NHS England (NHSE) will now publish ethnicity data on who is receiving the COVID-19 vaccine, following backlash and accusations of potential bias. For the first seven weeks of NHSE’s vaccination programme, Pinnacle, the digital registration system being used to record vaccination progress, has recorded information based on region and age band of recipient (80+ and under 80). This will now be supplemented by data on ethnic group and occupation, in order to highlight roll-out and uptake in high-risk groups, such as black, asian and minority ethnic (BAME) groups and those living in deprivation.
WHY IT MATTERS
The COVID-19 vaccine is being rolled-out initially according to priority groups determined by the Government and the Joint Committee on Vaccination and Immunisation (JCVI). This means that the primary recipients have been people aged 80+, care home residents and carers, and frontline and social care workers.
The allocation of these priority groups has been the source of some contention. Although the elderly are at great risk of mortality after contracting the virus, the prioritisation does not take into account the disproportionately worse outcomes of COVID-19 associated with ethnicity or disadvantage. A report by Public Health England published as early as August 2020 found that people of Bangladeshi origin were most likely to die from COVID-19 and that those from Black ethnic groups were the most likely to be diagnosed with the virus.
A recent publication by the Race Equality Foundation laid out recommendations to improve the distribution of vaccinations. These include the recommendation for the JCVI to alter priority groups to curtail the disproportionate number of deaths by COVID-19 amongst BAME groups, and to publish vaccination rates by sex and ethnicity as well as age to tackle misinformation around COVID-19 vaccination.
However, there has been some concern as to the outcome of collecting ethnicity data. Jabeer Butt, the chief executive of the Race Equality Foundation, although in support of ethnicity data collection, worried that, with the current prioritisation, ethnicity data could lead to misconceptions about a lack of uptake amongst ethnic minorities. He said, considering that only 3% of the UK’s over 80 population are from BAME groups, “current debates about vaccine hesitancy need to be treated with caution” in order that BAME communities are not stigmatised.
NHSE were initially resistant to including ethnicity data, highlighting that it is already stored in patient records linked to the National Immunisation Management System (NIMS) of which Pinnacle is a part. Data, however, suggests that ethnicity is recorded in only 60-70% of GP records.
THE LARGER PICTURE
In the US, Jvion recently unveiled a COVID Vaccination Prioritization Index, designed to highlight those most at risk of COVID-19 and to guide the vaccination effort accordingly to tackle racially-skewed health inequalities.
ON THE RECORD
Robert Ede, head of Policy Exchange’s health and social care unity, commented on the potential impact of not recording and responding to ethnicity data: “If uptake remains low in poorer, more ethnically diverse neighbourhoods, as well as higher risk of more death and serious illness further down the line, there will also be reasonable public health grounds to keep these areas under tighter restrictions while measures ease elsewhere. This would be a deeply undesirable situation that would amplify the health inequalities already found in society.”
The NHS Race and Health Observatory, an initiative set up in May 2020 to investigate racial inequalities in health, tweeted: “Data recording is essential here, not just to ascertain take-up levels (and target appropriate and culturally sensitive interventions) but also to improve ethnicity recording across primary care.”
Roger Kline, designer of the Workforce Race Equality Standard for the NHS, told HSJ: “[O]ne lesson from the first COVID-19 wave was its disproportionate impact on certain groups – notably BAME staff and patients. There is no reason to think this may still not be happening so it is hard to understand why recording ethnicity when vaccinating would not be mandated, especially given the evidence of lower acceptance levels for vaccination amongst BAME population groups. I cannot imagine that if this is happening it is driven by a public health imperative.”
NHSE commented on the development: “As has been the case from the start of the vaccination programme, when someone is vaccinated this fact links to their NHS records enabling population uptake to be monitored by ethnicity, and with aggregate data shared with local authority directors of public health as they lead work to ensure equitable community uptake. In addition, as a ‘belt and braces’ supplementary measure, ethnicity data is also being recorded as part of the vaccination collection through Pinnacle.”