Background: COVID-19 booster vaccinations are a critical public health tool for maintaining immunity against SARS-CoV-2, particularly with the emergence of new variants. However, significant disparities in primary vaccine uptake were observed among ethnic minority populations in the United Kingdom (UK). There is a pressing need to understand the specific factors influencing booster dose acceptance in these communities to ensure an equitable pandemic response. This systematic review aims to identify and synthesize the barriers and facilitators to COVID-19 booster uptake among UK ethnic minority groups.

Methods: A systematic review of qualitative, quantitative, and mixed-methods studies was conducted, following PRISMA 2020 guidelines. Key databases (including MEDLINE, Embase, and CINAHL) and grey literature sources were searched for UK-based studies published since December 2020 that reported on factors influencing COVID-19 booster uptake in ethnic minority populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. A thematic synthesis was performed to analyse the findings.

Results: Key barriers identified were: (1) persistent and deep-seated mistrust in government and healthcare institutions rooted in historical and ongoing discrimination; (2) the pervasive spread of targeted misinformation through community networks; (3) cumulative concerns about the safety and necessity of repeated vaccinations; and (4) structural barriers, including logistical and language challenges, that impede access. Key facilitators included: (1) engagement with trusted messengers such as faith and community leaders; (2) clear, culturally-competent communication that directly addresses community concerns; (3) hyper-local, convenient vaccination services; and (4) a strong desire to protect family and community.

Conclusion: Addressing inequities in booster uptake requires moving beyond generic public health messaging. Policy and practice must focus on long-term, trust-building partnerships with ethnic minority communities, co-designing tailored interventions that dismantle access barriers and empower trusted local voices.

Booster Vaccination, Vaccine Hesitancy, Ethnic Minorities

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