Covid and the Coalfields: Vaccine attitudes in Appalachia and Wales

I joined a team of researchers from Bangor University, Cardiff Metropolitan University, Public Health Wales and the University of Kentucky to investigate attitudes towards Covid-19 vaccines in coal mining communities in Wales and the US. Our findings are published in a new report for the British Academy, Covid and the coalfield: Vaccine hesitance in Wales and Appalachia.

The Covid-19 pandemic is a stark reminder of the social gradient in health, with disadvantaged communities being worse affected on a range of outcomes from infections to deaths. This gradient
also appears in the lower uptake of vaccines, which risks exacerbating long-term health inequalities.

Our research looks at vaccine attitudes in two coalfield regions, south Wales and central Appalachia. We completed a large-scale quantitative survey of over 9,000 people across Wales and the states making up central Appalachia, and online qualitative interviews with 40 vaccinated and unvaccinated people.

Vaccination and attitudes towards it

We found higher levels of vaccine hesitance and suspicion towards official accounts of the pandemic in coalfield areas. Compared to non-coalfield areas, respondents were less likely to agree that the vaccines protected people against Covid-19 or that they trusted the science behind the vaccines.

In our US sample, these attitudes were accompanied by a lower rate of reported vaccination in coalfield areas. In Wales, vaccination rates were equivalent in coalfield and non-coalfield areas, suggesting that the risk of lower vaccine uptake in Welsh coalfield areas was averted. While this represents a striking policy success, the structural conditions for vaccine hesitancy do exist and trust should not be taken for granted.

Social and political participation

We can point to how people’s social and political participation might influence the way they respond to public health advice. Unvaccinated respondents often appeared disconnected from the communities in which they lived and were less likely to report being a member of local community groups and trade unions. These associations were particularly strong in coalfield areas in Appalachia. Vaccinated interviewees generally presented as feeling part of their communities. However, nonvaccinated interviewees appeared more likely to be socially isolated and many lived alone, or with elderly parents.

Lack of trust in government and mainstream media was common among unvaccinated respondents. There were lower rates of vaccination among survey respondents who voted for Donald Trump in the US and those who planned to vote for Reform UK and, to a lesser extent, the Green Party in Wales. Rates of vaccination were lower for those who voted ‘leave’ in the UK’s referendum on European Union membership than those who voted ‘remain’.

Non-voters were also more likely to be unvaccinated. In Wales, those who expressed ‘devosceptic’ or hostile attitudes towards Welsh devolution were also less likely to be vaccinated, while many vaccinated respondents praised the Welsh Government response.

Policy implications

The vaccination campaign was supported by wider civil society. Perhaps partly for this reason, many who remain unvaccinated are disconnected from their local communities. Policymakers need to find the means and messages to reach these people. Encouraging people to help protect their communities may be less persuasive to those who do not feel part of these communities. In Wales, those sceptical of Welsh devolution, may potentially benefit from specific messaging (and carefully chosen messengers) to boost uptake.

Dr Robin Mann is a WISERD codirector based at Bangor University. Robin’s research interests and expertise are in political sociology, especially national identity, nationalism, civil society; class, migration and ethnicity; and the politics of local social relations. 


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