COVID-19 vaccine uptake in the UK - can we blame vaccine hesitancy?
COVID-19 vaccine uptake in the UK — can we blame vaccine hesitancy?
COVID vaccination programmes are underway all over the world. The UK government, somewhat controversially, was well stocked up with millions of vaccine doses and vaccinating over 80’s before most other countries had even received their first stocks of the COVID vaccine.
As we attempt to emerge from a pandemic that has had most of us in some form of lockdown for almost 18 months, our hope for the future is not only dependent on confirming the real-world efficacy of COVID-19 vaccines but also, and most importantly, on the uptake of these vaccines. At first glance the snapshot for the UK is positive — nearly eight months after the approval of the first COVID-19 vaccine to be administered, over 45 million people have had their first dose, which represents 87% of the adult population.
However, at close inspection, what the data does not really tell us is that the shocking disparity of vaccine uptake among different ethnic groups. Looking at the period from the start of December 2020 to the end of June 2021, 95% of white Britons over 50 have had at least one dose of the vaccine, while the percentages are much lower for Black Caribbean (66%), Black African (72%), Any other Black background (69%) and Pakistani (80%) people.
I am a researcher in the biomedical field, who has worked inside and outside the lab for almost 10 years, and I have been fortunate enough to have been offered both doses of the Pfizer vaccine in the beginning of 2021. I started my career in clinical trials working on a vaccine trial that looked at rolling out HPV vaccines to all adults; so, this moment in history, where we’re looking to vaccinate virtually every adult on the planet, is very exciting for me.
As a side note, I recently heard the expression “global majority” used instead of “ethnic minorities” or BAME and it is now part of my vocabulary. It does convey the disproportion in white versus all other ethic groups, overturning the view of “Black, Asian, and minority ethnic”, or BAME, to a realistic image of an actual global population majority that is non-white. So I will be using “global majority” in this blog as a term to indicate people from non-white ethnic groups.
Many prospective studies — those done before the COVID-19 vaccine was available — indicated that there was higher vaccine hesitancy among the global majority, and this raised the alarm as the risk of requiring hospitalization and death due to COVID are higher in some of these groups. A recent study showed that in the UK, there is higher vaccine hesitancy across some global majority ethnic groups, especially Black and Pakistani/Bangladeshi, and lower literacy groups.
As we know that COVID-19 disproportionally affects the global majority with more severe symptoms, higher likelihood of hospital admissions and higher mortality rate, we’re facing a double whammy here: the most at-risk populations are less likely to be vaccinated. These populations are also more likely to suffer from conditions such as diabetes, cardiovascular disease, depression and severe mental health problems.
We have the perfect storm, where populations that are already more at risk of worse physical and mental health outcomes are also more at risk of worse COVID outcomes (for example, black males are 4.2 times more likely to die from COVID than their white counterparts) but less likely to be vaccinated. The pandemic itself exacerbates these inequalities, resulting in higher unemployment, worse living conditions and violence, and of course, worse health outcomes in these communities. A poll by the Royal Society for Public Health found at under 60% of the global majority was willing to take the COVID-19 vaccination.
An example of this is the outbreak in Bolton (UK) of the delta variant. When looking at hospital admissions in Bolton in May 2021, most patients were eligible for the vaccine but were not vaccinated. On a recent news piece on the BBC, a local councillor has highlighted this issue as not of vaccine hesitancy but the direct result of deprivation, health inequalities and inadequate provision.
Even though an easy argument can be made for lower cognitive function (mental ability) and COVID-19 vaccine hesitancy, further complicated by “fake news” being churned through social media channels at an incredible speed, it would be lazy and frankly prejudiced to consider this as the only factor. According to a government report, the barriers to vaccine uptake are “the perception of vaccine risk, low confidence in the vaccine, distrust, inconvenience, socio-demographic context and lack of endorsement, lack of vaccine offer or lack of communication from trusted providers and community leaders”.
What is the solution then? Better engagement? Tailored solutions for each specific populations?
A recent paper suggested using “local champions” in the communities where vaccine hesitancy is higher, as well as creating major vaccination centres in areas of deprivation and/or areas with a high representation of global majority citizens. The same paper also suggested endorsement of vaccination by celebrities of these backgrounds.
The director of the NHS Race and Health Observatory has suggested that there are no “hard to reach” communities, just unsuitable communications — vaccination calls need to be translated to different languages and local faith leaders must be engaged in the rollout.
A Financial Times study now offers a glimpse of hope, with a narrowing of the gap of vaccination uptake between different ethnic groups of the population, meaning that, on a par with a high uptake of white Britons, the global majority seems to be less hesitant to take the vaccine. Any efforts being done now to shorten this gap come across an afterthought and not part of an articulated vaccination plan that had into consideration the global majority at the start of the vaccination rollout in the UK.
I believe that the only way to vaccinate the necessary amount of people to achieve some form of herd immunity — the achievement of low risk spread of a disease once the majority of a population is immune to the disease through vaccination — is, for now, to engage specific populations appropriately and from an informed place.
Otherwise “normal life” might never resume.
Vaccine hesitators are not simply misinformed, they are mistrustful for valid historical and social reasons. While we do this, we might learn a thing of two about how to include the global majority in decision-making rather than creating a system built by, and for, a global white minority.