Understanding vaccine hesitance could protect people against whooping cough, COVID-19 and health inequality

By Carissa Wong, 4th Year Cancer Immunology

These days, the sound of a well-caught cough is a good enough reason to cross the street, furrow your eyebrows or retch behind a mask. A nastier cousin of the everyday cough can be found in people suffering from whooping cough, a bacterial respiratory disease which is highly contagious and a serious threat to new-born babies. Patients suffer severe coughing fits separated by gasps for air that make an eery ‘whooping’ sound; babies are often hospitalised and can die.

New-born babies are first eligible to be vaccinated against whooping cough at eight weeks old, but before that age they are at serious risk. To combat this, pregnant mothers can be vaccinated in order to protect new-borns via passive immunity; the protective antibodies generated by the vaccinated mother are able to pass through the placenta to the baby.

However, it has been found that a third of pregnant women are not vaccinated against whooping cough. Dr Emma Anderson, Research Fellow and Health Psychologist from the Bristol Medical School, is leading an ongoing study that aims to identify the barriers and facilitators of the delivery and uptake of the whooping cough vaccine in pregnant women.

Studies into understanding healthcare inequalities in the UK are extremely important; the more, the better. Vaccine hesitancy arises from a myriad of intersecting factors that impact upon how people perceive scientists, the government and clinicians. For many people, their distrust is well-founded, and their reasons should not be dismissed.

A major factor influencing vaccine reluctance is ethnicity

It is likely that factors which have influenced vaccine hesitancy in the past and during this current pandemic, are also contributing to the lack of whooping cough vaccine uptake. Reasons for vaccine hesitancy are going to differ between specific vaccine programmes, though one significant factor influencing vaccine uptake is ethnicity.

Unfortunately, to get enough data to analyse in the first place, diverse ethnic groups are often lumped together. Though not fully representative of each ethnicity, it offers a starting point for researchers to understand how ethnicity might play a role in vaccine uptake.

During the current COVID-19 pandemic, a recent study (‘UK Household Longitudinal Study’) has shown that ‘Black or Black British’ and ‘Asian or Asian British- Bangladeshi/Pakistani’ groups have the highest rates of vaccine hesitancy, of 72 percent and 42 percent, respectively. This is compared to around 16 percent of ‘White British or Irish groups’ who were vaccine hesitant.

In particular, the high vaccine hesitance among Black British people is not surprising given the historical relationship between black people and healthcare globally and the racism that pervades all aspects of society, including healthcare.

Racism that pervades all aspects of society, including healthcare

An abhorrent example of racism in medical research was the Tuskegee Syphilis Study in America during the 1900s, which involved 399 Black men from Macon County, Alabama. These men were deliberately denied effective treatment for syphilis, in order to document the progression of the disease. Not only the men involved, but also their families and friends experienced unimaginable trauma – a trauma which was passed down through generations.

More recently, black people made up just 10 percent of participants in the Pfizer vaccine trials. Though this number is low, it is still better than most other vaccine trials. By failing to represent black people and other minority groups in medical trials, we are failing to understand how to implement effective treatment programmes within those communities. It’s also problematic to have limited data on how well vaccines work for different ethnic groups in the first place.

Women continue to be underrepresented in medical research

In addition to ethnicity, sex also plays a role. Women have been widely underrepresented in clinical trials and medical research for centuries. Pregnant women have been excluded from treatment trials since the 1960s until 2019. A lack of understanding the bodies of women and pregnant women means they are often excluded from life-saving treatments, in order to avoid any unintended consequences.

Sexism compounded with racial discrimination means that black women face a multitude of barriers to accessing healthcare. A recent study has shown that in the UK, black women are four times more likely to die from childbirth than white women.

Factors such as age, spoken language and place of birth are also going to impact how a person responds to a vaccine offer. For example, many healthcare messages in the UK are presented in the English language and are often not sensitive to religious or cultural beliefs held by ethnic minorities. It is not surprising that messages do not effectively reach those they were not well-designed for.

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Vaccine hesitancy is a top-ten global threat as identified by the World Health Organisation. We should no longer neglect investing time, money and effort into understanding the barriers between ethnic minorities and access to healthcare.

We must better represent ethnic minorities and pregnant women in medical research. This is not solely about improving one single vaccine programme, but about rebuilding trust between healthcare and those who have not been considered for too long.

Featured Image: UK Department for International Development / Simple Vaccines

When it comes to all kinds of vaccines, are you willing to be vaccinated when offered the chance?