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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 funded by the �Թ���վ Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), examined the attitudes of people from minoritised ethnic groups, young adults and those with long-term physical and mental health conditions toward the COVID-19 vaccination programme.

Researchers found that a “perfect storm” of marginalisation and experience of structural inequalities led to distrust of the COVID-19 vaccination drive – and that marginalised communities felt ‘left behind’ by policy and decision-makers prior to and during the pandemic.

The study, which is published , concludes that wider social inequalities, combined with experiences of marginalisation 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 amongst Black African, Pakistani and Black Caribbean groups.

For some study participants:

• The choice to not have the vaccine became almost a metaphor for political dissent against institutionalised 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 emphasised 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 marginalisation.

“We found that wider social inequalities, intersecting with experiences of marginalisation during the pandemic, have long-lasting and widespread implications when it comes to vaccination – and public health policy must recognise 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 immunisations rates have also fallen.”