Oxford University research has shown that the UK has some of the highest death rates from COVID-19 (Ourworldindata.org). It is noteworthy that data also reveal that Black, Asian and Minority Ethnic (BAME) communities have been severely affected by COVID-19, with a disproportionate number of deaths recorded in both the first and second wave. Despite the UK being so badly affected, it has also administered one of the highest number of doses of the COVID-19 vaccination in the world, with over 28 million people having received their first dose (Gov.uk, 2021).
This is positive news; however, recent research on BAME communities has shown that there is a lack of uptake of the vaccination (Razia et al, 2021). The report by The Royal Society for Public Health (RSPH, 2020) confirms that immunisation in childhood is also significantly worse in the BAME communities (Forster et al, 2016). This led me to look at the reasons why and to try to understand how we can build up trust in the community. I undertook personal research into the barriers to the uptake of the COVID-19 vaccination in BAME communities.
I found that mistrust generally stemmed from three things:
- A lack of understanding on health outcomes of COVID-19
- A lack of information on vaccines
- Misleading information shared on social media about COVID-19.
Public attitudes to COVID-19 vaccination
The RSPH commissioned a poll on public attitudes to the COVID-19 vaccine. They asked respondents ‘How likely or unlikely would you be to take a COVID-19 vaccine if you were advised by your GP or another health professional to take it?’.
When asked, 57% (185) of BAME respondents stated ‘likely’ compared with 79% (1876) of white respondents.
The poll went further to look at the socio-economic status of the participants, and found that those in higher professional roles compared to those in semi-skilled posts were also more likely to accept the vaccine with 84% of professionals accepting the vaccine compared to 70% of semi-skilled workers. There are clearly barriers in the uptake of the COVID-19 vaccination, which leads to low perception and distrust from the BAME population.
I then looked at how much the public trust and have faith in health professionals, together with how much information is shared from the right sources. The RSPH poll showed that there was lack of trust for the vaccine among BAME communities, but many said they would be willing to have the vaccine if they received appropriate information explaining how the vaccination worked (RSPH, 2020).
The RSPH report does not break down specifically the term ‘white respondents’ into categories showing white British, white Scottish or white European, for example. This was also noted in the categories for socio-economic status. It was also noted that the categories for ‘Black, Asian and mixed heritage’ were small and that there may be a great difference within these groups which needs further investigation.
The participants in my brief study were BAME, aged 65-85 years old, all retired and living in London. I asked several questions:
- How have you coped through the COVID-19 pandemic?
- What are your thoughts on COVID-19 vaccination?
- Have your family and friends encouraged you to take the COVID-19 vaccine?
- If you have a religion, how has it impacted your decision on the vaccine?
- How do you feel about getting the COVID-19 vaccine?
The participants I spoke to explained several different issues including:
- ‘If I don't take it I would not be able to travel if I don't have the vaccination.’
- ‘My friends would look at me if I told them I had the vaccination so I would take it but not say anything.’
- ‘I have lots of questions but they could not answer me when I asked so I delayed my vaccination.’
- ‘I make my own decisions and I have decided to have the vaccine as this is what is best for me.’
- ‘I am not sure right now about having the vaccination as last time I had the flu vaccine I got ill and I have heard that it was made too quick.’
- ‘I have not been able to read any information from my GP surgery so how can I agree to take something I do not understand.’
- ‘I cannot book the appointment online so I will wait for them to contact me again.’
Some of these statements identified a lack of endorsement and understanding of the vaccine and increased fear of what the community might say if they had the vaccine. It also highlighted those who did not agree with the vaccine and feared the chemicals being injected. Some people who were religious felt their belief made them more immune to COVID-19 and that they would be protected by their faith.
The RSPH poll (2020) showed that BAME people who were offered health information from their GP regarding the vaccination showed an increased uptake of up to 35%. This was doubled compared to the white respondents, of whom only 18% would be likely to change their mind. This confirmed that further accurate information from the GP or health professionals can make a difference to alleviate concerns and fears and build up the BAME communities trust with the health professional. When I spoke to friends and colleagues and listened to their concerns and worries, and fully explained how the vaccination worked, uptake improved. This showed again the great disparities among the communities, and assumptions that people are aware and understand what the true benefit of vaccination is.
Genuine fears and historic mistrust
The people I spoke to expressed genuine fears that surprised me. From receiving incorrect information on social media to ideas around the vaccination being made so fast and roll out being too quick. One person in particular expressed that her uncle who lived in USA was part of the Tuskegee trial (Gamble, 1997) (an ethically unjustified study of syphilis conducted between 1932 and 1972 in the US) and all of their family members were on high alert for vaccination. A settled retired (80-year-old) pensioner from the Caribbean stated ‘oh we were guinea pigs when we were younger when they gave us our BCG vaccination I have an extremely large scar on my arm nothing like my daughters scar that she has’.
Altink's (2014) study on mass vaccination in the fight with TB in the Caribbean in 1951 also shows that due to the management of the vaccination programme there was much mistrust. It is important to understand that TB cases were low in 1910. According to the article, it was found that there was little TB and that it affected mainly the European minorities. Yet there was a project to trial TB vaccinations in the, then-known, colonies.
On review there is clear mistrust of the government when it comes to vaccinations for people from the Caribbean and Asian countries, due to feeling historically misused in trials (Gamble, 1997). A study carried out in the USA showed that there was a greater sense of mistrust and hesitancy for COVID-19 vaccination (Ferdinand et al, 2020). They reported that social services and health providers were the most trusted sources on supporting the uptake of the COVID vaccination. Menzies et al (2020) carried out a study in Australia in the Aboriginal community and found that there was a high rate of decline for the flu vaccination. This was due to misconceptions and under representation of their community in general practice leaving them feeling mistrust and discriminated against. It was found that more active communication to target the Aboriginal community was seen as urgent to educate and was best received by the community.
Addressing inequality
This personal short study has uncovered that some senior members with health issues in underrepresented communities may suffer inequalities due to the lack of correct information and assistance when compared with those in other communities with health conditions.
COVID-19 has clearly shown a disproportionate death rate within BAME communities. Sir Michael Marmot's report (2020) also supports the idea that COVID-19 has exposed the secrets which have always been know. Inequalities in social and economic conditions before the pandemic have contributed to the high and unequal death toll from COVID-19. To reduce health inequalities which have been exacerbated by the pandemic, long term policies with equity at the heart are required.
Currently there have been no deaths from the COVID-19 vaccination, which has now been given to millions. There have, however, been well over a million who have died worldwide from this virus and many more are suffering from long-term conditions. Increasing vaccination rates is important.
At the beginning of my research, 70% of the participants said no to the vaccine. After further information and explaining in detail the benefits of the vaccine, some participants changed their opinion. Overall, this decreased by 30% which demonstrates that by providing people with information and bettering their knowledge on the vaccine they were able to make an informed decision. I will leave you to ponder these questions:
- Is it true that some people in the BAME community are reluctant to accept the vaccination?
- Due to the inappropriate distribution of communication, is there a lack of trust towards the vaccine within the BAME community?
- Has the effect of previous medical negligence towards the BAME community affected their decision?