When data doesn’t see race

By Florence Gildea

Since the Covid-19 vaccination programme began in the UK, it has hardly been possible to discuss vaccine confidence without referring to the variation between different ethnic groups. When we at RSPH polled the public in December 2020, we found a significant disparity in acceptance of the Covid-19 vaccine, with 57% of respondents from ethnic minority backgrounds saying they were likely to receive the vaccine if advised to by their GP or healthcare professional, compared to 79% of white respondents. Ever since that research, which has been cited in the media over 1,000 times, faith and ethnicity have rarely been left out of discussions about vaccine hesitancy, or initiatives to address it.

 It may come as a surprise then, that before the roll-out, there was little research looking at vaccine uptake data by ethnic group, or investigating the factors linked to such disparities in uptake. Although ethnic coding was introduced to medical records in 1995, it’s suggested that only 60-70% of GP records include this information. Not being able to breakdown population health data by ethnicity, as well as various other demographic characteristics, has hidden health inequalities and, accordingly, been an obstacle to system action to reduce them.

 Indeed, when, in light of surveys into confidence in a Covid-19 vaccine, QResearch analysed previous routine vaccination uptake data, they found that higher hesitancy among certain ethnic groups had likely long existed. Their analysis showed there was consistently reduced vaccination uptake for adult vaccination programmes in Black Caribbean and Black African patients (50%) compared to white patients (70%), and that uptake of new vaccinations introduced since 2013, such as rotavirus and shingles, showed a 10-20% lower uptake across all ethnic minority groups compared to the white population. As with so much else, the Covid-19 pandemic brought to light long-standing inequalities which could no longer be ignored when policymakers needed to influence the behaviour of every individual and every community to limit the spread of Covid-19.

 It is highly regrettable that the disparity in vaccine confidence was not fully appreciated before the Covid-19 pandemic, as by the time an epidemic hits, it is often too late to start building trust in the vaccines which can put an end to them. Moreover, faith in vaccines does not exist in a vacuum: it can be influenced by experiences of, or beliefs about, healthcare services and medical research more generally. Research in the US into lower H1N1 influenza vaccine acceptance among Black Americans, for example, identified lower trust in all institutions involved in the production and delivery of flu vaccines and the vaccine itself than among white Americans. Where participants reported racial discrimination in the healthcare system, they were more likely to perceive the vaccine as a risk to their health.

There are indications that similar factors may be at work in the UK. For instance, when we asked how much respondents would trust the opinion of various figures about a Covid-19 vaccine, trust in local GPs, nurses and pharmacists was lower among those from ethnic minority backgrounds than white respondents (60% vs 79% for GPs; 56% vs 76% for nurses; 54% vs 71% for a local pharmacist). Experiences of discrimination, neglect or condescension in one healthcare setting will likely carry over into another; and perceptions about whether the NHS, the Government and other public institutions truly exist to serve every citizen equally will have a bearing on how messaging from these organisations is received.

 Looking to the future, therefore, it is imperative to build and sustain trust in the entire public health and healthcare systems. Covid-19 has offered a unifying focus, demanding close partnership-working. Health inequalities, including inequalities in access to service, must become the agenda around which the system works closely, flexibly, and determinedly, even before the pandemic has passed.

 We cannot build trust if we start conversations with calls-to-action. We cannot build trust if we make assumptions from a distance. We cannot build trust if we treat people as problems. And we cannot build trust if we think only in terms of marketing and communications, instead of listening and participation. This may well require confronting bias head-on as well as changing systems and process. For we cannot truly be in the business of health, if we are not in the business of care, dignity and respect.

Article details

Could racism hold back the race to vaccinate?
Florence Gildea
First published May 20, 2021
DOI: 10.1177/17579139211003455
Perspectives in Public Health

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