Facilitators and barriers to COVID-19 vaccination uptake among ethnic minorities: A qualitative study in primary care.

INTRODUCTION: COVID-19 vaccination effectively reduces severe disease and death from COVID-19. However, both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is very limited understanding of the barriers and facilitators to COVID-19 vaccine uptake in Black and South Asian ethnicities. Therefore, we aimed to explore COVID-19 vaccination hesitancy in primary care patients from South Asian (Bangladeshi/Pakistani) and Black or Black British/African/Caribbean/Mixed ethnicities. METHODS: Patients from the above ethnicities were recruited using convenience sampling in four London general practices. Telephone interviews were conducted, using an interpreter if necessary, covering questions on the degree of vaccine hesitancy, barriers and potential facilitators, and decision-making. Interviews were transcribed verbatim and thematically analysed. Data collection and analysis occurred concurrently with the iterative development of the topic guide and coding framework. Key themes were conceptualised through discussion with the wider team. RESULTS: Of thirty-eight interviews, 55% (21) of these were in Black or Black British/African/Caribbean/Mixed ethnicities, 32% (12) in Asian / British Asian and 13% (5) in mixed Black and White ethnicities. Key themes included concerns about the speed of vaccine roll-out and potential impacts on health, mistrust of official information, and exposure to misinformation. In addition, exposure to negative messages linked to vaccination appears to outweigh positive messages received. Facilitators included the opportunity to discuss concerns with a healthcare professional, utilising social influences via communities and highlighting incentives. CONCLUSION: COVID-19 has disproportionately impacted ethnic minority groups. Vaccination is an effective strategy for mitigating risk. We have demonstrated factors contributing to vaccine reluctance, hesitancy and refusal and highlighted levers for change.

Facilitators and barriers to covid-19 vaccine uptake in BAME groups in primary care: a qualitative study

BackgroundCovid-19 vaccination is an effective strategy to reduce the spread of infection and achieve herd immunity. However, evidence suggests that both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is currently no qualitative study of the barriers and facilitators to covid-19 vaccine uptake in BAME groups in the UK primary care.MethodsWe aim to conduct in-depth telephone interviews using semi-structured, open-ended questions about covid-19 vaccination in patients from South Asian (Bangladeshi/Pakistani) and Black African/African-Caribbean ethnicities in primary care in March 2021. Patients will be recruited using purposive sampling in 5 socially and ethnically diverse general practices in London. Interviews will be transcribed verbatim and subjected to thematic analysis. Data on age, sex, occupation, co-morbidities, previous vaccination status, geographical location, country of birth, education level will be also be obtained. Patients will be selected through EMIS search. All adults over 18 who are eligible for covid-19 vaccination regardless of priority status and can consent will be included in the study. Questions will relate to desire to take the vaccine, barriers and potential factors that would change their view and decision-making.ResultsWe hypothesise that covid-19 vaccine hesitancy will be associated with deprivation, lower educational attainment, residential segregation, previous negative healthcare experiences, and poor trust of healthcare services. Other barriers and potential solutions will be explored in depth during the interview.ConclusionCovid-19 has had a disproportionate impact on ethnic minority groups with much higher mortality, and cases and hospitalisation rates compared to the White populations. Vaccination is an effective strategy in mitigating the risk. We need to understand the factors that cause vaccine reluctance, hesitancy and refusal, and how to facilitate engagement with vaccination programmes. This primary-care based study could help plan targeted public health campaigns to increase covid-19 vaccine uptake.

Gender balance in an unprecedented time.

As the NHS responds to the ongoing COVID-19 pandemic, the strain is being felt across the entire workforce. Both direct effects of COVID-19 and the response to the crisis are unearthing a number of societal inequalities, not least, those relating to gender. The fact that women play a disproportionate role in frontline health and social care roles and perform the majority of caregiving responsibilities is more exposed than ever before. Concurrently, the underrepresentation of women in senior clinical and leadership roles is being brought into stark relief. Redressing gender imbalance across health and social care is vital if we are to translate experience and learnings from our frontline workforce into our national preparedness and response effort. It is also important as we continue to promote wider gender and health equity goals within society. While we focus on responding to the current situation, an opportunity arises for greater value to be assigned to frontline health and caregiver roles. We must raise the profile of women leaders who are taking a stand during this crisis and use this opportunity to ensure that our future health and social care leadership reflects the wider workforce and the population.