It is widely recognised that the burden of COVID-19 has fallen disproportionately on ethnic minority communities. A recent Lancet article explores the various reasons why, naming hesitancy as a factor in lower vaccination uptake.
A issue underlying vaccine hesitancy is mistrust of both the vaccine’s efficacy and the system delivering it. The reasons for this have been explored comprehensively in a BMJ article which cites institutional racism, historical medical mistreatment of black people and cultural segregation as contributing factors.
I observed vaccine hesitancy first hand during my GP placement at St Bartholomew’s Medical Centre in Cowley, one of the most ethnically diverse areas of Oxford. The practice recognised that a relatively high proportion of their unvaccinated patients were from ethnic minorities; under supervision of Hanif Rahim, I undertook a small quality-improvement project to assess the reasons why.
Through conducting interviews with patients registered as unvaccinated, I ascertained that lack of trust, and the spread of misinformation, were commonly reported reasons for not getting vaccinated against COVID-19. I realised that NHS resources were viewed as an extension of the government, meaning they lacked credibility among people who felt disenfranchised by the state.
As a result of this experience I proposed a motion at the BMA medical student conference in 2022 to recognise the mistrust of the medical establishment among ethnic minority groups and to call on the BMA to work with NHS trusts and health boards to place a greater focus on building trust with ethnic minority communities. The motion’s content was drafted based on my experience during my GP placement, but its spirit was motivated by my personal grief. Having lost my grandfather in 2020 to COVID-19, before vaccines were available, it was heartbreaking to see members of my own community suffering needlessly due to lack of vaccine uptake.
Passed into policy
The motion, which passed into BMA policy after being successfully proposed by Lara Akinnawonu at the 2022 ARM, seeks to encourage vaccination among the communities disproportionately burdened by COVID-19, emphasising the need to rebuild trust as a primary strategy.
By passing this motion, the BMA has made a commitment to institutionalising strategies that we know work at a local level. St Bartholomew’s Medical Centre had an innovative approach for tackling vaccine hesitancy among their Muslim patients, who nationally recorded lower uptake. They partnered with the local mosque, sharing information about the importance of vaccines during sermons at Friday prayer, and directing attendees to local vaccine drives. The success of this endeavour exemplifies how integrating healthcare into well-established community structures can tackle the issue of mistrust.
Where certain groups of patients may be sceptical about the information shared by their GP, they may be more likely to trust their local imam, priest, rabbi, guru, youth worker or community elder.
It comes as little surprise that trust in state-funded systems of care has eroded. Many among Britain’s most marginalised communities, who have been hit hardest by a decade of cuts to their local services, struggle to believe that the government has their best interests at heart.
This mistrust is only compounded by a culture of scapegoating ‘experts’ for political point-scoring, and an ever-proliferating mass of fake news online. Even with the best of intentions, individual healthcare workers cannot alter population-level outcomes; healing the healthcare trust gap has to happen at a systemic level.
Working tirelessly
This is where the BMA has a role to play. The BMA has worked tirelessly to address the inequities brought to light by COVID-19, and our work on vaccine hesitancy is no exception. To list but a few examples, the BMA has:
offered specific advice to our members on tackling vaccine hesitancy amongst patients;
launched a social media campaign in May 2021 to promote COVID-19 vaccine uptake to ethnic minorities;
supported UK-REACH research into the impact of COVID-19 on the physical and mental wellbeing of ethnic minority healthcare workers;
lobbied for, and secured, a risk-assessment framework to ensure that vulnerable and ethnic minority doctors – who are at the highest risk of death from COVID-19 – are better-protected;
lobbied for, and secured, a national inquiry into the disproportionate impact of COVID-19 on healthcare workers and communities from minority ethnic backgrounds.
Where we can go further is to build links at a local level by ensuring all practices across the UK can model the approach taken by Oxford and other cities like Nottingham, where vaccinations have been delivered in local churches, community centres and the African Caribbean National Artistic Centre.
We must also continue to hold the pharmaceutical industry to account in order to redress the inequitable distribution of vaccines across world. If we only focus on hesitancy as a reason that black people are less likely to be vaccinated, we will ignore the very real vaccine apartheid that Britain, and other states of the global North, may perpetuate by limiting access to vaccines through alternate pricing schemes.
This problem is exemplified in Botswana, a nation that was forced to order Moderna vaccines at the equivalent of $15 a dose. We cannot claim to look after ethnic minority communities at home while withholding vaccines from their relatives oversees without expecting mistrust to develop along the way.
If trust in any system breaks down, it is incumbent on that system to self-reflect honestly, and work out why. We need to recognise that the medical establishment has, historically, played a role in harming communities that remain underserved to this day.
Moving out of the pandemic, which was a time of low resilience and intimate loss, the BMA has an opportunity to forge a new landscape where we are well-equipped to deliver care to those who need it most.
This Black History Month is an opportunity to put BMA policy into practice and ensure that doctors are part of a trusted network placing better health at the heart of every community. By reaffirming faith in the medical profession we, as medics, ultimately benefit – a system rooted in trust is a system destined to flower.
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