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

Abstract

Background The booster dose was developed to enhance protection againstemerging strains of SARS-CoV-2. However, disparities in booster dose uptake persist,particularly among ethnic minority groups and socioeconomically disadvantagedpopulations, exacerbating existing health inequalities. Addressing these inequities iscritical to ensuring equitable vaccine access and achieving global health security. TheTRUST study aimed to bridge this gap by improving the effectiveness of future boosterdose campaigns targeting specific audiences.Methods Individuals aged 50 and above who had declined the booster dose andresided in London (n = 15) and the West Midlands (n = 15) were invited to participatein online qualitative interviews. These interviews delved into participants’ attitudestowards COVID-19 vaccine booster doses and their encounters with misinformationrelated to COVID-19. Zoom recordings were transcribed using Otter.ai andsubsequently imported into NVivo V.12 for thematic analysis.Results Analysis revealed four primary themes: ‘Vaccine production andadministration’, ‘Health misinformation and beliefs’, ‘Personal circumstances and socialinfluences’, and ‘Policy and logistical factors’. Key factors influencing vaccine hesitancyincluded mistrust in vaccine manufacturing, lack of culturally tailored communication,and logistical barriers to access. The role of social determinants emerged, as significantcontributors to disparities in booster dose uptake.Conclusion Future booster dose campaigns must integrate equity-driven approachesto overcome vaccine hesitancy and increase uptake among underrepresentedpopulations. By prioritizing transparent communication about vaccine manufacturingand regulatory processes, these campaigns can build trust in the vaccine’s safety andefficacy. Addressing misinformation with culturally sensitive messages tailored todiverse communities will help dispel misconceptions. Additionally, leveraging variouscommunication channels will ensure that the messages reach and resonate with allaudience segments. Establishing robust monitoring and adaptation mechanismswill enable timely responses to public sentiment and emerging concerns, ultimately ensuring that vaccine distribution strategies contribute to health equity rather thanperpetuate disparities