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UK’s ‘colour-blind’ vaccine strategy puts ethnic minorities at risk, experts warn

Government warned current approach disregards pandemic’s unequal impact on black, Asian and minority groups

Samuel Lovett,Nadine White
Wednesday 10 March 2021 07:21 GMT
Another Covid surge inevitable, Chris Whitty warns MPs

The government has been urged to reconsider its coronavirus vaccine allocation strategy, with doctors, academics and public health campaigners calling for the targeted inoculation of vulnerable ethnic minority groups in the second phase of Britain’s rollout.

More than 23 million people in the UK have now received a first vaccine dose, including a majority of care home residents, people aged 70 and over, and healthcare workers.

Authorities are racing through the remaining at-risk groups, and the government has said that those under 50 will be vaccinated by age rather than occupation or ethnicity in the next phase of the rollout.

But in a commentary published by the Journal of the Royal Society of Medicine (JRSM), a group of experts has warned that the UK’s “colour-blind” approach puts ethnic minorities at higher risk of illness and death from Covid-19.

The authors say the strategy disregards the unequal impacts of the pandemic on minority groups, who have suffered from some of the highest Covid mortality rates, and risks exacerbating health disparities within these communities.

Other campaigners and public health figures have told The Independent they thought the government’s handling of the crisis – in failing to mitigate against the high-risk factors that ethnic minorities have faced – has left millions of people in the UK abandoned and vulnerable to infection.

Although the Joint Committee on Vaccination and Immunisation (JCVI) has acknowledged that people from ethnic minority groups face a higher risk of hospitalisation from coronavirus, it said last month that “continuing the age-based rollout will provide the greatest benefit in the shortest time”.

However, Azeem Majeed, a professor of primary care and public health at Imperial College London, has called on the government to prioritise all high-risk individuals, including ethnic minorities, arguing that a failure to do so puts the rest of the population in jeopardy.

Prof Majeed, lead author of the JRSM commentary, highlighted how ethnic minorities have been hit hardest by the pandemic – an outcome that is “largely explained by the social determinants of health, including systemic racism and socioeconomic differences, rather than genetics or biology”.

Research has shown that people from minority groups are more likely to live in crowded and multi-generational households, where self-isolation and social distancing may prove difficult, thereby heightening the likelihood of transmission, the authors said.

Similarly, ethnic minorities comprise a higher proportion of the high-risk and low-paid essential workers in the working-age population, especially in urban areas, again increasing their risk of exposure.

The JRSM commentary pointed to the example of London, where 34 per cent of the working population is black or Asian. However, these groups represent 54 per cent, 48 per cent and 44 per cent of food retail workers, health and social care workers, and transport workers, respectively.

“As individuals from these communities are more likely to not have the option of working from home, and may require regular public transport use, they are also exposed to a higher risk of infection by these routes,” Prof Majeed wrote.

Targeting these individuals for jabs would secure “the greatest benefit across the population”, he said.

And given the overrepresentation of ethnic minorities in critical and key jobs, prioritisation of these groups would help to “preserve the healthcare system, accelerate re-opening of society, revive the economy and enable the operation of essential community services,” the commentary added.

“If insufficient numbers of individuals from Bame [black, Asian and minority ethnic] communities are vaccinated, the virus will continue to spread amongst these groups, putting the general population at risk.”

Dr Zubaida Haque, a member of Independent Sage, criticised the JCVI for changing its strategy, saying it moved the emphasis for the next phase of the rollout from “risk and vulnerability to speed”.

“Their approach at the beginning was based on a risk score of vulnerabilities, and that’s why the elderly were vaccinated first, along with NHS staff and health care and social workers,” she told The Independent. “It was based on vulnerability and exposure at the beginning.”

Coronavirus in numbers

Dr Haque added: “Moving forward, they’ve clearly changed strategy and I think that begs the question of why. There is no clear justification for focusing on speed now while neglecting the vulnerabilities that black and ethnic minority groups are facing, other than the fact that the government has set a target.

“We know that black and Asian people are three to four more times at risk from Covid-19 death. More Bangladeshi and Pakistani people have died in the second wave than in the first wave, and actually the risk factors for them are getting worse. It does seem odd to me to draw the line now.”

The latest report from the Cabinet Office’s race disparity unit (RDU) showed that the direct outcomes of Covid-19 improved for most ethnic minority groups between the first and second waves of the pandemic.

However, Bangladeshi and Pakistani people have continued to experience a considerably higher risk of death compared to white people.

The second wave mortality rates have notably risen by 124 per cent and 97 per cent for men and women from Pakistani backgrounds respectively, according to the RDU.

Patrick Vernon OBE, an equalities campaigner, told The Independent that the disregard for minority communities “feels like Windrush scandal part two”.

He pointed to the “impact of [a] hostile environment where there is a lack of a duty of care again” and “limited engagement listening to the lived experiences of the community”.

The authors of the JRSM commentary also argued that ineffective vaccination strategies were fuelling the high levels of vaccine hesitancy recorded among ethnic minorities.

Prof Majeed said it was likely that a lack of trust among ethnic minority groups, concerns over safety and limited endorsement from community leaders were “key factors” in driving anxieties and fears surrounding the vaccines.

New survey data from the Office for National Statistics has shown that 4 in 10 of black or black British adults are reluctant to get a Covid-19 vaccine – the highest of all ethnic groups.

And according to recent research published by the Royal College of GPs, white people in England are more than twice as likely to be vaccinated as people from black backgrounds, and three times as likely as those from mixed ethnic communities.

Dr Halima Begum, director of the Runnymede Trust race equality think tank, said more needed to be done to ensure access to vaccines within these communities.

“Runnymede has been calling for practical ways of getting the jab to people’s doors through mobile vaccination units,” she told The Independent.

“Public information is necessary but not sufficient in driving uptake or dealing with disparities in vaccine update. Unless we can level up the huge inequities in health access, including access to the vaccine, we stand the risk that our BME communities will be blamed for not playing their part in the national Covid recovery.”

Dr Raghib Ali, independent expert adviser to the government on coronavirus and ethnicity, said the JCVI had concluded that biggest risk factor for death from Covid-19 was age, followed by certain co-morbidities.

He said that individuals who were vulnerable to a combination of risk factors – such as a black man with diabetes, obesity and living in a deprived area – had already been added to cohort six of the UK’s vaccination priority list.

A Department of Health and Social Care spokesperson said: “The independent JCVI’s advice on Covid-19 vaccine prioritisation was developed with the aim of preventing as many deaths as possible, with older age being the single greatest risk of death. We are following the JCVI recommendations so that we save lives.

“We have invested millions into research into ethnic disparities and Covid-19 and established a new NHS Race and Health Observatory to tackle the specific health challenges facing people from ethnic minority backgrounds.

“We want every eligible person to benefit from a free vaccine and will continue to work closely with the NHS to support anyone who has questions.”

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