The UK continues to be at the forefront of covid-19 vaccine development and deployment. The ambitious vaccination programme forms the centrepiece of the UK “roadmap” detailing the path out of lockdown. [1,2] Substantial resource has been expended on distribution efforts to enhance accessibility, overcome logistical barriers, and facilitate population-wide inoculation. In England, vaccination centres, GP surgeries, high-street pharmacies, and places of worship form over 1,700 vaccination sites meaning over 99% of the population live within 10 miles of a vaccination service.  This has contributed to over 94% of all older people and those in high clinically-vulnerable groups receiving at least one dose of the covid-19 vaccine. 
However, as possible links between the Oxford/AstraZeneca covid-19 vaccine to thromboses have emerged, leading to temporary suspension of the vaccine in a number of European countries, we ask if a more nuanced public messaging approach is now needed, one tailored to those in the lower risk groups and the healthy population. If confidence in the vaccination programme is to be maintained, there may need to be a change in policy towards respecting the differing perspectives to vaccination, considering how individual autonomy can be upheld, and advising the public on the ways in which they can access professional support to facilitate their decision-making.
The success of the vaccination programme depends on acquiring herd immunity, which is influenced by individual choices, confidence, and willingness to receive the vaccine.  Despite the overwhelming body of literature indicating the safety and benefits of vaccination, significant proportions of the UK population have reported resistance to (~14%) or being unsure (~23%) about becoming vaccinated. [6,7] Scepticism, mistrust, or uncertainty towards vaccination appears to be more common among individuals from some ethnic minority groups; those with lower levels of education, income, or covid-19 knowledge; and those identified as having poor compliance with government covid-19 guidelines.  The basis for these perceptions are complex. For example, they may stem from more deep-rooted fears and people’s lack of trust in science and mainstream health services, and experience of social inequality, discrimination, and racism. These may be reasons why some groups may not have sought help sooner and felt unsupported and abandoned.  Fully acknowledging these inequities in care is paramount in remedying the gaps in accessing healthcare services seen in ethnic minority groups.
We add to calls for the vaccination programme to be rooted in equality, respect for diversity, and cultural competence.  Little attention has been paid to genuinely listening to individual concerns and considering how existing patient-professional partnerships can be used to strengthen to support a person-centred approach. We propose strengthening three under-developed facets of care that could enhance vaccine confidence and lessen fears.
Firstly, public health messaging must be strengthened to uphold individual patient autonomy, empowerment, and advocate for a concordance-focused shared decision-making approach. Public discourse thus far has been dominated by the perceived threat of the virus, the knock-on impact on the NHS, and strongly advocating vaccination as the only route out of lockdown.  However, it is unfortunate that decades of evidence supporting personalised care founded on dignity, compassion, and respect have conveniently been swept aside in favour of an authoritarian and dogmatic approach. The literature on adherence to medicines supports the commitment to a person-led approach involving negotiation and power-sharing between equals to arrive at a shared decision.  The notable lack of ethno-culturally sensitive policies and the dismissive branding of all people who are hesitant about vaccination as “anti-vaxxers” stifles debate, and more importantly, constrains an individual’s willingness to openly express their apprehension or challenge medical assumptions. Frontline health professionals should reflect and consider whether they are creating opportunities for an open and honest dialogue with their patients so genuine concerns can be expressed and an informed decision reached.
Secondly, sustained efforts are needed to curtail scientific-sounding misinformation that lowers vaccination intent and intensifies vaccine hesitancy.  In an era of substantial misinformation and social media influence, there needs to be clear messaging encouraging individuals to speak to health professionals about their vaccine-related concerns. One option for instance, could be greater use of pharmacies. Pharmacists are accessible and concentrated in areas of higher deprivation where covid-19 transmission rates are higher and vaccine uptake likely to be lower. There is strong evidence of pharmacists improving adherence to medicines, including supporting the uptake of vaccinations.  Greater emphasis could be placed on how to utilise these trusted professionals in an effort to offer transparent, unbiased information that neither exaggerates nor minimises the risks or benefits of the vaccine.
Our final suggestion is a call for strengthening public involvement or “co-production,” particularly involving people from ethnic minority groups to optimise messaging and enhance trust in the vaccination programme and health services more broadly. Where innovative participatory approaches and outreach engagement strategies have been used, they have resulted in greater confidence and vaccine uptake.  Without equity, there are risks of covid-19 disparities widening, and this may also allow the virus to circulate more widely in vulnerable populations, jeopardising the effectiveness of the vaccination programme and achievements to date. [8,13]
Asam Latif, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK. Asam Latif is a pharmacist and Clinical-Academic at the University of Nottingham.
Sabina Ghumra, School of Pharmacy, Faculty of Medicine and Health Sciences, University of Nottingham, UK. Sabina Ghumra is a community pharmacist and Visiting Lecturer at the University of Nottingham
Zeenat Hassam, School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK. Zeenat Hassam is a pharmacist and Senior Lecturer in Clinical Pharmacy at De Montfort University.
Nargis Gulzar, School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK. Nargis Gulzar is a pharmacist and Senior Lecturer in Clinical Pharmacy at De Montfort University.
Competing interests: The authors declare no conflict of interest.
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