Examining the insights and beliefs of the UK population on COVID-19 vaccine uptake and hesitancy

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“Of all the rationales stated, “unless completely tested with no proven side effect” is the key reason for COVID-19 vaccine hesitancy.”


There is little evidence to suggest that the spread of COVID-19 will stop naturally through population immunity. Population immunity takes place when a sufficiently large proportion of immune individuals exist in a population. With an estimated 0·3-1·3% infection-fatality ratio, the cost of reaching population immunity through natural infection would be very high. Men, older individuals, and those with comorbidities are disproportionately affected, with an infection fatality ratio as high as 3·3%. Additionally, Public Health England revealed the death rate from COVID-19 in England to be four times higher for black people and three times higher for Asian people than for their white counterparts. Thus, an effective vaccine may offer the safest way to reach population immunity, particularly if immunity boosts are needed with virus variant formation or re-infections as we see in the case of the ongoing increase in infections due to the Delta-variant.

A further challenge for successful vaccine uptake, particularly with COVID-19, is vaccine hesitancy. Vaccine uptake rates can also vary across different communities and ethnicities, with significantly lower uptake rates in the BAME community. Furthermore, recently cited adverse outcomes in the ongoing trials could discourage the public from participating in a COVID-19 vaccine programme.

In the study published in the journal ‘BMJ’ in June 2021, we conduct UK’s largest cross-sectional examination to explore the key drivers and barriers to COVID-19 vaccine uptake at this pivotal time. This is also the first survey to focus specifically on the BAME population and other high-risk groups identified as the government’s priority for vaccination. The insights from this study were valuable in delivering, supporting, and promoting adequate uptake for the population-wide vaccine programme. The study was conducted in collaboration with NHS Trust and National Institute of Health Research, UK. The details of the findings were presented and discussed with the UK Governments Vaccine task force prior to the launching of the on-going vaccination programme.

The survey had 4884 respondents. Overall, 3873 (79·3%) respondents were interested in taking approved vaccines, whilst 677 (13·86 %) respondents were unsure and only 334 (6·9%) stated that they were not going to take the vaccine. The other key findings are: amongst those respondents who declared their educational qualification, graduates were more likely to take the vaccine compared to the non-graduates. Similarly, of those respondents who declared their gender, males were more likely to take the approved vaccine. Respondents belonging to the age groups 50 and above were more likely to accept the approved COVID-19 vaccine compared to the respondents below 50 years. Amongst the ethnicity-groups, it is evident that the BAME community was more likely to accept the COVID-19 vaccine. Within the BAME community, the South Asian ethnicity, i.e., Indian, Pakistani, Bangladeshi, showed more interest towards uptake of the approved COVID-19 vaccine.

In this study we also identified 16 reasons cited by the respondents for not taking approved COVID-19 vaccines. Of all the rationales stated, “unless completely tested with no proven side effect” is the key reason for COVID-19 vaccine hesitancy. However, it is expected that the uptake is most likely to increase, and the non-sure group might be more inclined towards vaccination with the assured positive results of the vaccine trials.

In late September, the UK Government published interim advice on high-risk groups that will be prioritised with the COVID-19 vaccination programme. A combination of clinical risk stratification and an age-based approach was used in determining these groups, placing clinically vulnerable and over 70 age cohort as priority groups. Both groups, according to our findings, are more likely to uptake the approved vaccine.Concerning the BAME community: Whilst the overall proportion of BAME participants was relatively low in our study, the BAME recruitment was greater than any other UK COVID-19 vaccination-based study thus far. Our results found that the BAME community in general are more likely to accept approved vaccines when compared to the non-BAME community. There have also historically been racial disparities surrounding trust in vaccines, where the BAME community are less likely to trust pharmaceutical companies and government strategies. A primary reason for a potential increase in uptake with the COVID vaccine may be due to the disproportionate number of COVID-19 deaths in the BAME population with a third of these patients being admitted to the intensive care unit.

To conclude, this study emphasises policies targeting the needs of increased participation from the BAME community, young people, and those with no diagnosed health conditions to uptake approved COVID-19 vaccines. This will allow the UK to effectively reach population immunity thresholds nationwide, and in controlling further outbreaks of this rapidly spreading disease. Widespread vaccine uptake will be a crucial turning point in rebuilding the nation’s social, health and financial losses from this unprecedented pandemic.

Paper Citation (co-authors): Sethi, Sonika, Aditi Kumar, Anandadeep Mandal, Mohammed Shaikh, Claire A. Hall, Jeremy MW Kirk, Paul Moss, Matthew J. Brookes, and Supratik Basu. "The UPTAKE study: implications for the future of COVID-19 vaccination trial recruitment in UK and beyond." Trials 22, no. 1 (2021): 1-12.