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11 January 2021

How the UK’s Covid-19 vaccination programme is failing to address racial disparities

Low levels of trust and poor access to healthcare among people from ethnic minority communities risk worsening racial inequalities.

By Samir Jeraj

Late last year, polling emerged that revealed some British, Asian and minority ethnic (BAME) communities were less likely to take up a Covid-19 vaccination.

The research by Queen Mary University suggests only 39 per cent of BAME Londoners are likely to take the vaccine, compared with 70 per cent of white Londoners. Another poll by the Royal Society for Public Health, conducted at a national level, found those numbers were 57 per cent for BAME people and 79 per cent of white people in the UK.

It may at first seem confusing that communities that have disproportionately suffered from Covid-19 and seen a higher rate of deaths are less likely to want to be vaccinated against the virus, but a closer look shows the reasons for both issues are rooted in the UK’s racialised health inequalities. The government is relying on a set of tools that have failed to address these inequalities in other aspects of healthcare, so why would they suddenly work for coronavirus?

See also: Why is coronavirus hitting Britain’s ethnic minorities so hard?

“There is quite a lot of variation between ethnic groups,” points out Professor Azeem Majeed, professor of primary care and public health at Imperial College London. While Indian communities see higher rates of vaccination in general, for example, African Caribbean and Bangladeshi groups tend to have lower rates. Geography plays a role too, with London having a lower rate of vaccination overall, particularly affecting ethnic minority communities. 

Some of the reasons for this gap are practical and could be tackled with a more pragmatic focus on logistics. Poverty, poor education and people simply moving around more all often contribute to the problem. Majeed therefore suggests bringing vaccination into local and community venues, as is done in schools, to widen access and ensure getting a vaccine is as simple and easy as possible.

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Other issues, however, require more thought. There are also particular religious concerns among Muslims – for example, over whether vaccine ingredients are halal. The British Islamic Medical Association (BIMA) has sought to alleviate fears by publishing an statement that strongly urges eligible Muslim to take up the vaccine. But it also highlights the poor trust in public health and government among minority communities and the need for better information.

This is symptomatic of more widespread challenges.

“People have still not been given adequate or any information,” says Lena Choudary-Salter, head of the community cohesion charity the Mosaic Community Trust. BAME communities are, like other groups, concerned about the safety and effectiveness of Covid-19 vaccines. And underlying suspicion of public institutions, fuelled by decades of bias and exclusion, make it less likely that the government’s blanket messaging will prove convincing.

Without clear and effective communication, Choudary-Salter says, people are susceptible to disinformation. That can spread through friends and family, online and via social media, playing on existing anxieties and distrust. The Mosaic Community Trust is using the BIMA’s statement as a guideline for its communications on the subject.

“We need more of this kind of information, which is credible in the eyes of the BAME communities,” says Choudary-Salter.

This is not an unexpected difficulty. The Race Equality Foundation has “been repeatedly raising worries about this and has produced an easy words and pictures flyer too”, according to its chief executive, Jabeer Butt. The charity has been asking for data on take-up of the flu jab, broken down by ethnicity, as it believes the Covid-19 vaccination programme is likely to follow a similar pattern. But it has yet to receive this information. 

“We are concerned that we are going to end up stigmatising a community or communities,” Butt warns. Early in the pandemic, for example, there was a rise in racist abuse and harassment of Chinese and east Asian people in the UK – and, indeed, other countries – because it was believed they were more likely to have Covid-19. If certain ethnic groups are thought to be rejecting vaccination, similar abuse could be levelled against them.

The reliance on digital information being put out by health authorities is another weakness. The existing hurdles of digital exclusion and language needs make it harder for those messages to get through to the people who need it most. Public health campaigns are mostly planned and executed at a national level, with little scope for tailored action to bring together health, local government and community organisations to meet the specific information needs of different communities.

These are not new issues  – they are challenges that crop up every year with the seasonal flu vaccine. Even in other areas of preventive health, such as cancer screening, BAME communities are underserved by the system.

“This isn’t just a Covid phenomenon,” says Professor Beate Kampmann from the London School of Hygiene and Tropical Medicine. She highlights the problems BAME communities face in accessing healthcare in general, and the disempowerment that structural discrimination creates.

This sense of “this isn’t for me” is something Kampmann has encountered in the focus groups she has done on vaccine hesitancy in general. “I don’t think it’s a specific difference with the Covid vaccine,” she says, but adds that she is surprised that the immediacy of the virus risk has not had a bigger impact in changing minds.

The guidance from central government means BAME communities are not one of the “priority” groups for vaccination, despite concerns raised by doctors’ groups and advice from the Joint Committee on Vaccination and Immunisation, which issued a statement on racial inequalities in early December urging authorities to “work together to ensure that inequalities are identified and addressed in implementation”.

Community engagement, with a focus on one-to-one conversations, on effective information from credible sources and on demonstrating that people from the same community are taking up vaccination is the only way to address these structural issues, according to Choudary-Salter. She suggests as a starting point that GPs, who command a high level of trust, could run group sessions in the community with the help of local organisations, to get the message across and answer questions.

“All of our experience in the community clearly demonstrates the power of community-level interventions and community participation in effectively communicating information,” she says. “At present, we do not see any such approaches being proposed.”

Nadhim Zahawi, the minister responsible for Covid vaccine deployment, commented:

“Vaccines save lives and it is vitally important that everyone is confident to take up the offer of a vaccine.

“We recognise the importance of raising awareness of the myriad benefits of vaccination within Black, Asian and minority ethnic (BAME) communities, who are known to be more at risk from Covid-19.

“The NHS and PHE are providing targeted advice and public information about the vaccination process to build awareness about its benefits.”