Preventing COVID-19 in multi-ethnic urban settings with a focus on vaccination

The COVID-19 pandemic has highlighted existing health inequalities between ethnic groups. Ethnic minority groups were disproportionately burdened by SARS-CoV-2, with high rates of infection, hospitalization, and mortality. Understanding COVID-19 prevention across different ethnic groups is crucial for reducing inequalities and improving preparedness for future public health crises.
This thesis examines COVID-19 prevention across different ethnic groups in Amsterdam and Madrid, focusing primarily on SARS-CoV-2 vaccination, with additional analyses of testing uptake and contact behavior. Using data from six ethnic groups in Amsterdam (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan ethnic origin), we explored vaccination intent around the start of the vaccination campaign, its association with subsequent first-dose uptake, the actual first-dose vaccination uptake during the first months of the campaign, spike protein antibody prevalence during a later phase of the pandemic (distinguishing between antibodies acquired through infection, vaccination or both), and testing behavior. To broaden the perspective beyond the Netherlands, we also investigated vaccination uptake in Madrid in relation to the proportion of residents with a migration background.
The findings show that vaccination intent and uptake were generally lower among ethnic minority groups in Amsterdam than among the ethnic Dutch population. These differences persisted throughout the vaccination campaign and were reflected in patterns of antibody acquisition. In contrast, vaccination uptake in Madrid was broadly similar across population groups, although some areas experienced delays in uptake. Testing uptake was largely comparable across ethnic groups, with some notable exceptions.
Together, these findings highlight the importance of developing targeted approaches to promote equitable uptake of preventive measures across diverse populations. Key recommendations include the early identification of target groups, active community engagement, accessible communication, rebuilding trust and strengthening inclusive public health systems to strengthen prevention strategies and preparedness for future infectious disease outbreaks.