I read with pleasure the Correspondence on behalf of the UK-REACH Study Collaborative Group which revealed the startling resolution of ethnic disparities in vaccine hesitancy amongst healthcare workers (HCWs). While an analysis of data from the baseline UK-REACH questionnaire (administered between 4 December 2020 and 19 February 2021) found that, compared to White British HCWs, Black Caribbean (aOR 3.37, 95% CI 2.11–5.37), Black African (aOR 2.05, 95% CI 1.49–2.82), and White Other ethnic groups (aOR 1.48, 95% CI 1.19–1.84) were significantly more likely to report vaccine hesitancy,1 a subsequent analysis of the first follow-up questionnaire (administered between 21 April and 28 June 2021) found no significant differences in risk of persistent hesitancy by ethnic group. 2 The closure of this disparity should be jubilantly celebrated, but also recognised as a learning opportunity.
The baseline analysis established drivers of vaccine hesitancy in HCWs, including mistrust of vaccines, employer, healthcare organisations, Government, and research. The subsequent work showed these factors are also important in determining whether hesitancy persists, and led the authors to sensibly suggest that building trust amongst ethnic minorities may successfully enhance future vaccine uptake. Exactly how this trust is to be built, however, remains unclear.
As identified by the authors, factors influencing trust varies between ethnic groups. The reported experiences of discrimination, perceived structural inequalities, and concerns of trial under-representation are likely to influence trust, and therefore hesitancy, amongst ethnic minority HCWs more so than White British HCWs, while concerns regarding speed of vaccine development and absence of long-term safety data influence all ethnicities equally.
This spectacular resolution of ethnic disparities in vaccine hesitancy presents an unmissable opportunity to learn how and why trust amongst ethnic minority HCWs so dramatically increased to trigger this outcome. This will require qualitative work involving ethnic minority HCWs who lost their hesitancy between the baseline and follow-up questionnaires, to specifically reveal: which drivers of hesitancy were most susceptible to defeat; how the influence of alleged discrimination and structural inequalities, and vaccine trial under-representation,3 was overcome; whether strategies suggested in the original and associated4 work were deployed and, if so, to what extent they were they effective; and whether additional factors became relevant after the baseline analysis (such as the increasing population of vaccinated people). The insights generated from this work could identify tangible, concrete, practical actions and policies to prevent recurrent vaccine hesitancy amongst ethnic minority HCWs in on-going and future vaccination programmes.
Declaration of interests
The author declares no conflict of interests
References
- 1.Woolf K., McManus I.C., Martin C.A. Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: results from the UK-REACH prospective nationwide cohort study. Lancet Reg Health Eur. 2021;9 doi: 10.1016/j.lanepe.2021.100180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Martin C.A., Woolf K., Bryant L. Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study. Lancet Reg Health Eur. 2022;13 doi: 10.1016/j.lanepe.2021.100299. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Armitage R. Addressing the under-representation of ethnic minority groups in COVID-19 vaccine trials. Perspect Public Health. 2022;142(1):13–14. doi: 10.1177/17579139211006741. [DOI] [PubMed] [Google Scholar]
- 4.Gogoi M, Wobi F, Qureshi I, et al. “The vaccination is positive; I don't think it's the panacea”: a qualitative study on COVID-19 vaccine attitudes among ethnically diverse healthcare workers in the United Kingdom. medRxiv 2021. 10.1101/2021.09.27.21264005. [DOI] [PMC free article] [PubMed]