Medics are working to improve Covid vaccine take-up of under 30% among clinically extremely vulnerable (CEV) people from some ethnic minority communities in Birmingham.
Figures published by NHS England of vaccine take-up in the city, as of February 23, show 84.47% of Irish and 79.30% of British – meaning white – or Mixed British CEV groups have received their first jab.
In comparison, only 21.74% of people from the Arab ethnicity group, 23.36% of people from Bangladeshi backgrounds and 27.15% of people of Pakistani ethnicity had been given a first dose by that date.
Dr Zania Stamataki, an immunologist at Birmingham University, believes peer pressure could be one reason why fewer people in the CEV category are getting vaccinated.
“They are being offered the vaccine when their peers have not been offered the vaccine yet,” she told HuffPost UK.
“Take a 40-year-old with underlying conditions who’s been called up to get the vaccine but all the people they know or speak to on Whatsapp haven’t been offered it yet – so they’re considered amongst their peers as an early adopter or a pioneer.
“They might hesitate and think, well you know I might wait a bit [to get vaccinated] and see what happens. Whereas among older people who are being offered the vaccine at the same time, everybody’s having the same experiences and conversations within their circles.”
People in the CEV category also have the lowest Covid vaccine take-up overall among the top five priority groups: 66%, compared to between 74% and 89% in other groups.
“As scientists, we need to be able to go out there and be available for people to ask questions to alleviate their concerns,” said Stamataki. “We’re very good at shouting on TV to take the vaccine, but are we actually making ourselves available for people to ask any questions they might have?”
Dr Salman Waqar, general secretary of the British Islamic Medical Association, said people classed as CEV are likely to have had more experiences in the health service, and with people from Black, Asian and minority ethnic backgrounds more likely to have had negative healthcare experiences, this could also be a factor.
“By nature being clinically extremely vulnerable means they have a lot of stuff going on with their health,” Waqar said. “If they’re finding it difficult to access or difficult to make sense of the situation then that assumption does seem to make sense.”
CEV groups have also been told to shield for months, which means they could be more hesitant to leave their homes to get vaccinated. “We have to remember that minority ethnic communities intersect quite strongly in terms of socioeconomic deprivation, so points around transport and access will need to be addressed,” said Waqar.
“Sites need to be more accessible, as well as being in community centres or local places of worship, schools and where people are more familiar with and have other social links.”
“Therapeutic landscapes” where people go for life-cycle events such as marriage, birth, death and celebrations that are within walking distance are also likely to encourage vaccine take-up, Waqar believes.
Birmingham is one of the most diverse cities in the country with 43% of its population from ethnic minority communities. Vaccination rates are lowest among its African and Caribbean communities, with an almost 40% difference in take-up compared to people of white British backgrounds.
Among the over-80s, people from African ethnic backgrounds had the lowest vaccine take-up at 60% – while 66% from Caribbean backgrounds and 65% of people belonging to “other Black” groups had been given a first dose. This compares to 93.83% of people who were “British” in the same age group.
There is a multitude of reasons as to why ethnic minorities have been statistically less likely to have been vaccinated against Covid-19 in Birmingham and across the UK. Vaccine distrust has long been high among Black, Asian and minority ethnic communities, partly due to historical medical racism and inequalities in the healthcare system.
Ethnic minorities are also the most likely to die from Covid-19: Black African men have suffered the highest Covid death rate of any ethnicity, followed by Bangladeshi men, Black Caribbean men and Pakistani men. As Professor Sophie Harman, who specialises in the politics of global health at Queen Mary University of London, puts it, “Would you trust a government that accepts you’re more likely to die of Covid-19 than your white neighbours and does nothing very much about it?”
Vulnerable communities – including homeless people, migrants, refugees, asylum seekers, and some people from Black, Asian and minority ethnic backgrounds – have also struggled to get hold of a jab even when they’re entitled to one.
But the vaccine take-up figures come as no surprise to Waqar. “You have to remember this is in the context of Black and Asian minority ethnic communities having poorer health in general, even when you control for socioeconomic background,” he said.
Waqar has previously spoken to HuffPost UK about the so-called “Mrs Bibi syndrome” or “Begum syndrome”, in which South Asian women’s health concerns are dismissed or belittled by healthcare professionals in the UK. He said: “There’s that, plus the fact that Black women are more likely to die in childbirth or that minoritised communities have persistently poorer outcomes in diabetes or cardiovascular disease.”
Stamataki points to issues surrounding how information – and misinformation – around the coronavirus vaccine is disseminated within the city’s minority communities. “It’s a complex situation,” she told HuffPost UK. “There could be a language barrier that prevents people from accessing information that will put their mind at ease.”
Earlier this year, there were concerns over ethnic minority communities being “targeted” by false information about the vaccine containing microchips, aborted foetus cells or traces of pork and beef. “Social media can be a very loud place,” Stamataki continued. “There are scientists shouting about how important it is to take the vaccine, and there are pseudoscientists shouting about how important it is to not take the vaccine. It can be hard for somebody to know who to trust.”
“People who are clinically extremely vulnerable are probably the highest stakeholders of finding out the right amount of information,” she added.
Waqar believes misleading vaccine news has become less of a concern as the rollout has gone on. “A lot of work has been done to dispel those myths. Most people now recognise that Covid is real and that vaccines are an important part of the response to it.” Instead, he believes that vaccine concerns from ethnic minority communities stem from very real and legitimate concerns about the health system.
“Vaccine hesitancy in the minority community has become a sort of reductionist soundbite. These communities haven’t been brainwashed, they’ve been hardwired into being hesitant. This isn’t solely about vaccines, it’s about structural issues that need to be addressed.”
Among the reasons cited by Birmingham city council for low vaccine uptake was a “legacy of historic medical research abuse”, ”trust and confidence” in the NHS and government as well as fake vaccine news and language barriers – all aspects that have particularly affected ethnic minority groups in Britain.
In addition, inaccuracies regarding patient data, a lack of digital access and confusion surrounding booking appointments and allergies were also listed as factors that prevented people from getting vaccinated.
Regular weekly meetings with faith leaders, community digital forums with local GPs and vaccination awareness sessions with care workers and social workers are all ways of tackling the problem, the council said.
Community and religious leaders, influencers and healthcare workers from these same groups and communities are already coming together to help fight against disinformation and raise awareness of the vaccines.
Mosques are using their Friday sermons to urge Muslims to get the jab while church leaders are appealing to African Caribbean communities to sign up for the vaccine. The Al-Abbas Islamic Centre in Birmingham became the country’s first mosque to open as a Covid-19 vaccination centre.
The government should also encourage doctors and scientists from ethnic minority backgrounds to speak to their communities directly. “If you’re a female of Black and Asian origin then it might help to speak to someone from your ethnic background to be reassured that it’s okay to receive the vaccine, and that people like you will not have a higher propensity of developing adverse effects from the vaccine.”
A representative from NHS Birmingham and Solihull said it is “working hard” to make sure “as many people as possible” are vaccinated.
“We are using mobile vaccination vans to go to places of worship and community locations where people feel safe and supported if they do not feel able to access a mass vaccination site or an unfamiliar GP practice,” Dr Rizwan Alidina, a local GP from east Birmingham said.
“Our work with local community leaders is helping to build trust and confidence in the use of these facilities. We are working hard to achieve our aim to vaccinate as many people as possible.”