In February this year, The Royal College of General Practitioners (RCOGP) called for a high-profile campaign backed by faith leaders and prominent figures from ethnic minority communities to increase vaccine uptake, illustrating a growing concern that those communities are at risk of being left behind by the UK’s vaccination programme. Vaccine manufacturers themselves have also acknowledged the issue and joined the campaign against hesitancy by offering re-assurance and transparency about how their vaccines were developed.
Encouragingly, from December 2020 to March 2021, we found that the proportion of ethnic minority respondents telling us they would take the vaccine, had already had it, or who had a vaccine appointment booked, increased from 70% to 92%. This increase was faster than that seen in White ethnic groups, and closed the gap between ethnic minorities and white groups to just 2ppt. But these numbers also conceal important differences between different ethnic minorities: government data shows that at the beginning of April 2021 around 30% of Black people in the UK were still hesitant, a considerably higher proportion than seen amongst any other ethnic group. And our very latest study has showed that while acceptance of the vaccine has plateaued across the general population (remaining unchanged at 94% from March to May), it has fallen back to 88% across ethnic minority Britons, suggesting that their favourability towards the programme is rather more fragile.
So, what can be done to address this?
We should begin by trying to understand why we’re still seeing greater hesitancy among particular communities - the additional context might offer important clues to help identify some appropriate solutions.
The gap between ethnic minority readiness for the vaccine and that of the general population can be explained partly by age. Ethnic minority Britons are younger on average than White Britons (at the time of the last census, there was a gap of around 10 years in the median age) and we know that age is closely associated with vaccine hesitancy: younger Britons are more likely to express reluctance to accept one. But this only explains part of the difference, as do other socio-economic factors such as income and deprivation.
Sometimes, there are practical obstacles to vaccine uptake, such as language or access to media, which is where word-of-mouth community-based initiatives such as “pop up” vaccination clinics in places of worship can make a difference. The Policy Institute at King's College London recently examined some specific worries around taking the vaccine and found that ethnic minorities shared similar concerns with white ethnic groups, placed those concerns in the same order of importance, but were worried to a much greater degree in every case.
Clearly, more deep-rooted cultural factors play the greatest role in explaining why some ethnic groups are more vaccine hesitant than others. There are profound issues in some communities stemming from a perception that the healthcare system (and public institutions in general) treat them poorly. This distrust is evident in the many personal stories told of ‘being treated differently’ that have left a mark across some ethnic minority communities, and these stories are repeatedly corroborated by studies. For example, earlier this year, we learned that Black mothers were 4 times more likely to die in childbirth than White mothers (and Asian mothers twice as likely), while research cited in the Biomed Central journal has found that Black women were prescribed less pain relief in labour, and the Government’s own research has found that Black men are more likely to be sectioned under the Mental Health Act. There are also lingering cultural memories of historical mistreatment in clinical trials, such as the Tuskegee Syphilis Study where six hundred African American men took part in a trial to receive treatment for the disease but were instead given no treatment at all.
Thankfully, the rate at which the vaccination programme is covering the British population suggests we will succeed in reaching herd immunity even with the current small minority of people remaining reluctant to receive the vaccine. But this still leaves a risk of localised outbreaks, concentrated amongst communities that have already disproportionately suffered with both the health and the economic effects of the pandemic. And there are worrying signs that the gap in vaccination rates may have a negative impact on race relations, particularly with the emergence of new variants that have links to immigrant communities in the UK.
All of this also plays into fears about vaccine passports, which – if introduced – risk worsening discrimination against ethnic minorities and further entrenching division. The prospect of ethnic minority Britons being less likely to be eligible for vaccine passports is reflected in their fears about the effects – our research from March of this year revealed that fewer than half of them agreed that the potential benefits to the economy outweighed the ethical and legal concerns, compared to nearly two-thirds of White Britons that felt that way.
So, what does all this mean about the various campaigns to address vaccine hesitancy? We think there are three important elements to any initiative designed to overcome vaccine hesitancy amongst ethnic minority communities. Firstly, any campaign must understand the diversity amongst and within ethnic minority groups – each of the communities is as different from one another as they are from White Britons, and the data shows that their experiences and attitudes vary considerably. Secondly, campaigns must acknowledge the contextual history of ethnic minority experiences in healthcare if they are to successfully engage with that audience. Thirdly, whilst no-one can undo historical injustices, it is possible to build trust through communications and work toward ensuring those injustices are not repeated. Some of the success in reducing vaccine hesitancy has come about through the skilful use of ethnic minority celebrities and clinicians supporting the vaccine rollout. As the government continues to review the potential consequences of vaccine passports, it should take account of ethnic minority concerns and try to understand the impacts through the lens of race to ensure that systemic and structural racism is not exacerbated by any attempt to introduce them.
In April 2021, a study by the Policy Institute found that 23% of ethnic minority Britons say they now trust the UK government more because of the vaccine programme, although this still lags the increase amongst White ethnic groups. But there are clear signs here of a change in perceptions that indicate ethnic minority Britons can become more receptive to positive messaging, and an opportunity for campaigns to leverage this growing trust and connect with a wider audience.
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