Vaccination Uptake: “I Would Be At The Front Of A Queue”

Vaccination Uptake: “I Would Be At The Front Of A Queue”

By Dr Kofi Anie MBE, Consultant Psychologist & Deputy Clinical Director at Central Middlesex Hospital

In June 2020, the Prime Minister and Secretary of State for Health and Social Care commissioned the Minister for Equalities, with support from the Cabinet Office Race Disparity Unit (RDU), to take forward work on the disproportionate impact of COVID-19 on ethnic minority groups. This commission included developing an understanding of the drivers of disparities in infection and death rates of COVID-19, reviewing the effectiveness of current actions being undertaken by the government to lessen disparities, and modifying or developing policy where needed.

The report identifies in regard to vaccination uptake a really concerning finding amongst Black Caribbean and African healthcare workers:

  • Black Caribbean healthcare workers were more than 3 times more likely to be vaccine-hesitant than White British healthcare workers. Black African healthcare workers were approximately twice as likely and White Other healthcare workers were approximately one and a half times more likely.[1] 

NHS England has explicitly stated in a policy document on Jan 7 that all healthcare workers, including those working in the independent sector and the Ministry of Defence, will receive COVID-19 vaccinations as a priority. They made clear that the vaccination of healthcare workers, in line with the Joint Committee of Vaccination and Immunisation’s (JCVI) prioritisation.[2] was a critical step to ensure we protect health and care workers, patients and the public at a time when COVID-19 pressures across health and care are intensifying. The JCVI recommended that within this group, priority be given to frontline staff due to a high risk of acquiring infection or at risk of transmitting infection to multiple vulnerable persons or other staff in a healthcare environment.

Healthcare workers include physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, allied health professionals, laboratory technicians, pharmacists, hospital volunteers, and administrative staff.

Dr Mary Ramsay, Head of Immunisation at Public Health England, said “Vaccines are the most important tool we have against COVID-19 and they have already saved thousands of lives. That is why it is vitally important to get both doses of your vaccine as soon as they are offered to you, to protect you and those around you. The more people that get 2 doses of the vaccine, the more lives will be saved.”

The report goes onto outline the predictors of hesitancy are as follows:

1. Younger age

2. Female sex

3. Higher score on a COVID-19 conspiracy beliefs scale

4. Lower trust in employer

5. Lack of influenza vaccine uptake in the previous season

6. Previous COVID-19

To be clear none of these indicators are sufficient reasons to delay or not to seek vaccination against COVID-19. There are legitimate concerns from young women concerned with fertility issues, for example, nonetheless seeking out correct information and having one-to-one conversations for staff to discuss their concerns is essential. In addition, there is education through locally driven solutions such as NHS trusts and civil society organisations who are holding vaccination sessions with most up-to-date and accredited information.

Vaccine hesitancy, characterised by uncertainty and ambivalence about vaccination, is a legitimate viewpoint, underscoring the failure or lack of effective public health messaging. People who are hesitant can still be convinced of the vaccines’ safety, efficacy, and necessity,[3] and, most importantly, they are not “anti-vaxxers.”

Trust has been eroded by systemic racism[4] and discrimination, previous unethical healthcare research in black populations,[5] under-representation of minorities in health research and vaccine trials,[6] and negative experiences within a culturally insensitive healthcare system.

Royal College of Nursing general secretary and chief executive Dame Donna Kinnair said: “BAME health and care workers are doing all they can to keep their patients safe while facing a disproportionate risk from COVID-19 themselves.”

Prioritising vulnerable members of minority communities, in particular healthcare workers, for COVID-19 vaccination and recognising their roles as trusted sources of information could reduce the perceptions of risk of COVID-19 vaccines among people from ethnic minorities. Such communications can be made more effective by providing educational resources in multiple languages.[7] Vaccination could be made more convenient and accessible through measures such as providing transport, particularly for people who work in lower paid public facing roles and using places of worship as vaccination sites.[8]

Personal experience from Dr Kofi Anie MBE, Consultant Psychologist & Deputy Clinical Director at Central Middlesex Hospital

I work with patients who have sickle cell disease or thalassaemia, are predominantly from black and minority ethnic communities, and ‘clinically extremely vulnerable.’ I believe it is my duty of care and best interest of these patients to provide precise information and encouragement for the uptake of vaccines. Importantly, clinical and social care staff who treat and look after these vulnerable people need to ultimately protect them from COVID-19 by helping to stop transmissions themselves with vaccines.

Personally, I am black and clinically extremely vulnerable. Consequently, I always used to say that when vaccines become available I would be at the front of a queue to receive mine. Certainly, I did not hesitate and took my first dose on the first day it was offered in the NHS Trust where I work. I took pictures and videos when I was having my vaccine on both occasions to demonstrate to patients and staff that this is very important to me. With my two doses I feel protected and self-assured when I am at work, out and about, and travelling, knowing that we all have to live with the risk of COVID-19 for a long time.

Vaccines are the best way to protect people from coronavirus and have saved thousands of lives. Research has shown that vaccinated people are less likely to have serious illness from COVID-19, to be hospitalised, or to die from it. There is also clear evidence that people who have been vaccinated are less likely to pass the virus onto others. We need to engage, listen with respect, communicate effectively, and offer practical support to those who have yet to make up their minds about the vaccine.


[1] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/988838/Third_quarterly_report_on_progress_to_address_COVID-19_health_inequalities.pdf

[2] https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/C0994-System-letter-COVID-19-vaccination-deployment-planning-30-December-2020.pdf

[3] Mills M, Rahal C, Brazel D, et al. COVID-19 vaccine deployment: Behaviour, ethics, misinformation and policy strategies.Royal Society, British Academy, 2020

[4] Razai MS, Kankam HKN, Majeed A, Esmail A, Williams DR Mitigating ethnic disparities in covid-19 and beyond.BMJ2021;372:m4921. doi:10.1136/bmj.m4921 pmid:33446485

[5] Gamble VN Under the shadow of Tuskegee: African Americans and health care. Am J Public Health1997;87:1773-8. doi:10.2105/AJPH.87.11.1773 pmid:9366634

[6] https://www.gov.uk/government/publications/factors-influencing-covid-19-vaccine-uptake-among-minority-ethnic-groups-17-december-2020

[7] Hoppe KK, Eckert LO. Achieving high coverage of H1N1 influenza vaccine in an ethnically diverse obstetric population: success of a multifaceted approach. Infect Dis Obstet Gynecol2011;2011:746214. doi:10.1155/2011/746214 pmid:21760700

[8] https://www.theguardian.com/society/2021/feb/07/faith-leaders-join-to-counter-fears-over-vaccine-among-bame-communities[2][2]