“Alarming” racial inequality in third vaccine doses for the immunocompromised

We've condemned the “alarming” racial inequality in access to third doses of Covid vaccines for the severely immunocompromised in England, as new data has showed take-up among white British people is almost double that of some ethnic minorities.

The analysis of NHS England data, obtained by Blood Cancer UK after a Freedom of Information request, shows 84% of immunocompromised people from a white British background had three vaccine doses by mid-December, compared to just 43% of immunocompromised people from a Pakistani background.

The 500,000 immunocompromised compromised people in England (just under half of who have blood cancer) are at higher risk from Covid and are less likely to respond well to the vaccines, and so they need three primary doses and then a booster dose 12 weeks later.

The racial disparity in third dose uptake means there are thousands of immunocompromised people from ethnic minorities who are at needlessly high risk of becoming seriously ill with Covid. This has happened at a time (Oct to Dec) when there was a big increase in deaths from Covid among people with blood cancer.

While some of the difference in third dose uptake may be because of varying levels of vaccine hesitancy, this does not explain why the gap for third doses is much larger than the gap for the first two doses. For example, there was a 14-percentage point difference in take up of the first two doses between White British immunocompromised people (95%) and those from a Pakistani background (81%), but the gap between the two groups’ uptake of the third doses was 41 percentage points.

Similarly, for the first two doses there was a gap of 11 percentage points between white British people and people from a Bangladeshi background, but for third dose uptake this increased to a 35-percentage point gap.

We believe that the main reason for this is the chaotic and poorly communicated rollout of third doses for the immunocompromised, which left many people struggling to access them despite being eligible for them. There is lots of evidence the health system can be harder to navigate for people from ethnic minorities, and we fear that the problems with the third dose rollout disproportionately affected people from ethnic minorities.

Health Secretary Sajid Javid has already committed to tackling racial disparities in health care, commissioning an independent review into whether biases in medical devices like oximeters could be leading to worse health outcomes for people from ethnic minorities. We are urging him to investigate the racial inequality in take up of third doses, so that the NHS can learn lessons for the future.

Gemma Peters, Chief Executive of Blood Cancer UK, said: “We know that people from ethnic minorities have been disproportionately affected by the pandemic and it is alarming that there is a clear racial disparity in the rollout of third doses for the immunocompromised. It means many thousands of people from ethnic minorities who are among those most vulnerable to Covid do not have the protection they would have if their community had been given third doses at the same rate as white British people.

"As a result of this, we fear that immunocompromised people from ethnic minorities who have died of Covid who would have lived if they had been white British.

“Much of the public debate around lower vaccination rates in some communities has centred around vaccine hesitancy, but it is inconceivable that many thousands of immunocompromised people from ethnic minorities have willingly had the first two vaccine doses and then decided they did not want a third dose. A much more likely explanation is that while the chaotic roll-out of the third doses meant lots of people struggled to get a third dose, the impact of this fell disproportionately on the shoulders of people from ethnic minorities.

“If the NHS is serious about making sure it offers people from ethnic minorities the same quality of care as it does white British people, it needs to learn from this. We hope Sajid Javid will follow up his welcome commitment to addressing racial disparities in healthcare by looking what has gone wrong in this case.”

Orin Lewis, Co-founder and Chief Executive of ACLT (African Caribbean Leukaemia Trust), said: “The disparity this data reveals is deeply shocking and numbing in its quietness, as is the fact that this must have been obvious for some time now yet it is only coming to light after a Freedom of Information request.

“We know that there has been racial disparities in the impact of Covid since the start of the pandemic, and so it is tragic that the NHS has not done more either to stop it happening in the first place, or to sound the alarm once it was clear there was a problem. “

Notes to editor:

• There are different definitions used for “immunocompromised”, but all this data refers to the group considered severely immunosuppressed. There are 539,000 of these in England, of whom around 230,000 have blood cancer.
• The data in this press release are until December 14, 2021, and we expect the racial disparity to have narrowed since then as more people have been given third doses. But this would still mean that people from these groups were disproportionately at risk from Covid between October and December, a period when the infection rate was high.

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