National identification and trust in institutions: understanding lower COVID-19 vaccination uptake among ethnic minorities in Europe

COVID-19 vaccine hesitancy among ethnic minority groups presents a public health challenge. However, there is limited understanding as to why ethnic minorities often exhibit lower levels of vaccine uptake. This study investigates the role of national identification and institutional trust in explaining differences in COVID-19 vaccine uptake between majority and minority ethnic groups. Using a large, cross-national dataset of 20 European countries (N = 31 240), we conducted multilevel structural equation modelling to assess the impact of ethnic identification on COVID-19 vaccine uptake, mediated by national identification and trust in institutions. Our findings revealed significant group differences, with minority group members reporting lower levels of national identification, trust in institutions and COVID-19 vaccine uptake compared to majority group members. We also found that ethnic identification indirectly influences COVID-19 vaccine uptake through national identification and trust in institutions. Specifically, people from minority ethnic groups tend to report lower levels of national identification, which makes them less likely to trust institutions. This lower level of trust, in turn, reduces their likelihood of COVID-19 vaccine uptake. Our findings underscore the importance of fostering inclusive national identities and building institutional trust to reduce COVID-19 vaccine hesitancy among ethnic minorities. Public health strategies that address these social dynamics are essential for increasing vaccination rates and ensuring equitable health outcomes across diverse populations.