Research: relationship between vaccination readiness and socioeconomic status

In neighborhoods where residents have a higher socio-economic status, the vaccination rate against Covid-19 is higher. That appears from an investigation of the National Institute for Public Health and the Environment (RIVM) on participation in the National Immunization Programme, which was published on Friday.

In neighborhoods with relatively many vaccinated residents, people also more often vote for right-wing liberal, progressive liberal and Christian middle parties. Residents of neighborhoods with a lower vaccination rate voted more often for right-wing Christian and right-wing conservative parties.

Fewer people also had themselves vaccinated in neighborhoods where many people with a non-Western migration background live. The relationship between these characteristics and willingness to vaccinate was mainly seen in people aged 50 and older.

Little surprising

The results are hardly surprising, says health economist Bram Wouterse of Erasmus University Rotterdam. He is an expert on health policy and calls it a “known phenomenon” that people with a lower socio-economic status are more difficult to reach by governments and health authorities. “While in those groups the most health gains can often be achieved with effective policy.” That dilemma plays out across the “entire breadth” of preventive health care, says Wouterse, and therefore also in the vaccination campaigns.

As a health economist, Wouterse looks, among other things, at ways to “bridge” between authorities and citizens that are more difficult to reach. This can be done, for example, by improving social cohesion, he says. What does that look like? “Think of a community center where general practitioners are also present, or people who can refer to the right authorities. Give it a place in the neighborhood.” People who are less willing to get vaccinated often have less confidence in the government. But the GP is often trusted.

During previous vaccination campaigns, Rotterdam general practitioners, among others, went to the market to talk to people about vaccination. An effective way to reach people, according to Wouterse. “Such a role in public health policy suits the GP well – although of course he is already very busy.” Instead of general practitioners, GGDs, for example, could also fulfill such a role, he says.

Wim Groot, a health economist at Maastricht University, also points to a broader distrust in government. “And that is not entirely unjustified: the government does not always show itself to be reliable. The Supplementary Affair, for example, mainly affected those groups that were already less well off. It is therefore not surprising that distrust is growing there.”

According to Groot, the government can work on that trust through ‘informal information channels’. So no official letters, but through contacts in certain communities. “Role models, for example. PO box 51 [de vroegere naam van de officiële informatiekanalen van de overheid] is no longer sufficient.”

Too many websites

Groot refers to an excerpt from The Evening Show with Arjen Lubach, in which presenter Lubach shows how many different websites the government has. “I was also surprised when I went to make my vaccination appointment: you are referred from one web page to another. Yes, then people drop out.”

In neighborhoods where there is mainly a connection between a low vaccination rate and a right-wing conservative or right-wing Christian conviction, government campaigns would be less likely to work, thinks Wouterse. “That touches more on the essence of someone’s being. Health policy should also be about what people consider important. In the end, everyone decides for themselves.”

A spokesperson for the RIVM says that the outcome of the investigation is currently no reason to change anything about the information provision. “This is an epidemiological overview from which we do not draw any conclusions. But we are always thinking of ways to better reach people.”

The Netherlands has a relatively high vaccination rate: over 82 percent of adults have been vaccinated twice (the basic vaccination). More than 60 percent also obtained a repeat shot.