Pressure on government over ethnic minority vaccines

The vaccine rollout is gathering pace. More than 10 million people in the UK have now received their first dose of the Covid-19 jab, including nine in ten of those aged 75 and over in England. But there is growing concern about the uptake among ethnic minority groups.

New analysis has found that vaccination rates for the Covid-19 jab in England are much lower among non-white people aged 80 and above compared to their white counterparts, and the chief executive of NHS England has expressed “genuine and deep concern” about the issue.

But why are some people from ethnic minority groups more hesitant to take the vaccine? According to Dr Rochelle Burgess, a lecturer in global health at UCL, vaccine hesitancy is rooted in a historic lack of trust.

“The biggest levels of vaccine hesitancy in the UK are traditionally among groups who have historically faced oppression, exclusion and various forms of violence from the same systems that are linked to developing, administering and delivering these vaccines,” she said.

Dr Burgess explained that this historic exclusion has the potential to make minority groups more vulnerable to misinformation campaigns.

“If a misinformation campaign is anchored to a source that is trusted, and the content of the message confirms an existing belief that is established through lived experience – for example, feeling that the government does not always have my best interests at heart because of experiences of police brutality or being impacted by the Windrush scandal – then it’s easier for you to believe in that, because it’s anchored to something that you believe to be true.”

Vaccine hesitancy and misinformation among minority ethnic groups is particularly concerning given the overwhelming body of evidence that people from these groups are at a disproportionate risk of catching and dying from coronavirus; data from the first wave of the pandemic shows that ethnic minorities were up to twice as likely to die from the virus.

Although the government has suggested on more than one occasion that these statistics are due to different ethnic groups being naturally more susceptible to Covid-19, these comments have come under fire.

In a blog post criticising comments made by the Home Secretary, Priti Patel, a research analyst at race equality think tank Runnymede Trust wrote: “We know well that there is absolutely no biological basis to race, and that there is no substantial evidence behind earlier peddled-out theories of the link between vitamin D deficiencies among black and minority ethnic (BME) people and higher coronavirus rates.”

The use of vitamin D as a preventative or treatment method for Covid-19 has been much debated during the pandemic. Taking regular doses of vitamin D can help boost defences against infections such as influenza and  deficiency is more common in those who are older and overweight as well as in the black and Asian populations. The evidence that vitamin D can help prevent people contracting Covid-19 is inconclusive, however.

Instead, research has consistently shown that structural inequalities are to blame. As The Kings Fund explains: “People from ethnic minorities are more likely to have underlying health conditions that make them more vulnerable to the virus, work in roles where they are exposed to it and live in conditions in which it is more likely to spread.”

In spite of this significant body of research, BME communities are not currently prioritised on the Joint Committee on Vaccination and Immunisation (JCVI) list. There are growing calls from MPs and public health experts for a review of vaccine prioritisation.

One of the policies announced last week to reduce vaccine hesitancy among ethnic minority groups that are currently eligible for the vaccine is the publication of information on ethnicity and occupation of those who have received their jab.

According to the NHS, vaccine data on different demographics has always been available via patient healthcare records but has yet to be published. An NHS spokesperson said “In addition, as a “belt and braces” supplementary measure, ethnicity data is also being recorded as part of the vaccination collection through Pinnacle [an NHS IT system]”.

But there are concerns about the completeness of NHS healthcare records. The HSJ reported that “although the NHS can ascertain ethnicity for some people by linking vaccine data to GP and other healthcare records, this is likely to exclude a substantial number of recipients, and may take longer”. Ethnicity is thought to be recorded in around 60 to 70 per cent of GP records.

Dr Gurch Randhawa, professor of diversity in public health at the University of Bedfordshire, said: “It is important to know who has been offered a vaccine, not just how many people. Just as importantly, we need to know who has accepted or declined the vaccine, not just how many people.”

“Publishing up to date information by characteristics such as age, gender, ethnicity and socio-economic status would help build trust and confidence – this level of detail is not currently available.”

Mandating comprehensive and quality ethnicity data collection and recording was one of seven recommendations made in PHE’s report on the impact of COVID-19 on BME communities, published in June.

Another was the funding, development and implementation of culturally competent COVID-19 education and prevention campaigns.

According to the Cabinet Office’s quarterly report on progress to address COVID-19 health inequalities published in October, the strategies taken to improve ethnic minority communication include: working with specialist marketing agencies and targeting audiences with bespoke messaging, ongoing polling and focus groups with ethnic minority audiences and continued use of press partnerships.

But some academics, including Dr Randhawa, believe these measures have not gone far enough.

“Building trust and confidence between public and government is an ongoing journey, not something that can become the norm overnight. This requires meaningful and sustained engagement and partnership working at local level with trusted community organisations, and not just working with ethnic minority marketing agencies on an ad-hoc basis,” he said.

Research published this week by the London School of Hygiene and Tropical Medicine found that 64 per cent of London’s strictly-Orthodox Jewish community has been infected with COVID-19 – a rate nine times higher than the national average and one of the highest “anywhere in the world”.

The findings have heightened concerns about the challenges of sharing public health information with those ethnic and religious minorities who are less likely to engage with mainstream media.

According to Dr Burgess, the government needs to take an inclusive approach to public health messaging in order to engage ethnic minority groups: “A picture of a person of colour being vaccinated doesn’t automatically do anything to change the message, or its ability to change you. You need to create opportunities for discussion about these things, in collaboration with people who are already trusted by and within a community.”

Dr Burgess would like to see the creation of a programme that shows a commitment to prioritising groups of different ethnic backgrounds.

“As a first step, the government needs to fund meaningful engagement within and led by communities,” she said. “They need to devolve resources and responsibility to local authorities, who then cascade that down to community organisations, because while they may not trust the government anymore, they do trust each other.”

Dr Burgess said that this needs to happen now, before the vaccination rollout gains pace and leaves behind those communities with high levels of hesitancy. “My big fear is that we just continue on as we are and that inequality in terms of the burden of deaths will just get even worse,” she said.

“What the NHS has done in the past month to vaccinate millions of people is a testament to the true capacities of the NHS, and all of that will just get thrown down the drain if there isn’t an effective, funded, devolved response working in parallel against vaccine hesitancy in the communities that we already know are more likely to be hesitant.

“These communities will tell us exactly what they need in order to participate in vaccine rollout if we ask them. But nobody is asking.”