Understanding lower vaccine uptake among ethnic minorities in europe

Abstract Background 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 vaccine uptake between majority and minority ethnic groups. Methods Using a large, cross-national dataset of 20 European countries (European Social Survey; N = 31,240), we conducted multilevel structural equation modelling to assess the impact of ethnic identification on vaccine uptake, mediated by national identification and trust in institutions. Results Our findings revealed significant group differences, with minority group members reporting lower levels of national identification, trust in institutions and vaccine uptake compared to majority group members. We also found that ethnic identification indirectly influences 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 vaccine uptake. Conclusions Our findings underscore the importance of fostering inclusive national identities and building institutional trust to reduce 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. Key messages • Ethnic minorities report lower levels of national identification, trust in institutions, and vaccine uptake compared to majority groups. • National identification and trust in institutions mediate the relationship between ethnic identification and vaccine uptake.