Governments are already planning who will get the Covid-19 vaccine first, prioritizing the elderly and the vulnerable.
Those plans should not presume that everyone who can have the vaccine will be willing to receive it. There is already much scepticism, resistance, and all-out hostility to vaccination, particularly in minority communities.
This is about much more than the “anti-vax” movement that has lately been associated with the far-right in the United States, or, where I live, the largely white anti-lockdown and anti-vaccine protestors who have regularly marched throughout England.
I sit on the management group of the Novavax vaccine trial at the Bradford Royal Infirmary, one of six vaccines preordered by the UK government, and the first trial of its type anywhere in the world. Bradford is one of the most ethnically diverse parts of Britain; more than a third of the town is nonwhite. A quarter of Bradford’s residents are Pakistani.
Ethnic minorities were 10 times less likely than the general population to participate in the vaccine trial: They comprise 36 percent of the population, but only 3 percent of trial participants.
Many of the factors that make them more susceptible to Covid also make them more likely to refuse a vaccine.
The common thread is lack of access to and distrust of official government communication. In March, I called for all official government Covid information websites to be available in multiple languages. Eight months later, some governments are still only communicating in official languages. This immediately excludes many older first-generation immigrants—precisely the demographic that is most at risk. In Bradford, Pakistani and Kashmiri immigrants who speak Urdu and local Kashmiri languages like Potwari are largely left in the dark.
There also needs to be a shift away from top-down, almost dictatorial communications. These pressers (along with an aggressive social media strategy) have been a ratings hit and invaluable in providing a single, authoritative source of information. But what about communities who do not watch the mainstream channels or don’t actively use social media?
Minorities also already have poorer health outcomes than the general population. When many minorities feel failed by health services (despite their own communities being over-represented in the delivery of health and care), there is naturally lower trust.
Compounding this is the fact that many minorities also already felt alienated by government policies. The ever closer alliance between health experts and political leaders is likely to tar the former with the distrust directed towards the latter.
African Americans are more than three times as likely to be killed during a police encounter, just as Black Britons are 40 times more likely to be stopped and searched by police. Many Latino communities in the US live in constant fear of ICE enforcement teams. Muslims on both sides of the Atlantic have complained of profiling and over-zealous counter-extremism programs like the Prevent strategy. If you’re not white, it’s inevitable these policies will color your feelings about an officially endorsed vaccine.
This is a (perhaps unforeseen) consequence of the politicization of health authorities. Epidemiologists like Anthony Fauci or Chris Whitty, England’s chief medical officer, may feel that they can stand at the podium next to the president or prime minister and still claim to be impartial scientists. Optics matter, and in some quarters health authorities are now as distrusted as the governments who fund them.
This has created real resistance in some communities towards vaccines. When the Bradford Novavax trial sent representatives to the local Mosque to plead for minority participants, they were politely welcomed, but it didn’t increase participation.
What minority communities need is to receive this message about vaccine safety from those they identify with and trust within their own communities. Instead of top-down communication from health authorities and medical professors, we need horizontal encouragement: relatives, friends, the server in the restaurant, the taxi driver who drives you to school, they should all be encouraging you. Crucially, we need respected and trusted figures in the community to advocate. Religious leadership is also key. Mosque leaders and spiritual authorities should be publicly taking the vaccine.
Cultural attitudes aren’t the only barrier. There are also entirely rational concerns about a vaccine process that has taken months instead of the usual 10 years. Rather than dismiss those concerns, we need transparency. It's crucial to show everyone what goes on behind the scenes, and why we can be sure it's safe.
The heavy-handed alternatives are not workable. The Royal Society, the UK’s national academy of sciences, has suggested that vaccine misinformation should be made a criminal offense. That’s likely to exacerbate the divide, similar to forcing or coercing people into taking the vaccine. The harder you push, the more pushback you will get.
There needs to be vaccination by consent. It’s essential we do this to avoid lack of vaccinations exacerbating social and economic divisions. In the UK, government officials and companies alike have discussed making receiving a vaccine a condition for work, travel, or attending public events.
If we end up with parts of society not taking the vaccine, it will lead to a level of de facto segregation we haven’t seen for generations.
We need to build trust now. Whatever happens with the vaccine, there are inevitably going to be stories of side effects that go viral and create irrational fear of the jab’s consequences.
Even if those stories are sidelined by broadcast media and suppressed by social media, they will spread like wildfire in private Whatsapp groups and through word of mouth. Public health officials should identify influencers in all communities so they can help engage the public.
Vaccine delivery isn’t just about getting it into people’s bloodstreams. It's about building support and trust for it in their hearts and minds—especially in hard to reach communities. We should work as hard on that as we are working on the vaccine itself.
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