Trusted messengers are key to encouraging vaccine uptake 

Recent reports have highlighted concerns regarding uptake of the covid-19 vaccine in ethnic minority groups, including among healthcare workers. Guidance on how to increase covid-19 vaccine uptake among frontline NHS staff suggests one-to-one conversations with line managers as a method of increasing vaccine confidence. 

Disparities in covid-19 exposures and outcomes have laid bare the effect of racism on health outcomes, with a disproportionately higher number of healthcare workers from ethnic minority backgrounds dying from covid-19. Labelling people from particular groups as “vaccine hesitant” obviates recognition of this context and risks alienating and stigmatising an already traumatised workforce at high risk of burnout. An individual who needs support to feel well informed and empowered to take the vaccine is often misidentified in the generalisations about whole communities holding vaccine hesitant views.

Race concordance has been shown to improve health communication, with the most effective messengers identified as experts within communities. Outreach on vaccine efforts needs to be led by doctors, nurses, and other healthcare professionals that are trusted, and reflect the diversity of the workforce. 65% of staff in London North West University NHS Trust are from an ethnic minority background. 

In response, we recognised disparities in vaccine uptake within our Trust and built a multidisciplinary and multispecialty group of vaccine advocates, predominantly from Black and Asian backgrounds, to address these issues. Since 26 January 2021, we have held regular online “Q&A” webinar sessions with hospital staff in both clinical and non-clinical roles across the Trust. The ethos is to provide a safe and non-judgemental forum to acknowledge the concerns and apprehensions that exist.  

In addition, we used a variety of different formats such as videos, blogs, and screensavers to address common misconceptions. A blog to communicate an individual advocate’s vaccine journey received 2124 hits through the staff intranet. Staff newsletters containing the blog were opened over 25,000 times. Our materials acknowledge that vaccine misinformation is in circulation and provide factual truths in a balanced manner. 

These practical methods, designed to validate and address concerns, have been well received. In early February 2021, vaccine uptake among staff was 56% overall despite availability of vaccine appointments. As of May 2021, this has increased to 78% among all staff and from 59% to 77% among ethnic minority staff. 

Our experience led us to develop a framework for vaccine advocacy that includes:

    • Regular Q&A sessions hosted by a consistent moderator, delivered online via a suitable video communications platform
    • Sessions advertised and supported by Trust-wide communication (e.g. email, intranet webpages, digital screensavers and posters, personal weblogs)
    • Vaccine advocate panellists comprised of a multidisciplinary range of healthcare professionals representing different specialities and ethnic groups
    • Interactive polls at the start and end of sessions to encourage engagement and collate concerns
    • Dedicated panellists available to monitor and respond to concerns raised in the chat facility or shared via email
    • Adequate collection of vaccine uptake data according to ethnic group to allow tracking of impact
    • Flexibility to respond to updates in vaccine policy, safety and efficacy data

Vaccine advocacy is not a passive role; it involves active self-education, an ability to communicate safety, risk, and uncertainty with engagement in the evolving discourse. In recent weeks, the UK has reported increased cases of the Delta variant (B.1.617.2). Early data suggest significant protection against this variant in fully vaccinated people. This underscores the urgent need for ongoing engagement to increase levels of confidence and trust in the vaccine amongst our diverse populations. Trusted messengers in vaccine advocacy must be supported and adequately resourced as they contribute to the critical public health messaging needed to reach the goal of a “community of immunity.”

Padmasayee Papineni, Consultant in Infectious Diseases and Acute Medicine at London North West University Healthcare NHS Trust.

Sarah Filson, Infectious Diseases and Microbiology Registrar at Chelsea and Westminster NHS Foundation Trust.

Isabel Martin, Surgical Research Fellow at London North West University Healthcare NHS Trust.

Manmeet Matharoo, Consultant Gastroenterologist at London North West University Healthcare NHS Trust. 

Anu Obaro, Radiology Research Fellow at London North West University Healthcare NHS Trust.

Chima Oti, Consultant Anaesthetist at London North West University Healthcare NHS Trust.

Joan St John, GP with special interest in diabetes at NHS Brent Clinical Commissioning Group.

Evelyn Mensah, Consultant Ophthalmic Surgeon at London North West University Healthcare NHS Trust.

Competing interests: none declared.

We acknowledge the contribution of the extended network of vaccine advocates within the Trust to deliver this work.