by Michael Addelman, University of Manchester

Credit: Pixabay/CC0 Public Domain

The COVID-19 pandemic and subsequent vaccination rollout enabled a "perfect storm" for deepening health inequalities in Greater Manchester, the results of a study have shown.

Research led by University of Manchester academics, examined the attitudes of people from minoritized ethnic groups, young adults and those with long-term physical and mental health conditions toward the COVID-19 vaccination program.

Researchers found that a "perfect storm" of marginalization and experience of structural inequalities led to distrust of the COVID-19 vaccination drive—and that marginalized communities felt "left behind" by policy and decision-makers prior to and during the pandemic.

The study, published in BMC Public Health, concludes that wider social inequalities, combined with experiences of marginalization and discrimination, have long-lasting and widespread implications for vaccination uptake and health outcomes.

During the pandemic, Greater Manchester experienced higher levels of mortality from COVID-19, higher case rates and greater impacts to productivity than the national average—with disproportionately high COVID-19 mortality rates in the most deprived areas and among Black African, Pakistani and Black Caribbean groups.

"We found that wider social inequalities, intersecting with experiences of marginalization during the pandemic, have long-lasting and widespread implications when it comes to vaccination—and public health policy must recognize this broader context for future public health crises and vaccination drives," says Stephanie Gillibrand.

For some study participants:

• The choice to not have the vaccine became almost a metaphor for political dissent against institutionalized failures.

• Elements of distrust appeared to be established prior to the pandemic—and enhanced due to intensified episodes of racism experienced over the course of the pandemic.

• Feelings of distrust were emphasized via the perceived mishandling of the pandemic by the government and paradoxical government policy-responses to aspects of the pandemic, including U-turns and mixed public messaging.

• Culturally insensitive public messaging and practices during the pandemic heightened longstanding and widespread disenfranchisement.

• Longer-term injustices were perceived to be further intensified during the COVID-19 pandemic—links were made between long-term failings for underserved communities and the disproportionate impact of the pandemic.

• Pushback against the vaccine was articulated via a sense of establishing boundaries against an oppressive system.

Stephanie Gillibrand, Research Fellow at The University of Manchester, said, "Existing research in this area tends to focus on the psychological or socio-economic factors that influence an individual's uptake of vaccination. We sought to understand the complexities around vaccination motivations, exploring broader social and historical contexts or people's experiences of marginalization.

"We found that wider social inequalities, intersecting with experiences of marginalization during the pandemic, have long-lasting and widespread implications when it comes to vaccination—and public health policy must recognize this broader context for future public health crises and vaccination drives.

"These implications may already be apparent, where new data has suggested that MMR vaccination rates are at a ten-year low since the start of the pandemic, and other childhood immunization rates have also fallen."

More information: Stephanie Gillibrand et al, Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region, BMC Public Health (2024). DOI: 10.1186/s12889-024-18308-0

Journal information: BMC Public Health 

Provided by University of Manchester