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Rapid response to:


Covid-19 vaccine hesitancy among ethnic minority groups

BMJ 2021; 372 doi: (Published 26 February 2021) Cite this as: BMJ 2021;372:n513

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Rapid Response:

Re: Covid-19 vaccine hesitancy among ethnic minority groups

Dear Editor

Hesitancy in Uptake of Covid Vaccine by Certain Population Groups

A year ago, on 11th March 2020, the WHO declared COVID-19 as a pandemic; so far, the impact of COVID on people and economy worldwide has been devastating. Globally, this pandemic has already killed over 2.67 million people; the mortality rate has slowed down but the threat of second wave or the new variant of Coronavirus still continues. For instance, Italy has announced lockdown on 14th March 2021 to curb fast growing COVID new cases. On the other hand, the new vaccine (the very first successfully announced by Pfizer) has given hope to combat the virus effectively in future. The United Kingdom has completed 100 days of vaccination programme, setting priorities to offer vaccines initially to healthcare professionals and then to the elderly in residential care homes. The Office for National Statistics (ONS) death data reveals that about 85% of COVID-19 deaths were amongst people aged over 70; thus, obviously formed the next priority to receive vaccination from early January onwards. The UK government achieved this 70 plus target by the end of February. Now this has been extended to aged 60 and over as well as to people with long-term chronic conditions. By mid-March, the UK successfully covered 45% of adult population and has also started a second dose to those who were vaccinated 12 weeks ago. The aim is to cover all 50 plus population with two doses by mid-May.

Israel is the only country (though smaller in size) which has already vaccinated and protected their citizens. On the other spectrum, the most populated country affected the most by COVID is India where the vaccination programme is on-going at full-swing and has already achieved 24 million coverage by mid-March (the highest number of people vaccinated by any country in the world). However, in terms of percentage of population vaccinated India is still far behind many OECD countries including the UK (as it covered just 2% of population).

However, a real issue in terms of equity and hesitancy in uptake of vaccine by certain population groups has emerged. The UK has experienced the highest death rates among Black and South Asian population than the White majority (which was 3-4 times was higher in the former compared to the latter group). Also, it was noticed that people of Black, Asian and Minorities Ethnic (BAME) group who died due to COVID were at least 12-15 years younger than their White counterparts (mean age 51 vs. 65 years); they were mostly men in the working ages from BAME communities consequently, their BAME families have suffered a devastating impact on their livelihoods as they lost a main earning member in the COVID pandemic. Despite this fact, BAME people being in the highest risk group have not received priority in getting into vaccination drive. As the BAME population has a much younger age distribution than the White population, they just waited for their turn to come for vaccination. There were few instances of hesitancy to uptake vaccination in the BAME community specially by those who were in the 70+ age group and received invitation in the first slot in January. This could be partly due to the fact that no prior information regarding vaccination was available to them as UK continued to remain in full lockdown since 30th December 2020. All community and religious places which are the main centres for communication and engagement for BAME communities are not open. They relied for their healthcare needs and health information through their GPs which are also not accessible physically. Furthermore, for a vast majority of elderly people in BAME communities English is not their first language and thus remained completely aloof from the English Media about vaccination drive information. Finally, the vaccination drive started with Pfizer dose, which was not developed in the UK, whereas the UK-based AstraZeneca vaccine was in approval stage which in fact recruited BAME people during their Clinical Trial Phase. Thus, BAME community was not much aware of Pfizer effectiveness, but shown reliance on the one introduced by AstraZeneca in mid-February. I think over a period of time, these small cases of hesitancy would disappear in the UK with improvement in age-specific coverage.

India is also undergoing similar phase of hesitancy and inequity in vaccine uptake. I think both UK and Indian Governments have not designed the right approach to prioritise the vaccination drive. Instead of initially targeting the oldest age-group, the government should have used the cluster area approach. In the UK the highest mortality and incidence of COVID were observed in the larger cities of London, Birmingham, and Manchester where they had the highest population density as well as highest infection rate due to enormous daily commuting population from their hinterlands. Therefore, irrespective of age-specific targeting, these geographical localities should have been given the first priority to get vaccinated and then in the next phase this could be rolled-out nationally. In India also almost all major cities and metros and about 150 (out of 700) districts where with the infection rates as well as death rates were alarmingly high, should have been given priorities for vaccination. We have not missed the train yet in India, the ‘highest-risk’ geographical area approach can still be planned so as to prepare better and safeguard against the second wave or the new variant of Coronavirus in the future. At least, we know that the Indian Government has till now shouldered the free vaccination drive responsibilities and thus ensured the poor and underprivileged should not be left out from the mainstream vaccination programme.

Competing interests: No competing interests

16 March 2021
Anil Gumber
Senior Health Economist
Sheffield Hallam University
Faculty of Health & Wellbeing, Sheffield S10 2BP