Low vaccine uptake in BAME communities is a cause for concern, especially as they have been hit the hardest by the pandemic. Here, we explore the reasons behind the vaccine hesitancy.

We have previously written about how minority ethnic groups have been hit hard by the COVID-19 pandemic, both by dying and suffering from COVID-19 to a greater extent and by suffering more from restrictions and the economic consequences. However, since the start of the vaccine rollout in December 2020, it has become apparent that the BAME communities are also not being vaccinated to the same extent as the White British population. As of 31^st May 2021, 75.6% of White British people had received at least their first dose of the vaccine, compared to 47% of BAME people.

Rather than being due to anti-vaccine sentiments, the vaccine hesitancy amongst minority ethnic communities is linked to long-standing inequalities and racism within the healthcare system. Experiences such as not feeling listened to or understood, or feeling that cultural differences are being disregarded are common amongst ethnic minorities. A frequent concern is also that GPs and other healthcare professionals do not know how individuals from BAME groups present with symptoms, and either have to look it up during consultations or are not able to diagnose correctly. Such experiences — understandably — tend to lead to a lack of trust for the healthcare system.

Historically speaking, the healthcare system has given ethnic minorities even less reason for trust. In the 19^th century, it was commonly accepted that those who were not White had different — ‘inferior’ — bodies, something which is obviously not true. In the 20^th century, there were many occasions of mistreating ethnic minorities within medical studies by not getting informed consent from participants and not respecting their bodily autonomy. The most infamous example is the 1932 Tuskegee study, during which 600 Black men, 399 of which had syphilis, were recruited under the presumption that they would be treated for “bad blood”. However, instead, the study’s purpose was to observe the natural history of untreated syphilis, which meant that, even when treatment for syphilis became widely available in 1943, none of the participants received treatment.

This historical legacy of mistreatment and racism has not only created mistrust for the healthcare system in general, but also created a scepticism towards anything which seems like it might be an experiment in disguise — such as the COVID-19 vaccinations — because BAME communities do not want to be treated like guinea pigs again.

What does not help the hesitancy and mistrust is that there also tends to be a lack of BAME participants in research trials. Not only is this a result of the historical mistreatment, but also of researchers not having connections to minority ethnic communities and BAME groups being underrepresented in senior researching positions. In COVID-19 vaccine trials in the UK, only 5.72% of the participants were from ethnic minorities. With such low representation of ethnic minorities in the clinical trials, it is no wonder that some may be concerned that the vaccine will not be as effective for them, or that the side-effects might affect them differently.

Compounding the problem of mistrust and concerns about the vaccine is the practical problem of accessibility. In most cases, vaccinations will cost both time and money for travel, and for some these might be a barrier to getting the vaccination unless they are compensated for the costs. There is also a lack of information in languages other than English, which makes it harder for minority ethnic groups to inform themselves or receive information from their healthcare professionals on topics like how effective the vaccine is, if the vaccine contains ingredients which are not halal, or rectify misconceptions created by misinformation. A poll by the Royal Society for Public Health showed that 33% of those from minority backgrounds would be more likely to take the vaccine if they received more information from their GPs, thereby highlighting the importance of accessible information.

To combat the immediate problem of lower vaccination rates, a good place to start would be to provide information in more languages, build stronger relations with local community leaders, and address accessibility concerns. However, it will take a long time to heal the wounds created by the long-standing racism and White bias within the healthcare system, if they can ever be fully healed.

At JAN Trust, we have long spoken out about the need to address persistent structural inequalities that result in discrimination. We must all work together to combat the societal biases and stereotypes that result in people being treated differently on matters of life and death.