How do we improve vaccine uptake in older adults from ethnic minorities?
Young men and women arrived from Eastern Europe, the Caribbean and the Indian subcontinent to the UK in search of better life from the late 1940’s onwards. Many arrived with little money and thick coats to protect themselves against the bitter cold. Fast forward half a century and those young men and women have grown older, had children and now stand alongside us facing the greatest threat for a generation: the COVID-19 pandemic.
However, when it comes to the threat of dying from the COVID-19 infection, older adults from ethnic minorities face a double risk: from their age and their ethnicity. The raised risk of death from coronavirus due to age may be due to a less efficient immune system or having other medical problems as compared to younger people. With regards to ethnicity, social factors are likely to be at play; such as, coming from poorer backgrounds or having jobs that may lead to greater exposure to coronavirus infection such as taxi drivers. Curiously those countries from where the ethnic minorities originate do not have the same disproportionate mortality from coronavirus compared to ethnic minorities in this country. This throws shade on the theory of inherent genetics or biological risk factors which may increase this risk; one such supposition is possible low vitamin D levels. Some ethnic minorities were also distrustful of health services and presented later after their initial infection.
It is this distrust of health services what many believe is negatively impacting COVID-19 vaccine uptake amongst ethnic minorities, especially older adults. This reluctance to take up the vaccine is what many call vaccine hesitancy. The equalities minister, Kemi Badenoch, stated at a recent enquiry that such distrust cannot be tackled by the government alone but required family and community members to challenge vaccine hesitancy more directly.
We looked at all the research on the views of older adults from ethnic minorities towards all vaccinations to develop a greater understanding of the topic.
What did we find?
From looking through 2485 database records, we found 28 studies on the views of older adults from ethnic minorities towards all vaccinations. These views were towards the (viral) influenza, pneumococcal (bacterial pneumonia), pertussis (bacterial infection causing prolonged cough) and tetanus (bacterial infection) vaccines.
Factors decreasing vaccine uptake:
● Vaccine misinformation: perception of influenza as a mild illness, lack of awareness of vaccine recommendation or increased risk of disease with increasing age.
● Patient-related: perceptions of good health, perceptions that vaccines are ineffective or harmful, mistrust in the healthcare system including less trust in Western-centric medicine, negative past experiences with healthcare systems and clinicians.
● Access-related: vaccine cost, lack of available transport to vaccine site and appointments in general, experience of lack of previous vaccine shortages.
Factors increasing vaccine uptake:
● Healthcare professional related: recommendation from healthcare professional with a long-term relationship and efforts to ‘persuade’ vaccine uptake; vaccination reminders including at clinic and media for example.
● Patient-related: encouragement from family, friends and community & cultural leaders; fear about contracting infectious disease; recognition of age as a risk factor; understanding that vaccines prevent illnesses and decrease disease severity.
● Different preferences of vaccine settings: preferred traditional medical settings to community settings.
We can see some of these strategies already in use including healthcare professionals calling up patients from ethnic minorities as well as holding vaccine information webinars and setting up vaccination hubs in community centres and places of worship. New strategies used during this pandemic include involving celebrities to communicate the safety of vaccines.
Most studies were from the USA with a handful from Japan, Brazil and Hong Kong, China. Most of the studies involved multiple ethnic groups including African Americans/Black, Latinx/Hispanic, Chinese and Japanese people. There is just one multinational study including people from the UK. This makes it hard to apply our results from the research to older adults from ethnic minorities in the UK. However this signals the need to learn about views towards the COVID-19 vaccine as well as existing vaccines in the NHS schedule through future research.
The most over-stated phrase during recent times is “No one is safe, until everyone is safe.” Immunising everyone to prevent coronavirus transmission and further viral mutation is integral to bring an end to this pandemic and the negative effects of repeated lockdowns and economic turmoil. We hope our work will help support the future work to support vaccine uptake for older adults from ethnic minority background not only in this pandemic but also in future pandemics.
Acknowledgements: Thanks to Dr Umar Chaudhry for his comments on earlier drafts of this article.
