How can collaborative methods help us understand vaccine hesitancy among youth?

Published on 14 June 2022

Megan Schmidt-Sane

Research Fellow

Santiago Ripoll

Research Fellow

Tabitha Hrynick

Research Officer

Elizabeth Benninger

Research on the context of COVID-19 vaccine ‘hesitancy’ can highlight a wide range of long-standing historical, political-economic, and social issues faced by marginalised communities. Young people, for example, were often labelled ‘vaccine hesitant’ when COVID-19 vaccines first became available, as uptake was lower amongst youth in the United Kingdom and United States. Such labelling can portray young people as ‘ignorant’ without addressing the deeply rooted causes of vaccine hesitancy. We know from social science research on vaccination that uptake of vaccines is rooted in context. Community experiences with authorities and the medical establishment can influence who they trust.

Our research, funded by the British Academy, used collaborative and participatory methods with young people (ages 12-18) in the Ealing borough of London and Cleveland, Ohio to understand how social context, including experiences of systemic racism and structural inequalities, shape responses to COVID-19 vaccines. Using a comparative case study approach and a ‘political economy of health’ lens, we found that vaccine uptake was patterned by age (younger youth were more likely to get a vaccine), experiences of marginalisation and deprivation, and family and peer influence. Rather than encountering misinformation on social media, young people were inundated with information (both good and bad) in the news, on social media, and from friends and family. Young people who were vaccinated were more likely to have friends and family who were vaccinated, and vice versa. Most importantly, young people’s engagement with COVID-19 vaccines reflected their experiences as youth in the UK and US. This showed up in mistrust between racially minoritised youth and local authorities.

Cleveland’s long and complicated history of racial diversity, marked by discriminatory housing policies (‘redlining’) and segregation in schools, among other injustices, shapes how the city’s Black youth relate to and trust in authorities. In Cleveland, as in many other cities, place matters. Where you live in the region determines what kind of housing is available, which schools children can go to, and whether there are supermarkets with healthy foods to purchase. Patterns of racial inequities also show up in wide health and education disparities. Black populations face higher infant mortality, while Black and Latine/Latinx are 3 times more likely to live in poverty (compared to whites). Black Clevelanders have a life expectancy that is 6 years lower than whites.

In Ealing, nearly half of the population was born abroad and it is one of the UK’s most diverse local authorities. Many residents face economic precarity and poverty, and overall, the borough ranks as the 87th most deprived of 326 local authorities in England, according to the Index of Multiple Deprivation (IMD). People from ethnic minority backgrounds are disproportionately impacted by issues of deprivation. COVID-19 also disproportionately impacted racialised communities in Ealing, with western parts of the borough being more affected by transmission, serious illness and death.

We engaged 123 young people in both settings using traditional research methods (in-depth interviews, focus group discussions) and youth participatory action research (YPAR). We worked with Youth Advisory Boards in each place that provided oversight of the research, validated study results, and helped with dissemination of findings. In both contexts, young people from racial minorities  reported facing barriers to employment, negative experiences within the education system, and worsening mental health. In Cleveland, young people reported symptoms of depression and anxiety during the pandemic that still have not been fully addressed. In Ealing, young people reported facing racism in schools and over-surveillance by local police who used Section 60 and ‘stop and searches’ as reasons to harass them. This contributes to a sense of being targeted, as well as ignored and under-represented in local and national political processes. This provides fertile ground for mistrust in government, and by extension, in COVID-19 vaccines.

Our work has been published in various formats, including this short summary report on the British Academy website, and two in-depth case studies of Ealing, London and Cleveland, Ohio. We also have two policy-oriented briefings on Ealing and Cleveland available on the Social Science in Humanitarian Action Platform (SSHAP). 


This blog was originally published by the Social Science in Humanitarian Action Platform (SSHAP). Follow SSHAP on Twitter to keep up to date with the latest activities and outputs.

The views expressed in this opinion piece are those of the author/s and do not necessarily reflect the views or policies of IDS.

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