Background International evidence has documented ethnic inequalities in COVID-19 vaccine uptake, but national evidence for Australia remains limited. We aimed to quantify ethnic inequalities in COVID-19 vaccine uptake in the first 6 months of 2024 and examine retrospective trends in Dose 1–4 (2021–22) across detailed ethnic groups among older adults.

Methods We conducted a nationwide cohort study of Australian residents aged ≥75 years who were not Aboriginal or Torres Strait Islander (N=2,038,522) by linking the 2021 Census, Australian Immunisation Register, death, and migration data. Age-standardized uptake of any COVID-19 vaccine dose by ethnic group was calculated (Jan 1–June 30, 2024). Stratified descriptive analyses were conducted to explore intersections between ethnicity and other key sociodemographic characteristics. Uptake of Dose 1–4 during 2021–22 was also assessed across ethnic groups.

Results In the first 6 months of 2024, 31.1% of the cohort received a COVID-19 vaccine. Uptake was substantially lower in several ethnic groups, including Central Asian (<10.0%, 95% CI <10.0–10.7), North African and Middle Eastern (<10.0%, 95% CI <10.0–<10.0), Pasifika (13.0%, 95% CI 11.7–14.4), and South Eastern European (10.5%, 95% CI 10.3–10.7) groups. These differences persisted even among individuals born in Australia, with higher English proficiency, higher educational attainment, and living in less disadvantaged areas. Similar inequalities were observed across earlier vaccine doses.

Conclusions Substantial ethnic inequalities in COVID-19 vaccination uptake persist among older Australians. Reliance on country of birth, language, or socioeconomic factors alone does not fully identify groups with the lowest uptake. Incorporating more detailed ethnicity information may improve identification of under-served groups and inform more targeted and culturally appropriate vaccination strategies.

Christina Abdel Shaheed reports grant support provided by the National Health and Medical Research Council (NHMRC) and the Medical Research Future Fund (MRFF) outside the submitted work. Bette Liu is supported by an NHMRC Investigator Grant and receives research funding related to COVID-19 from the NHMRC and MRFF outside the submitted work. All other authors declare no competing interests.

This study was supported by the Medical Research Future Fund (MRF2016680). The funders had no role in the design of the study, the undertaking of the study, the writing of the manuscript, or the decision to publish the manuscript.

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The New South Wales Population and Health Services Research Ethics Committee gave ethical approval for this work (2020/ETH01066).

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