Addressing Vaccine Hesitancy to Reduce Racial and Ethnic Disparities in COVID-19 Vaccination Uptake Across the UK and US

Fuller, Harriett; Dubbala, Keerthi; Obiri, Dorotheah; Mallare, Meryll; Advani, Shailesh; Souza, Sophie De; Stoby, Karlene S.; King-Okoye, Michelle

doi:10.3389/fpubh.2021.789753

Cited by 17 publications

(16 citation statements)

References 9 publications

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“…Previous studies have reported a positive association between daily incidence and mortality rates, [1] which is consistent with the present study. There was disparity on critical supply, testing of the cases, vaccination [46][47][48] and structural factors [49] in low-income and middle-income countries and it is in line with our results. The present findings have shown that the daily incidence rate was associated with the daily mortality rate; as the daily incidence rate increased, the increase in the daily mortality rate became steeper.…”

Section: Discussionsupporting

confidence: 90%

COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries

Park

Ranabhat

2022

Arch Public Health

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Background The coronavirus disease 2019 (COVID-19) pandemic has transitioned to a third phase and many variants have been originated. There has been millions of lives loss as well as billions in economic loss. The morbidity and mortality for COVID-19 varies by country. There were different preventive approaches and public restrictions policies have been applied to control the COVID-19 impacts and usually measured by Stringency Index. This study aimed to explore the COVID-19 trend, public restriction policies and vaccination status with economic ranking of countries. Methods We received open access data from Our World in Data. Data from 210 countries were available. Countries (n = 110) data related to testing, which is a key variable in the present study, were included for the analysis and remaining 100 countries were excluded due to incomplete data. The analysis period was set between January 22, 2020 (when COVID-19 was first officially reported) and December 28, 2021. All analyses were stratified by year and the World Bank income group. To analyze the associations among the major variables, we used a longitudinal fixed-effects model. Results Out of the 110 countries included in our analysis, there were 9 (8.18%), 25 (22.72%), 31 (28.18%), and 45 (40.90%) countries from low income countries (LIC), low and middle income countries (LMIC), upper middle income countries (UMIC) and high income countries (HIC) respectively. New case per million was similar in LMIC, UMIC and HIC but lower in LIC. The number of new COVID-19 test were reduced in HIC and LMIC but similar in UMIC and LIC. Stringency Index was negligible in LIC and similar in LMIC, UMIC and HIC. New positivity rate increased in LMIC and UMIC. The daily incidence rate was positively correlated with the daily mortality rate in both 2020 and 2021. In 2020, Stringency Index was positive in LIC and HIC but a negative association in LMIC and in 2021 there was a positive association between UMIC and HIC. Vaccination coverage did not appear to change with mortality in 2021. Conclusion New COVID-19 cases, tests, vaccinations, positivity rates, and Stringency indices were low in LIC and highest in UMIC. Our findings suggest that the available resources of COVID-19 pandemic would be allocated by need of countries; LIC and UMIC.

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Section: Discussionsupporting

confidence: 90%

COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries

Park

Ranabhat

2022

Arch Public Health

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“…Vaccine hesitancy has been more prevalent in minority ethnic groups and patients from socially deprived backgrounds, despite increased COVID-19-related morbidity and mortality. [14]. It has been speculated that, although low health literacy may play a role, hesitancy is mainly driven by mistrust in these patient groups towards drug industry research, healthcare systems, and government policies due to historical structural inequalities [14].…”

Section: Discussionmentioning

confidence: 99%

“…[14]. It has been speculated that, although low health literacy may play a role, hesitancy is mainly driven by mistrust in these patient groups towards drug industry research, healthcare systems, and government policies due to historical structural inequalities [14]. The infamous US Tuskegee syphilis study in 1993, which deprived Black participants of antibiotic treatment when it became available to inspect the natural history of untreated diseases [15], is exemplary in the history of unethical medical research that continued into the 1990s in some academic institutions [15].…”

Section: Discussionmentioning

confidence: 99%

Increasing Uptake of COVID-19 Vaccination and Reducing Health Inequalities in Patients on Renal Replacement Therapy—Experience from a Single Tertiary Centre

et al. 2022

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Background: COVID-19 vaccination has changed the landscape of the COVID-19 pandemic; however, decreased uptake due to vaccine hesitancy has been observed, particularly in patients from minority ethnic backgrounds and socially deprived areas. These patient characteristics are common in patients on Renal Replacement Therapy (RRT), a population at extremely high risk of developing serious illness from COVID-19 and who would thus benefit the most from the vaccination programme. We designed a bespoke COVID-19 vaccination programme for our RRT population with the aim of decreasing health inequalities and increasing vaccination uptake. Methods: Key interventions included addressing vaccine hesitancy by deploying the respective clinical teams as trusted messengers, prompt eligible patient identification and notification, the deployment of resources to optimise vaccine administration in a manner convenient to patients, and the timely collection and analysis of local safety and efficacy data. First, COVID-19 vaccination data in relation to ethnicity and social deprivation in our RRT population, measured by the multiple deprivation index, were analysed and compared to uptake data in the total regional adult clinically extremely vulnerable (CEV) population in Greater Manchester (GM). Univariate logistic regression analysis was used to explore the factors associated with not receiving a vaccine. Results: Out of 1156 RRT patients included in this analysis, 96.7% received the first dose of the vaccination compared to 93% in the cohort of CEV patients in the GM. Age, gender, ethnicity, and a lower index of multiple deprivation were not identified as significant risk factors for poor first dose vaccine uptake in our cohort. Vaccine uptake in Asian and Black RRT patients was 94.9% and 92.3%, respectively, compared to 93% and 76.2% for the same ethnic groups in the reference CEV GM. Vaccine uptake was 96.1% for RRT patients in the lowest quartile of the multiple deprivation index, compared to 90.5% in the GM reference population. Conclusion: Bespoke COVID-19 vaccination programmes based on local clinical teams as trusted messengers can improve negative attitudes towards vaccination and reduce health inequalities.

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“…8 Though the reasons for vaccine hesitancy amongst ethnic minority groups are complex and multifactorial, racial discrimination is likely to be a key upstream cause. 9,10 Research conducted before the COVID-19 pandemic has found that racial discrimination contributed to delayed medical screenings, 11 lower expectations of the quality of medical treatment, 12 and barriers to seeking mental and physical health care services. 13 In relation to COVID-19 vaccination, a cross-sectional study in the USA conducted in December 2020, found lifetime experiences of racial discriminationbut not discrimination due to religion, gender, or sexual orientation -was associated with 21% increased odds of COVID-19 vaccine hesitancy.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Racial and ethnic discrimination in turn leads to mistrust of government and public health institutions, 17,18 which are key barriers to vaccination. 9,10,16,19 Qualitative research conducted with ethnic minority groups during the third UK lockdown also points to mistrust of government and public health bodies as a mediator between racial/ethnic discrimination and vaccine hesitancy. 20 Further, quantitative studies have suggested that once trust in government and the health system are accounted for, ethnic minority group status no longer associates with COVID-19 vaccine unwillingness.…”

Section: Introductionmentioning

confidence: 99%

Racial discrimination, low trust in the health system, and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups

Paul

Razai

2021

Preprint

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Objectives To assess the role of racial and ethnic discrimination in determining covid-19 vaccine refusal in ethnic minority groups. Design Population based cohort study. Setting Survey data from the University College London COVID-19 Social Study. Participants Data from 633 adults belonging to ethnic minority groups who took part in the study from 23 July 2020 to 14 June 2021 were included. Experiences of racial/ethnic discrimination occurring since the start of the first lockdown were collected in the last week of July 2020. Structural equation modelling was used to model the direct effect of racial/ethnic discrimination on covid-19 vaccine refusal, as well as the indirect effects through low trust in the central UK government and the UK health service to handle the pandemic. The model adjusted for a range of demographic and covid-19-related covariates. Main outcome measures Data on covid-19 vaccination status was collected from 23 December 2020 to 14 June 2021 and operationalised as having had or agreed to have at least one dose versus having been offered but turned it down (refusal). Results Nearly one in ten (6.7%) who had refused a covid-19 vaccine reported having experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. The total effect of racial/ethnic discrimination on refusing a covid-19 vaccine was nearly 4-fold (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.4 to 10.9) and was mediated by low trust in the health system to handle the pandemic (indirect effect: OR = 2.5, 95% CI = 1.1 to 5.4). Conclusions Findings underscore the importance of addressing racial/ethnic discrimination in order to increase covid-19 vaccine uptake amongst ethnic minority adults. The results also highlight the crucial role the National Health Service must play in regaining trust from ethnic minority groups in order to overcome vaccine hesitancy.

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Addressing Vaccine Hesitancy to Reduce Racial and Ethnic Disparities in COVID-19 Vaccination Uptake Across the UK and US

Cited by 17 publications

References 9 publications

COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries

COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries

Increasing Uptake of COVID-19 Vaccination and Reducing Health Inequalities in Patients on Renal Replacement Therapy—Experience from a Single Tertiary Centre

Racial discrimination, low trust in the health system, and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups

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