Rethinking vaccine hesitancy among minority groups

In countries such as the UK and USA that are privileged to have adequate supplies of COVID-19 vaccines but also plagued by histories deep inequities white supremacy, it was predictable benefits would not be equally shared across all sectors society. The challenge low vaccine access uptake some groups is multidimensional. Although hesitancy often implicated, this framing mistakenly places responsibility on minoritised become less hesitant, rather than public health systems more trustworthy accessible. This inadvertently underemphasises barriers been incompletely addressed for these populations. a nationally representative survey 12 035 people conducted during November December, 2020, 71·8% Black 42·3% Pakistani Bangladeshi respondents were “unlikely or very unlikely” take vaccine.1Robertson E Reeve KS Niedzwiedz CL et al.Predictors in Household Longitudinal Study.Brain Behav Immun. 2021; 94: 41-50Crossref PubMed Scopus (312) Google Scholar Available data from 43 US states up April, 2021, show vaccination rates White almost twice high Hispanic people,2Ndugga N Pham O Hill L al.Latest vaccinations race/ethnicity. Kaiser Family Foundation.https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/Date: April 14, 2021Date accessed: 2021Google despite higher proportion Republicans being unsure unwilling when asked about taking vaccine.3Michelson A likely reject any other group America.Business Insider. March 15, https://www.businessinsider.com/white-republicans-more-likely-to-reject-covid-19-vaccine-2021-3?r=US&IR=TDate 19, Vaccine disparities not, therefore, fully explained so-called hesitancy. There an urgent need government agencies collect inform strategies address uptake, disaggregated ethnicity race, availability location, complex reasons refusals, including previous negative experiences interacting with services locations timings centres inconvenient.2Ndugga Scholar, 4Women Equalities CommitteeGovernment failing BAME communities young women take-up.https://committees.parliament.uk/committee/328/women-and-equalities-committee/news/153480/government-failing-bame-communities-and-young-women-on-vaccine-takeup/Date: 27, Insights quantitative qualitative increase among uptake. Misattribution drivers can lead inappropriately tailored solutions. term typically implies individuals choosing grounds confidence incorrect beliefs.5MacDonald NE hesitancy: definition, scope determinants.Vaccine. 2015; 33: 4161-4164Crossref (2320) However, study included 2600-people interviews showed many Asian faced discrimination accessing local services, police, population.6RSAEthnic minorities face services.https://www.thersa.org/press/releases/2021/ethnic-minorities-twice-as-likely-to-face-discrimination-in-local-servicesDate: 12, indicated past discrimination—eg, stating “actively make my life difficult”—are associated lower uptake.6RSAEthnic Failures acknowledge institutional racism, exemplified March, Commission Race Ethnic Disparities report,7Commission DisparitiesThe report Disparities.https://www.gov.uk/government/organisations/commission-on-race-and-ethnic-disparitiesDate: 31, prevent concerted efforts tackle structural their practical impacts. addition health, justice, social include no inadequate insurance, insufficient information patients' justified questions possible adverse events, concerns related historical practices unethically exploited medical experiments.8Boyd R better access, attitudes.The New York Times. 5, 9Kama-Kieghe S How GPs communities. GP Online.https://www.gponline.com/gps-tackle-vaccine-hesitancy-bame-communities/article/1707882Date: Feb 22, With respect latter, Britons Americans might question whether pharmaceutical companies informing protecting them, knowing case programmes Tuskegee syphilis experimental drugs used Nigerian children there appropriate informed consent obtained parents.9Kama-Kieghe 10Lenzer J Nigeria files criminal charges against Pfizer.BMJ. 2007; 3341181Crossref Fears certain populations misled vaccines11de Figueiredo Simas C Karafillakis Paterson P Larson HJ Mapping global trends investigating uptake: large-scale retrospective temporal modelling study.Lancet. 2020; 396: 898-908Summary Full Text PDF (454) recourse powerful if they harmed, alongside barriers, will translating into different languages, leveraging shift groups. Ultimately, investments most effective trust non-medical sources advice.11de Learning responded challenges, Pakistan, instructive. Experience Pakistan suggests although crucial offer free at point care without legal residency checks, sufficient ensure which state has previously coercive absent providing health-care services.12Ali SAM Altaf SW Citizen trust, administrative capacity burden Pakistan's immunization program.J Public Administr. (published online 29.)https://doi.org/10.30636/jbpa.41.184Crossref parallel could drawn both immigrant minority USA, whose current care, treated differently seeking help spoken rudely, act barrier uptake.9Kama-Kieghe Misinformation disinformation spread through media poorly commentators mass platforms unresolved challenges countries,11de quick fixes strengthening credible information, journalism, regulation.13Khan YH Mallhi TH Alotaibi NH al.Threat Pakistan: measures neutralize misleading narratives.Am Trop Med Hyg. 103: 603-604Crossref (141) As WHO emphasises, only exacerbated infodemic challenge; rapid volume health-related accurate inaccurate, makes monitoring management resource intensive.14WHOCall action: managing infodemic.www.who.int/news/item/11-12-2020-call-for-action-managing-the-infodemicDate: Dec 11, 2020Date Part solution lies sufficiently resourcing trusted, providers time needed listen community concerns, specific fears, counter misinformation, build communities, convince vaccine. Evidence indicates vicious cycle occur do tools counter-narrative encounters, therefore hurry interactions patients may benefit lengthy discussions.15Jamal D Zaidi Husain al.Low rural Sindh, refusal, ignorance access?.Vaccine. 38: 4747-4754Crossref (16) Thus, push roll out rapidly results insufficiently supported encounter, result professionals appearing dismissive, thereby exacerbating trust.12Ali 15Jamal Not prioritising community-centred engagement falsely implicate poor understanding untrusting. key lesson offers importance acknowledging types rational gaps one-size-fits-all reassurances unlikely work.12Ali An evidence-based of, response to, unique needs allow policy makers move beyond focusing individual choices underlying causes lack governments broadly, well issues convenience access. Supporting already disproportionately affected equity issue achieve broader population immunity. Since delays collecting complete, localised race acceptance refusal learning lessons important.2Ndugga Indeed, too late improve track records contexts disadvantaged pandemic. We declare competing interests.