On 20 January, Priti Patel warned against hesitancy towards the covid-19 vaccine among ethnic minority groups and said that it is “safe for us all,” after reports that misinformation about the vaccination is spreading in some groups. But she and the government have missed the point. They haven’t done what they committed to do in the early summer—engage with the communities at risk, address legitimate concerns, or communicate with them in a culturally competent way.
A recent report showed that black people over the age of 80 were less than half as likely to have received the vaccine as white people during early rollout of the vaccine in England. For people of mixed, other and south Asian ethnicities, the vaccination rate was around two thirds that of white people. [1]
It is not enough to tell people to have the vaccine. Based on previous reports on vaccine hesitancy and surveys during covid-19 there are numerous reasons why people may be undecided. Providing clear information to the public and professionals on how vaccines are developed and tested is essential. As is the ability to quickly and effectively respond to public safety concerns, whether they are founded or unfounded.
The government would have known from the introduction of past vaccination and health check programmes, well before the pandemic, that there might be a problem with uptake of any new vaccine in these and other demographic groups.
In 2020 of all years, when ethnic minority issues could not have been more front and centre, one would have hoped that government would have finally decided to do the right thing and tackle the inequalities that have been so rife in the UK for so many years. Unfortunately they have failed to do so.
History is littered with government and other reports aimed at tackling health inequalities among ethnic groups. One wonders whether the reports themselves have been binned, as there has been little or no focus on making sustainable changes.
Accountability lacking
What is common in all these reports is the lack of clear responsibility and accountability for implementing their recommendations. Public Health England’s (PHE) report published in June confirmed that covid-19 has hit ethnic minorities hard, both in the community and among healthcare staff. [2] At the time the UK prime minister accepted PHE’s recommendations. But acceptance isn’t enough.
PHE’s recommendations were in fact the same as those from many other pre-pandemic reports. All of them say that inequities should be addressed by tackling determinants of health, with a focus on cultural competence and calls for routine collection of ethnicity data. This means taking into account, age, gender, ethnicity, and social class when developing policies that affect these groups. The PM’s race disparity unit made a set of similar observations and recommendations in its first quarterly report in October.[3]
Cultural competence or incompetence?
The fact that the government has consistently failed to comply with its duties under the 2010 Equalities Act doesn’t bode well for the Race Equalities Act recommended by the Labour party’s review on the impact of covid-19 on ethnic minority communities [4].
Equality impact assessments appear to have taken a leave of absence during the pandemic. If they had been conducted, policies could have adequately taken into account ethnicity and ensured this, and other demographic determinants of health, were addressed in plans to protect the most vulnerable.
If government had taken all this seriously, it would have supported a traditional public health approach to tackling the pandemic: public protection, risk communication, and support to test, trace and isolate. It would have also developed a bespoke and sophisticated response to building trust among ethnic groups, co-designing culturally competent messaging with communities, which would have enabled a dialogue and materials that would have supported much higher rates of vaccine uptake.
The PHE report and others also called for the routine collection of ethnicity data. Ethnicity has never been recorded on death certificates, and we are still waiting for that to happen, although it was promised by January.
There will no doubt be more inquiries, reports, and recommendations on the impact of covid-19 on ethnic minority health outcomes. We must shift away from the historical cycle where very little is done to implement them. At best this looks like negligence, but at worst it looks like disdain from a government that has no interest in having anything to do with tackling inequalities. Indeed, this pattern of inaction and lack of accountability is a stark example of the structural racism that persists within the UK.
The irony of the fact the UK trains many other countries about these classic public health approaches is not lost on perplexed public health practitioners from overseas who don’t see them being implemented here.
It is vital that this government takes a public health approach to address the UK’s health inequalities. Let covid-19 be the tipping point for translating the familiar mantra of “levelling up” to the reality of tackling inequalities.
Gurch Randhawa is professor of Diversity in Public Health at the University of Bedfordshire.
Twitter: @gurchrandhawa
Shaun Griffin is a communications consultant and medical writer
Twitter: @drshaungriffin
Competing interests: SG writes freelance for The BMJ. SG and GR both used to work at the Human Tissue Authority. GR is a member of the BMA Medical Ethics Committee.
References:
- O’Dowd A. Covid-19: Black people over 80 in England are half as likely as white people to have been vaccinated. BMJ 2021;372:n35. doi:10.1136/bmj.n357. 05 February 2021.
- Public Health England. Beyond the data: understanding the impact of covid-19 on BAME groups. 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf
- HM Government Race Disparity Unit. Quarterly report on progress to address covid-19 health inequalities. 22 Oct 2020. https://www.gov.uk/government/publications/quarterly-report-on-progress-to-address-covid-19-health-inequalities
- An avoidable crisis. The disproportionate impact of covid-19 on black, Asian and minority ethnic communities, a review by Baroness Doreen Lawrence. October 2020. www.lawrencereview.co.uk