As misinformation circulates about the safety of Covid-19 vaccines, GPs say they need more help to reassure ethnic minority patients amid a climate of mistrust, finds Nicola Merrifield
Health bosses knew early on in the vaccination programme that mistrust could prove an obstacle to Covid-19 vaccine uptake among black, Asian and minority ethnic (BAME) patients.
GPs in east London were told in mid-December by local health authorities that ‘we are noticing that there are much lower numbers of people from BAME groups attending for vaccination’.
The ‘urgent’ message, sent by commissioners and the local council to local primary care networks, said: ‘This early local observation is backed up by national information demonstrating that our BAME communities are less likely to trust the vaccination.’
It warned: ‘This clearly risks increasing pre-existing health inequalities in some of our most vulnerable populations.’
A poll of UK adults commissioned by the Royal Society of Public Health at the start of December found only 57% of respondents from BAME backgrounds – 199 respondents – were likely to accept a Covid-19 vaccine, compared with 79% of white respondents.
Two months into the programme and the problem has not been resolved.
An RCGP analysis of NHS England data on the number of vaccinations given nationally by 31 January shows white people are three times more likely to have had the Covid jab than people from mixed ethnic backgrounds. Similarly they are twice as likely to have been vaccinated than black people, and 1.5 times more likely than Asian people.
NHS England is taking action. In recent weeks it has become a contractual requirement for GPs to record their patients’ ethnicity. But GPs say that will not be enough to tackle the issue.
‘It will make a difference, it will be good to know how patients identify themselves,’ says London GP and North Lewisham PCN clinical director Dr Sebastian Kalwij.
‘But these groupings are very broad brush. They don’t give the nuance between the different groups and those with different income or education levels.’
There are practical reasons for the lower uptake among BAME groups. In a Healthwatch survey of 2,500 patients, almost 1,800 respondents said they would most likely get the vaccine. Of those, 22% said the location of the vaccine centres could be a barrier, with more than 1 in 10 expressing concern about taking public transport.
Respondents from black communities were 50% more likely to see the locations as a barrier and close to twice as likely to be nervous about using public transport.
However, in keeping with other findings, the Healthwatch survey also found patients from black communities were more likely to express concern around vaccines’ safety and effectiveness.
The reasons for vaccine hesitancy – and sometimes rejection – among a number of minority ethnic groups are wide ranging.
Greater Manchester LMCs chair Dr Amir Hannan says: ‘There’ve been a lot of myths flying around. Initially it was things like there being porcine in the vaccine, which means it’s not halal, so people thought they can’t have it.’
In many cases, misunderstandings – and outright lies – are being circulated online.
Dr Hannan adds: ‘There have been myths around things like microchips.’
East London GP Dr Farzana Hussain, who is also clinical director of Newham Central 1 PCN, has seen similar problems: ‘There’s a lot of misinformation about a microchip in the vaccine, it will cause infertility, it will change my DNA.’
Of course, myths around microchips and fertility are prevalent among all sections of the population. And GPs say they hear the same concerns from all groups about the fast pace of vaccine development and unknown side-effects.
But there is more hesitancy among ethnic minority groups. That is partly because of a mistrust stemming from NHS encounters they have had in the past or wider racial injustice they see in their daily lives.
Dr Kalwij says black African patients in particular say they don’t want to be the first in line for the vaccine ‘experiment’.
‘They may have had bad experiences in the past and don’t feel that enthused about being part of what they call an experiment. They say the vaccine is new, it hasn’t been tried and tested, and why should I put myself in the frontline?’
These bad experiences have often been down to interactions with clinicians, says Dr Kalwij: ‘I have had many patients over the years from BAME backgrounds who have found it hard to get heard, or to have their symptoms taken seriously and this perpetuates the feeling of being discriminated against.’
Dr Hussain says her black African patients share those concerns: ‘It’s a historical mistrust that is exacerbating the mistrust in the vaccine.’
Messages on social media make this worse, she says; a patient showed her a Whatsapp message warning against taking the vaccine. ‘It was all about the white supremacist race. They want to make sure they carry on by making the BAME communities infertile. The messaging was extremely sophisticated.’
Essex GP Dr Adwoa Danso, who is an executive at the Ghanaian Doctors and Dentists Association UK, says confusing messages from the Government have added to the sense of a ‘hidden agenda’.
She says: ‘For months they have said in one breath that black Africans are most at risk [from coronavirus] – but then they were not being prioritised [for the vaccine by the JCVI]. So what kind of message was that giving?’
GPs are doing their best in their conversations with patients to tackle damaging myths and misinformation, as well as confusing messaging. They are also helping to run vaccine hubs in places of worship – while faith groups themselves are using their services to reassure members of their communities that it’s safe to get a jab.
NHS England meanwhile has put together a ‘specialist equalities team’ to address low rates of vaccine uptake. It has also set up another team, led by primary care director Dr Nikki Kanani, to support ‘effective communication’ with BAME healthcare staff.
South London GP Professor Azeem Majeed, who is head of Imperial College London’s primary care and public health department, says local outreach work is crucial: ‘There are [good practice] examples of the NHS working with local groups, community centres, patient and public groups to promote vaccination.’
He says this work will make more of a difference than the new contractual requirement for GPs to record ethnicity.
‘Ethnicity data are good for research and surveillance but it may be less useful for trying to improve uptake rates.’
GPs say some patients may not wish to provide information on their ethnicity – and point out that the questions only provide broad ethnic categories and ignore other contributing factors.
More importantly, nationally funded interventions are required as GPs’ one-to-one conversations with patients are ‘labour intensive’ says Dr Kalwij.
He adds: ‘The help we need is staff on the ground making those phone calls.’
Last month NHS England announced a new tool for assessing patients’ risk from Covid-19, which considers ethnicity as well as health conditions.
The QCovid risk algorithm, produced by the University of Oxford, has added an extra 1.7 million people to the shielding list, ensuring they are prioritised for vaccination.
Dr Danso welcomes the tool, but now wants to see more action: ‘We need to look at more funding and education and also whether we can have more specific vaccine clinic times for those vulnerable people… so being able to prioritise people for those spaces.’
The risk of not tackling the issue soon is too great, she warns: ‘The point of a vaccine schedule is to protect the most vulnerable. We know who they are so we must focus on increasing those numbers.’
‘We’re trying to get to the hardest-to-reach groups’
We’re planning to have a fleet of ‘Vaxi Taxis’ operating across London, preferably every day of the week, from first thing in the morning until late at night. Hopefully other areas of the country will follow suit.
At our first series of pilot events we had a pop-up vaccination centre within a synagogue – and some people were ferried back and forth in the taxis if they had transport difficulties, like requiring wheelchair access, or health problems that require a carer.
There was also an outdoor heated tent offering vaccines, provided by London Fire Brigade, and house calls as well for housebound patients.
Vaccinations were possible in the taxis themselves too as they’re big vehicles with wheelchair access.
We’re trying to get to the hardest-to-reach groups, collaborating with communities – along with the support of the NHS. GPs in west London are involved so far and others can use our framework by PCNs and CCGs helping to identify locations where they want to do more focused work to increase uptake of vaccination.
In our first weekend we had four places of worship (a church, a synagogue, a gurdwara and a mosque) plus a homeless centre working together to get members to come and get vaccinated.
We had clinical specialists at the sites answering patients’ questions about the vaccine. We also had a preliminary Q&A event on Zoom the night before the sites opened, for all the faith leaders and homeless centre leaders to help inform people, along with clinicians.
We want to address myths around the vaccine so people can understand what the facts are and the benefits.
Dr Sharon Raymond, GP in London, director of the Covid Crisis Rescue Foundation, and co-founder of the ‘Vaxi Taxi’ vaccination project