Many column inches in the UK have been devoted to vaccine hesitancy with a specific focus on Black and Minority Ethnic communities. A reasonable level of investment by government is being made through local NHS infra-structure and through consultants to create media messages to encourage communities to take the vaccine. This approach is based on what is regarded as information deficit, misinformation or disinformation.
The COVID -19 vaccine has been a noisy landscape with actions and initiatives all with good intentions, but without understanding the underlying causes on belief formation and attitude towards the vaccine and therefore determining what works is impossible. The fact is that hesitant attitudes to vaccination are prevalent and have certainly increased over the last five years. For many people vaccination attitudes are shaped not just by health care professionals but also through other sources, including online, social media and the global family network of our fellow citizens.
Available evidence from ONS demonstrates that certain minority ethnic groups are at greater risk of catching the virus and recently data released by ONS for the period 2 March -15 May 2020 shows:
“The risk of death involving COVID-19 varies across religious groups, with those identifying as Muslims, Jewish, Hindu and Sikh showing a higher rate of death than other groups. For the most part the elevated risk of certain religious groups is explained by geographical, socio economic and demographic factors and increased risks associated with ethnicity. However, after adjusting for the above, Jewish males are at twice the risk of Christian males, and Jewish women are also at higher risk. Additional data and analyses are required to understand this excess risk.”
Given the evidence it is interesting that JCVI decision not to prioritise Black and Minority Ethnic communities for the vaccine. Watch this space for reports justifying JCVI position. If JCVI did consider the prioritisation issue please be transparent and put this in the public domain.
Belief and attitude formation has played a pivotal role in behaviours not changing despite the higher level of risk of catching the virus and a higher mortality rate for minority ethnic communities. In other communities this level of risk has been translated into behaviours that mitigate risk including vaccine protection. But clearly that is not the case within minority ethnic communities. We are not asking the right questions- for they require a fundamental shift in the manner in which our major state Institutions operate.
A key ingredient of allaying fears and reassuring citizens is trust. Trust plays a key role in forming our beliefs, as we do not have the time to check the evidence for everything. Our experiences guide, inform and shape the information to be trusted or not. There is substantial evidence of the low level of trust that exists within a large section of the Black and Minority Ethnic community towards our major Institutions. This trust deficit is based on experiences within health, judicial system, government and sadly also directed at science for its role in un-ethical practices.
So, who do we trust? The family still remains a powerful driver of influence within minority communities, it is not just the immediate family but also those in Countries of origin who through social media platforms communicate information (not necessarily factual) but information designed to help the recipient make a decision on the vaccine.
Speak to any GP in London they will tell you that take up of childhood vaccines has dropped, flu vaccine has suffered the same fate and it is no surprise that the COVID- vaccine is also receiving the same treatment. It is more than likely that the vaccine will become an annual event and if we are to win the war with the virus, we urgently need to develop longer term thinking.
Our Institutions are still not keen to address the issue of trust, instead the diagnoses are that we have an information deficit, therefore the prescription is identify the “right messengers” – In 2021 we still hear the phrase “community leaders” are putting their support behind the vaccine”- they will be our messengers.
I am a strong supporter of vaccines and have first hand experience of the protection and the value that they offer. In the absence of Institutions not addressing trust it is vital that Black and Minority Ethnic communities create and are creating alternative networks that they trust to navigate their way through a noisy and difficult landscape where the search for social justice continues.
What works– Having spent a large amount of time in vaccination centers, numerous community workshops, residents’ associations and inter-actions with health care professionals, what I am learning is that the current approach premised on information deficit will not necessarily yield greater take up from these communities. The insights from these events demonstrate that the greatest influencer is the family unit and in some family units’ key individuals hold more persuasive power. Understanding personal risk does not mean that it is translated into behaviours that will mitigate risks. Surviving the hardships of COVID induced lockdowns is a bigger priority within some minority ethnic groups where grinding poverty is causing untold harm.
Better understanding of the impact of COVID -19 within different ethnic groups, their belief formation and attitude provides a more accurate assessment of the tolerance of risks and which messenger and message they will trust. We need to win the long-term battle of building trust within our Institutions and the important role that vaccines play. For another “Black swan” event will not be far away.
