Addressing the elephant in the room: COVID-19 vaccine hesitancy in Black and Asian communities

As a vaccinator with the City and Hackney GP Confederation, vaccine hesitancy is something I deal with every shift. For the most part, people are very grateful; however, there are the select few who are still hesitant to receive the vaccine. The evident trend is that the majority of patients who are vaccine hesitant belong to minority groups.

I agree wholeheartedly with Julia Darko in that the solution to the discrepancy in outcomes from COVID-19 infection lies with systemic change and that generations of trauma cannot be undone without meaningful structural change.¹ However, this does not solve the current public health issue of people of Black, Bangladeshi and Pakistani backgrounds having the lowest vaccination rates in England.²  These reduced uptake rates also exist on a background of significantly increased risk of COVID-19 morbidity and mortality, including more aggressive disease and poorer survival rates creating a massive health discrepancy.³

In my experience, the most important consideration to make is understanding why exactly the patient is vaccine hesitant as this varies significantly from person to person. This idea of exploring the ICE (Ideas Concerns and Expectations) of the patient is strongly emphasised at medical school but has been lost slightly in the clinical environment. A pilot programme conducted by NHS Leicester City CCG demonstrates the importance of ICE in vaccine uptake, where 69% of unvaccinated patients booked appointments after a 15-minute call from a GP.⁴ I have also found that a discussion with the supervising GP in the centre helps alleviates anxiety and increases vaccine uptake.

Institutional racism, discrimination and underrepresentation of minority groups in health research are all factors that foster a lack of trust in healthcare services in the UK. I strongly agree that the ultimate goal should be structural change, however this does not address the current healthcare disparities that exist in tackling COVID-19. As healthcare professionals, we need to take the time to explore individual concerns, listen respectfully, deliver reliable information and give appropriate reassurance to begin rebuilding trust with patients to help tackle vaccine hesitancy in minority groups.

References

1. Darko J. Addressing the elephant in the room: COVID-19 vaccine hesitancy in Black and Asian communities. Br J Gen Pract 2021;71(705):170-170.

2. Razai M, Kankam H, Majeed A, Esmail A, Williams D. Mitigating ethnic disparities in covid-19 and beyond. BMJ. 2021; m4921.

3. Office for National Statistics. Coronavirus and vaccination rates in people aged 70 years and over by socio-demographic characteristic England: 8 December 2020 to 11 March 2021.  Available at: www.ons.gov.uk/releases/vaccinationratesbysociodemographiccharacteristicsengland8december2020to11march2021 (accessed 4 May 2021].

4. Mohamoud A. GPs convince 70% of patients who refused Covid vaccination to reconsider. PULSE 2021. Available from: www.pulsetoday.co.uk/news/clinical-areas/immunology-and-vaccines/gps-convince-70-of-patients-who-refused-covid-vaccination-to-reconsider/ (accessed 4 May 2021).