This is probably my favourite of my COVID-era papers. It was one of those rare projects where everything moved at speed: we started planning in early January, had data coming in by early February, analysis wrapped up by March, and a pre-print out by April. Sadly, that’s also where things slowed to a crawl, with the paper eventually taking until the following January to make it through to publication.
I also feel incredibly lucky to have worked with the NHS Race and Health Observatory on this project. The team were thoughtful, collaborative, and grounded in real-world impact in a way that made this feel like research that actually mattered. I’d strongly encourage anyone interested in health inequalities or applied public health research to spend some time looking at the work they do.
What follows is a brief summary of what we found, but it’s worth saying upfront that this paper is as much about systems, workplaces, and trust as it is about individual vaccine decisions.
This paper explored COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK during the very early stages of the vaccine rollout. Using a mixed-methods approach, we combined a large national survey (nearly 2,000 participants) with in-depth interviews to understand not just who was or wasn’t getting vaccinated, but why. Health and social care workers were prioritised for vaccination because of their elevated risk, yet uptake varied considerably across roles, sectors, and demographic groups.
One of the clearest findings was that access and workplace context mattered a great deal. Social care workers were more likely than healthcare workers to report not being offered a vaccine at all, often because of fragmented employment arrangements and unclear responsibility for vaccine delivery. We also found that feeling pressured by employers to get vaccinated was associated with lower uptake, while feeling positive about one’s organisation as a place to work was associated with higher uptake. In other words, trust, autonomy, and organisational culture played a central role alongside individual beliefs about safety and effectiveness.
The paper also highlighted important ethnic inequalities. Black African and Black Caribbean health and social care workers were more likely to decline vaccination and expressed greater concerns about safety, side-effects, and trust in institutions, shaped by both historical and contemporary experiences of racism in healthcare. The key takeaway was that vaccine hesitancy in this context was not about ignorance or irrationality, but about access, trust, and lived experience. Addressing these issues requires structural solutions, culturally informed engagement, and genuine partnership with organisations like the Race and Health Observatory, whose involvement made this work both possible and meaningful.
You can read the full open access paper here: Bell, S., Clarke, R. M., Ismail, S. A., Ojo-Aromokudu, O., Naqvi, H., Coghill, Y., … & Mounier-Jack, S. (2022). COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK: A mixed-methods study. PloS one, 17(1), e0260949.
Richard M Clarke (PhD) 