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Project #48:
Recording of "COVID-19 vaccine declined" among vaccination priority groups


All patients in England within vaccine priority groups were offered a COVID-19 vaccine by mid-April 2021. Clinical record systems contain codes to denote when such an offer has been declined by a patient (although these can in some cases be entered for a variety of other reasons including vaccination delay, or other administrative issues). We set out to describe the patterns of usage of codes for COVID-19 vaccines being declined.

We identified all patients in key vaccine priority groups: aged over 50, or over 16 and at increased risk from COVID-19 (Clinically Extremely Vulnerable [CEV] or otherwise “at risk”). We describe the proportion of patients recorded as declining a COVID-19 vaccination for each priority group, and by other clinical and demographic factors; whether patients recorded as “declined” subsequently went on to receive a vaccination; and the distribution of code usage across GP practices.

We found that clinical codes indicative of COVID-19 vaccinations being declined are widely used in English general practice. Of 24.5 million patients in priority groups as of May 25th 2021, 89.2% had received a vaccine, 8.8% had neither a vaccination nor a decline recorded, and 2.7% had a decline code recorded. Of patients with a recorded decline, 18.9% were subsequently vaccinated.

Declines were substantially more commonly recorded among Black and South Asian patients, and patients from more deprived areas. There is a need for more detailed survey and/or qualitative research with patients and clinicians to determine the most common reasons for these recorded declines.


  • Study leads: Helen Curtis
  • Organisation: University of Oxford and London School of Hygiene and Tropical Medicine