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The Covid-19 pandemic highlighted that people from ethnic minority backgrounds have a greater risk of dying from Covid-19 than people of White ethnicity but are less likely to accept the Covid-19 vaccine.

As the UK Covid inquiry into decision-making made by the government during the pandemic continues, it is pertinent to highlight the mistrust rooted in structural inequality which may be a key barrier to Covid-19 vaccine uptake.

We need to better understand how structural factors (including socioeconomic position and experience of racism) influence vaccine confidence.

Understanding and addressing these processes is likely to lead to longer-term impacts than providing people with vaccine information alone.

We aimed to find out more about the concerns of ethnic minority groups relating to the Covid-19 vaccine.

We conducted qualitative interviews and focus groups with 22 people from London and surrounding areas in December 2021 to March 2022.

15 participants were members of the public from ethnic minority backgrounds and 7 were professionals working in the NHS, public health and third sector.

Our findings suggest that people from ethnic minority backgrounds make decisions regarding Covid-19 vaccination based on a combination of social structures (institutional infrastructures and power relations, political authority, social position, social interactions, race and racial inequality) and internal processes ((including morals, principles and attitudes, and vaccine-specific knowledge).

We may be able to support knowledge accumulation and interpretation through the provision of reliable and accessible information, particularly through primary and community care.

But future recommendations for policy and practice should include action on the social structures (particularly power relations and racial inequality) which reduce vaccine confidence in ethnic minority communities.