Call to prioritise minority ethnic groups for Covid vaccines
People in high-risk minority ethnic groups must be prioritised for Covid immunisations, alongside a targeted publicity campaign, experts and politicians have said amid growing concerns over vaccine scepticism.
With figures on Monday recording more than 4m Covid vaccine doses now administered across the UK, and the rollout being expanded to all over-70s, public health experts and MPs called for black, Asian and minority ethnic (BAME) communities to be better protected.
The Scientific Advisory Group for Emergencies (Sage) has also raised concerns after research showed up to 72% of black people said they were unlikely or very unlikely to have the jab.
Prof Martin Marshall, chair of the Royal College of GPs, urged Whitehall to begin a public health campaign. “We are concerned that recent reports show that people within BAME communities are not only more likely to be adversely affected by the virus but also less likely to accept the Covid vaccine, when offered it,” he said.
“As such, where appropriate, we’re calling for public health communications to be tailored to patients in BAME communities, to reassure them about the efficacy and safety of the vaccine and ultimately encourage them to come forward for their vaccination when they are invited for it.”
His remarks came as the vaccines minister, Nadhim Zahawi, admitted he feared some BAME communities could remain exposed to coronavirus despite high expected uptake of the jabs.
“My big worry is if 85% of the adult population get vaccinated, if the 15% skews heavily to the BAME community, the virus will very quickly infect that community,” he said.
Bereaved relatives said some misinformation played on religious concerns, including that the vaccine might contain pork and is not halal or that it could result in modification of DNA.
Dr Habib Naqvi, director of the NHS Race and Health Observatory, said language and cultural barriers played a role in fuelling vaccine scepticism, adding: “We need to be clear to our communities that there is no meat or meat products in the vaccine. There is no pork, there is no alcohol and it has been endorsed by religious leaders and religious councils. Officials were working with role models and community and faith leaders to debunk myths, he added.
Data from the first wave of the pandemic shows that ethnic minorities were up to twice as likely to die from Covid.
Coronavirus mortality rates for black African and Bangladeshi males aged nine to 64 were around five times the rate among white males of the same age during the first wave of the pandemic, according to the Office for National Statistics (ONS).
With figures on Monday showing a record 37,475 patients in hospital, and another 599 people having died in the 28 days to Monday, the rollout of the vaccine is seen as key to bringing the pandemic under control.
Amer Awan, whose father Nazir was formerly a director at the Birmingham Chamber of Commerce and died of Covid in April, said he was getting daily reports of relatives and friends contracting the disease and others dying as vaccine scepticism and “brainwashing” was taking hold in pockets of Birmingham.
Awan asked for ethnicity to be included as a factor in vaccine prioritisation and urged the government to act now to quash conspiracy theories. “There are a few quite influential people who are using online platforms to say quite ridiculous things about this vaccine – about its side-effects, that it has pork in it and even that it will put a microchip in people’s bodies. It’s ridiculous but also scary because the people that need this vaccine the most might not get it,” he said.
Marshall highlighted that GPs could use discretion when offering vaccines, taking into account the need of local communities.
“Whilst those from BAME communities are not specifically on the Joint Committee on Vaccination and Immunisation (JCVI) list, ethnicity is one of the criteria for prioritisation within each group according to guidance from NHS England. As such, GPs are able to use their clinical judgment within the priority list to ensure the programme meets the needs of local communities.”
He has previously written to Matt Hancock, asking the health department to provide more information on the decision to omit BAME communities from the JCVI priority list.
According to ONS figures up to late July in England and Wales, the Covid death rate for black African men was 62 per 100,000 compared with 12 per 100,000 for white men. The rate for Bangladeshi men was 61 per 100,000.
Black African women had the highest under-65 death rate of any ethnic group, with 27 deaths per 100,000, compared with seven per 100,000 white women. The rate for Pakistani women was also more than three times as high as the rate for white women, with 26 deaths per 100,000.
Research highlights how systemic racism is driving health inequalities, with experts from UK and US universities revealing that racism is a root cause and major driver of ill health in general and increased mortality rates from Covid-19.
The report, published in the BMJ, explores the possible societal causes of these trends. Where risk of exposure to the virus is high, the authors recommend that ethnic minorities should be supported at work into non-public facing roles and away from Covid risk areas where possible, with those at high risk prioritised to receive a jab.
Co-author Prof Aneez Esmail, of the University of Manchester, said 10 months into the pandemic it had become clear that Covid-19 had exposed inequalities in society.
“We are not in this together as many politicians have tried to claim. Ethnic minorities, including ethnic minority healthcare staff, in the rich countries of Europe and North America have been disproportionately affected by the impact of Covid-19, whether it is because of increased death rates or the significant morbidity that patients suffer as a result of the infection,” he said.
The authors, also from Harvard University and Imperial College London, say everyday discrimination, people’s implicit biases, and cultural and structural racism lead to worse health outcomes.
Sadiq Khan, the mayor of London, has written to the health secretary and the JCVI calling for the prioritisation of vaccines for emergency service workers, TfL staff and other key workers.
“Black, Asian and minority ethnic communities are over-represented in frontline occupations and have been disproportionally impacted by Covid-19. I have urged ministers to learn lessons from the first wave about how this virus exacerbates inequalities and affects particular communities. This should include monitoring and publishing detailed data on vaccine take-up,” he said.
The Labour MP Apsana Begum said the failure to prioritise at-risk BAME groups for vaccines was a dereliction of duty. “With the pandemic in its most dangerous phase, the government must change course and adopt a policy of prioritising vaccines for those in the BAME community who are most vulnerable to Covid,” she said. “Unless ministers agree to prioritise atrisk BAME groups without any further delay, the government will be to blame for many more lives being lost in these communities.”
In the US, the Centers for Disease Control and Prevention released guidance in October for state and local planners, urging them to identify “critical populations” that should get the vaccine early, which included “people from racial and ethnic minority groups”.
A spokeswoman for the Department for Health and Social Care said the list of conditions used to identify individuals who may be clinically extremely vulnerable to Covid is agreed by the four UK chief medical officers on the basis of the latest available evidence, adding: “Clinicians in the NHS are able to add any patient to the shielded patient list, based on clinical judgment and an assessment of their need.”