR odds ratio.