Recording of ‘COVID-19 vaccine declined’

A description of the patterns of usage of codes for COVID-19 vaccines being declined.

Eurosurveillance, 2022

Paper information

Curtis, Helen J and Inglesby, Peter and MacKenna, Brian and Croker, Richard and Hulme, William J and Rentsch, Christopher T and Bhaskaran, Krishnan and Mathur, Rohini and Morton, Caroline E and Bacon, Sebastian CJ and Smith, Rebecca M and Evans, David and Mehrkar, Amir and Tomlinson, Laurie and Walker, Alex J and Bates, Christopher and Hickman, George and Ward, Tom and Morley, Jessica and Cockburn, Jonathan and Davy, Simon and Williamson, Elizabeth J and Eggo, Rosalind M and Parry, John and Hester, Frank and Harper, Sam and O’Hanlon, Shaun and Eavis, Alex and Jarvis, Richard and Avramov, Dima and Griffiths, Paul and Fowles, Aaron and Parkes, Nasreen and Evans, Stephen JW and Douglas, Ian J and Smeeth, Liam and Goldacre, Ben. Recording of ’COVID-19 vaccine declined‘: a cohort study on 57.9 million National Health Service patients’ records in situ using OpenSAFELY, England, 8 December 2020 to 25 May 2021.


Priority patients in England were offered COVID-19 vaccination by mid-April 2021. Codes in clinical record systems can denote the vaccine being declined.


We describe records of COVID-19 vaccines being declined, according to clinical and demographic factors.


With the approval of NHS England, we conducted a retrospective cohort study between 8 December 2020 and 25 May 2021 with primary care records for 57.9 million patients using OpenSAFELY, a secure health analytics platform. COVID-19 vaccination priority patients were those aged ≥ 50 years or ≥ 16 years clinically extremely vulnerable (CEV) or ’at risk’. We describe the proportion recorded as declining vaccination for each group and stratified by clinical and demographic subgroups, subsequent vaccination and distribution of clinical code usage across general practices.


Of 24.5 million priority patients, 663,033 (2.7%) had a decline recorded, while 2,155,076 (8.8%) had neither a vaccine nor decline recorded. Those recorded as declining, who were subsequently vaccinated (n = 125,587; 18.9%) were overrepresented in the South Asian population (32.3% vs 22.8% for other ethnicities aged ≥ 65 years). The proportion of declining unvaccinated patients was highest in CEV (3.3%), varied strongly with ethnicity (black 15.3%, South Asian 5.6%, white 1.5% for ≥ 80 years) and correlated positively with increasing deprivation.


Clinical codes indicative of COVID-19 vaccinations being declined are commonly used in England, but substantially more common among black and South Asian people, and in more deprived areas. Qualitative research is needed to determine typical reasons for recorded declines, including to what extent they reflect patients actively declining.