COVID-19 vaccinations and race equality: no trust without agency

The NHS Race and Health Observatory responds to our report VacciNation: Exploring vaccine confidence with people from African, Bangladeshi, Caribbean and Pakistani backgrounds living in England.
Man getting a COVID-19 vaccine

For most of us, agency is something that, until recently, was easy to take for granted. In normal life, we make hundreds of choices every day and feel, for the most part, that decisions regarding our life and our health are ours to make. In other words, we feel free.

The last year has challenged this freedom in more ways than one. The COVID-19 pandemic, and the government’s response to it, has meant sacrificing many of our liberties – from small freedoms such as going out for a meal, to the more important freedoms like seeing our loved ones. We have developed a new relationship with freedom and sacrifice.

When it comes to vaccination, though, questions about freedom and agency become more complicated. Ever since COVID-19 vaccines became available for public use at the end of 2020, people have had a choice to make – take the vaccine or decline it – and while vaccination is not mandatory, there has been a persistent pressure applied, formally and informally, for people to comply.

None of this is to say that the vaccines aren’t safe. I have no doubt that an effective vaccination effort is the fastest and safest route back to normality, but it is vital that the vaccine roll-out doesn’t further embed the ethnic health inequalities that have been highlighted during the pandemic. Evidence shows that Black and minority ethnic communities have tended to be more likely to decline a vaccine. Data drawn from a subset of participants in the UK Household Longitudinal Study, showed that while overall vaccine hesitancy was low (17%), the rate of hesitancy was significantly higher in in Black (71.8%) and Pakistani/Bangladeshi (42.3%) ethnic groups.

The first instinct of some has been to stigmatise these communities – but doing so ignores the collection of entirely legitimate concerns that people have about vaccinations developed over a very short time frame and necessarily subject to no long-term research. This new report is vital in that it seeks to understand why people are hesitant about the vaccine, and to present practical steps to improve the way policymakers and leaders talk about the vaccine. 

You don’t need to look far to find newspaper headlines criticising those with concerns about vaccination as ‘anti-vax’ or ‘conspiracy theorists’. Government messaging too, has often sought to apply pressure. For many, this has presented a challenge to their agency, especially among some Black and Asian communities who have felt especially targeted by this messaging.

The vaccines are safe, but that fact must be communicated in a compassionate way, based on genuine participatory community engagement, and with an understanding that trust needs to be built (or re-built) gradually.

Ethnic health inequality will persist until we can put aside stigma and condemnation and take everyone’s concerns seriously and at face value.
— Sam Rodger, Senior Policy and Strategy Lead, NHS Race and Health Observatory

Agency has emerged from this research as a key element affecting public trust. One of the failures of public messaging around the vaccine is that it has sought to deny people agency, telling them to take the vaccine but failing to acknowledge any doubt whatsoever. As seen in this report, for many Black and Asian people, vaccine hesitancy relates to a deeply ingrained mistrust of a system that has not always served them well. Institutional racism and health inequality are matters of fact in this country, meaning trust between communities and public authorities cannot simply be taken for granted.

Agency is also part of the answer. We shouldn’t be speaking down to people by asking Black and Asian celebrities to endorse the vaccine. We should be inviting people to genuinely engage with the evidence; that evidence should be presented to them in an honest way by qualified professionals; and those people should be free to come to their own conclusions and decisions.  

Ethnic health inequality will persist until we can put aside stigma and condemnation and take everyone’s concerns seriously and at face value. The NHS Race and Health Observatory exists to commission and synthesise research and evidence around race inequality in health. It is important to us that this evidence is freely available to all who want to engage, and we are committed to having an open conversation about that evidence, however difficult it can become. We have been happy to support Healthwatch England in conducting this important research, and we invite those reading this blog to take seriously its findings and recommendations.

Read the full report

Find out more about people's views and experiences of the COVID-19 vaccine roll-out. 

Download the report