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COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake

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  • Attwell, Katie
  • Turvey, Jake
  • Wood, Lisa

Abstract

Recent studies have used the World Health Organization's new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework's limitations regarding the centrality of the state in shaping people's vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state's role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals' willingness to engage. Government systems that leave some populations behind increase those populations' susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients' trust, especially in the context of vaccine mandates. Reframing the state's responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, “Recentering the State in Vaccine Uptake,” arising from our analyses.

Suggested Citation

  • Attwell, Katie & Turvey, Jake & Wood, Lisa, 2024. "COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake," Social Science & Medicine, Elsevier, vol. 348(C).
    • Handle: RePEc:eee:socmed:v:348:y:2024:i:c:s0277953624002569
    DOI: 10.1016/j.socscimed.2024.116812
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    References listed on IDEAS

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    1. Jane Currie & Olivia Hollingdrake & Elizabeth Grech & Georgia McEnroe & Lucy McWilliams & Dominic Le Lievre, 2022. "Optimizing Access to the COVID-19 Vaccination for People Experiencing Homelessness," IJERPH, MDPI, vol. 19(23), pages 1-16, November.
    2. Katie Attwell & Adam Hannah & Julie Leask, 2022. "COVID-19: talk of ‘vaccine hesitancy’ lets governments off the hook," Nature, Nature, vol. 602(7898), pages 574-577, February.
    3. Sayil Camacho & Sarah C. Henderson, 2022. "The Social Determinants of Adverse Childhood Experiences: An Intersectional Analysis of Place, Access to Resources, and Compounding Effects," IJERPH, MDPI, vol. 19(17), pages 1-21, August.
    4. Jamison, Amelia M. & Quinn, Sandra Crouse & Freimuth, Vicki S., 2019. "“You don't trust a government vaccine”: Narratives of institutional trust and influenza vaccination among African American and white adults," Social Science & Medicine, Elsevier, vol. 221(C), pages 87-94.
    5. Heinrich, Carolyn J. & Camacho, Sayil & Binsted, Kaitlin & Gale, Shadlan, 2022. "An audit test evaluation of state practices for supporting access to and promoting Covid-19 vaccinations," Social Science & Medicine, Elsevier, vol. 301(C).
    Full references (including those not matched with items on IDEAS)

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