Barriers to equitable COVID-19 booster uptake among adults aged 50 and older in the UK: psychological factors and misinformation influencing vaccine hesitancy

The booster dose was developed to enhance protection against emerging strains of SARS-CoV-2. However, disparities in booster dose uptake persist, particularly among ethnic minority groups and socioeconomically disadvantaged populations, exacerbating existing health inequalities. Addressing these inequities is critical to ensuring equitable vaccine access and achieving global health security. The TRUST study aimed to bridge this gap by improving the effectiveness of future booster dose campaigns targeting specific audiences. Individuals aged 50 and above who had declined the booster dose and resided in London (n = 15) and the West Midlands (n = 15) were invited to participate in online qualitative interviews. These interviews delved into participants’ attitudes towards COVID-19 vaccine booster doses and their encounters with misinformation related to COVID-19. Zoom recordings were transcribed using Otter.ai and subsequently imported into NVivo V.12 for thematic analysis. Analysis revealed four primary themes: ‘Vaccine production and administration’, ‘Health misinformation and beliefs’, ‘Personal circumstances and social influences’, and ‘Policy and logistical factors’. Key factors influencing vaccine hesitancy included mistrust in vaccine manufacturing, lack of culturally tailored communication, and logistical barriers to access. The role of social determinants emerged, as significant contributors to disparities in booster dose uptake. Future booster dose campaigns must integrate equity-driven approaches to overcome vaccine hesitancy and increase uptake among underrepresented populations. By prioritizing transparent communication about vaccine manufacturing and regulatory processes, these campaigns can build trust in the vaccine’s safety and efficacy. Addressing misinformation with culturally sensitive messages tailored to diverse communities will help dispel misconceptions. Additionally, leveraging various communication channels will ensure that the messages reach and resonate with all audience segments. Establishing robust monitoring and adaptation mechanisms will enable timely responses to public sentiment and emerging concerns, ultimately ensuring that vaccine distribution strategies contribute to health equity rather than perpetuate disparities.