Black, Asian, and minority ethnic communities worldwide have a disproportionate risk of severe COVID-19. In the UK, as of May 19, 2020, 36% of critically ill patients with COVID-19 requiring intensive care were from Black, Asian, or minority ethnic groups.1 According to Public Health England, the mortality risk from COVID-19, after accounting for sex, age, deprivation score, and geographical region, is double in Bangladeshi people and up to 50% higher in Black and south Asian people compared with White British people.1 This finding contrasts with age-adjusted all-cause mortality from previous years, which was lower in Asian and Black people than in White British people.1 These data imply that COVID-19 has more serious effects in Black and Asian people.
The ethnic groups most affected by COVID-19 are under-represented in the COVID-19 vaccine trial data published so far. Despite efforts to encourage participation from Black, Asian, and minority ethnic groups, of the 552 participants in the phase 2/3 Oxford–AstraZeneca trial (based in Southampton and Oxford, UK), only one participant was Black and 19 were Asian.2 Large-scale trials also have a smaller proportion of minority groups compared with the populations sampled (appendix).3, 4, 5
Black, Asian, and minority ethnic individuals are under-represented in research. However, the ongoing pandemic necessitates that access to trials and vaccinations shifts from being equal to being equitable. Study recruitment and participation designs should improve diversity in ethnic groups to maximise the validity of results to the populations concerned. Age and sex are routinely considered in recruitment design—the same should now apply to ethnicity.
In the context of a pandemic that has higher infection and mortality risks in certain ethnic groups, it is important that these specific groups are adequately represented in vaccine trials to evaluate both immunogenicity and efficacy.
We declare no competing interests. Both authors contributed equally.
Supplementary Material
References
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