UCL Minds


Transcript: Episode 42

Why are some black people hesitant about the vaccine?


people, vaccine, black, trials, vaccinated, ucl, taj, lola, ethnic minorities, population, vaccination, communities, chris, urology, vivienne, speak, mistrust, podcast, new england journal, important


Taj Fregene, Leye Ajayi, Chris Brew-Graves, Lola Emanuel-Kole, Vivienne Parry


Vivienne Parry  00:04

Hello and welcome to Coronavirus, the whole story UCL award winning podcast all about the pandemic. My name is Vivienne Parry. I'm a writer broadcaster and UCL alumna and I'm here to bring you more UCL stories and experiences of Coronavirus. This week's episode we're returning to the topic of vaccines. At the time of recording nearly 20 million people across the UK have received at least one dose of a vaccine. And thanks to the tireless efforts of frontline staff, we're still on track to vaccinate everyone over the age of 18 by July, but vaccines have not been universally well received. In Tower Hamlets for instance, one of the most diverse London boroughs vaccine uptake is 10% less among the Asian population than in the white population, and 25% less in black communities. Given that Coronavirus disproportionately affects black communities, this hugely concerning state of affairs risk further widening health inequalities. So today I'm speaking with clinicians and researchers from UCL about vaccine hesitancy in the black community. Let me introduce my guests to you. I'm joined by Mr. Leye Ajayi, consultant, urological surgeon clinical service lead for urology and clinical lead for endo urology stem disease at Royal Free London. Leye is also a member of the European Association of Urology section of Euro technology and performs live kidney stone surgery at the annual European urology conference. I'm also joined by Dr. Lola Emanuel- Kole, who is the Consultant Anaesthetist and lead in obstetric anaesthesia at the Royal Free. Lola leads the multidisciplinary simulation team in maternity services would use a simulation training as an educational tool to improve safety and clinical practice and has developed and written a protocol for the safe management of obstetric deliveries and surgical procedures using simulation to remove hazards. and by Dr. Taj Fregene as a Consultant Anaesthetists at the Royal Free. Taj is the author of multiple papers on improving the experience and quality of elective surgery as well as several works of fiction. As part of his work. The Royal Free Taj also supervises the Weekly Journal Club for trainees. And finally, last but absolutely not least, I'm joined by Chris Brew-Graves. Chris is the National Cancer Imaging Translational Accelerator Programme Manager. She's been working in clinical trials since 1994, and helped to change and improve best clinical practice and she's currently writing up a PhD in health economics in the [UCL] Institute of Epidemiology and Healthcare. So first of all, very quick question to each of you. And I will start with Leye. Have you each been vaccinated?


Leye Ajayi  02:51

Yes, I've been vaccinated. I had my second vaccine last week, last Friday, and it very interesting to the first vaccine when I had the first vaccine. I did lose my sense of taste for a 12 hour period. Thankfully, it was a very short, brief loss, otherwise very effective. no side effects whatsoever.


Vivienne Parry  03:14



Lola Emanuel-Kole  03:15

I had toe second dose last week, and aside from having a very sore arm and feeling a little bit tired, I think I've probably weathered it relatively easily.


Vivienne Parry  03:24

Chris, how about you?


Chris Brew-Graves  03:26

Yes, I've had my first days. I'm very needle phobic, and I have very low pain threshold. So I did take painkillers a day after because I had a sore arm but otherwise nothing to report


Vivienne Parry  03:38



Taj Fregene  03:39

I have had my vaccine as anaesthetist who spent a lot of time working in intensive care units. These past 12 months I've seen the devastation that Coronavirus can do to people's bodies firsthand. So when there was a safe and effective back way preventing it I was very happy. So I had my first dose in December my second dose like lay low last week, had a bit of salt on for like 12 hours. But apart from that, I feel fine.


Vivienne Parry  04:00

Very good. I can also put I had mine, and I've had COVID and I have the A Zed vaccine. And I did feel really quite poorly the evening after. But otherwise, my immune system is on tip top form. Thank you very much. My T cells in particular on overdrive. So great to hear that you've all had your vaccines. Now we've had on this podcast of the many different factors that have contributed to ethnic minorities disproportionate representation amongst Coronavirus, affected communities. And yet still, there's hesitancy within some communities to get vaccinated. Where do you think this hesitancy is coming from? And why do so many black people distrust the vaccine and the vaccination rollout? Leye, let's start with you not to talk about the actual vaccines themselves and how they were developed, but the number of ethnic minorities that were included in trials, because part of the suspicion is that the trials have been done on Europeans mostly, and not on people from ethnic minorities or even majorities.


Leye Ajayi  05:16

All right, you make a very valid point here as collisions, this whole situation does affect us enormously. So we're all very enthusiastic and very keen to read about the vaccine, when the initial trials were published. So with my clinical head on, I looked at the article in the New England Journal of Medicine, I think it was published on New Year's Eve, that this is the biotech Pfizer vaccine, and I read the paper with interests that are very well written, good protocols, etc. And I remember having a conversation with a friend who's a black friend of mine, and I tell him about Yes, I'm thinking about having a vaccine. And his comment to me was, well, you know, yes, it's good, you're good to have a vaccine. But if you look at the trials, and how many black people were actually in that trial, and I didn't think about that, the first time I read the paper, and then what I did a slightly deeper dive into the ethnicity of that, and the New England Journal does give you a very good breakdown of ethnicity. 83%, white, only 9% were black, or African American, 28%, Hispanic or Latino. So in that paper, the New England Journal, the Pfizer, there was a there was 9% black population, whereas AstraZeneca papers are also quite interesting. When you look at the cohort of countries which were involved in that trial, when you also break that down the UK trial, only 0.4% were black 93% were white, in the Brazilian study, 11% were black. So when I wrote it in a bit more detail, I'm afraid I do, I can understand some anxieties here. Because the population, it didn't, it wasn't a proportional representation of the population of the people who were in the study. I'm aware that AstraZeneca tried to amend this by running a trial in Kenya, looking predominantly at black people. But it is interesting that a small proportion only were black people in this trial.


Vivienne Parry  07:07

And we've seen big trials in South Africa because of course, one of the things about doing trials is that you need to have a high incidence of Coronavirus in the country that you're trialling and a lot of African countries have not had, thankfully, a very high incidence except in South Africa. And there have been trials there.


Leye Ajayi  07:27

Correct? Correct. The New England Journal, the Pfizer trials did enrol for centres in South Africa to do the study. You're quite right. Also that AstraZeneca also enrolled South Africa as well. So you're quite right, you do need a high proportion of the virus in that country to be able to do a proper trial.


Vivienne Parry  07:44

And that's the difficulty, isn't it? Because on the one hand, I've heard people say disparagingly that the trials shouldn't be done in Africa, because obviously, people in those nations are being used in as guinea pigs. But on the other hand, you need to be doing trials that involves a representative sample. How do you get out of that bind?


Leye Ajayi  08:05

Right. It does create slight bias it doesn't it in order to run a trial you're doing like you like rightfully said, you do need proportional representation. And it's slightly difficult but I think Astra Zenica are looking at this a bit more detail by running a trial trial in Kenya. In a lot of these African countries, their average life expectancy is over individuals in their 50s. So you're dealing with a younger population who passed won't necessarily succumb to the side effects of the severe effects or Coronavirus. So again, you're dealing with a slightly different biassed population in Africa compared to that in the Western world.


Vivienne Parry  08:44

Let me turn now to Lola because we've heard the from a that the missit ward, the under representation of black people in trials is a important part of vaccine hesitancy. But there is structural racism within the health services too and Lola you're based in maternity care where this is an issue. Is this also feeding into hesitancy?


Lola Emanuel-Kole  09:10

Yes, thank you for asking this question. Actually, if you look at certain outcomes, or maternity outcomes for let's let's say black women in particular, the figures are not very good. So every year we publish a report or there's a report published called the embrace port, which essentially looks into maternal and foetal mortality and investigate all the cases that are reported to this organisation. And they look at lots of variables socio economic, you know, health outcomes, all sorts of things. And what had shown consistently in the last few years is that there is an increased risk of morbidity and mortality during the pregnant period for black women. And it was as high as five times the risk of death in pregnancy compared to the white population that has now reduced it And actually, it is astonishing. It's it's, it's something that seems to be quite prevalent in the developed or Western population. If you look in the US and some states within the US, the figures are even higher than that it's actually quite appalling. To be honest. However, the figures have come down slightly, it's, this year's report has showed it, your risk is four times higher. And if you're an Asian woman, your risk is twice as much as if you're a black woman. There are definitely some, you know, stark inequalities there. However, the vaccine uptake in the pregnant population as a whole in this case, I think it doesn't necessarily pertain to race. There's a lot of hesitancy for drugs, vaccines delivered to women in pregnancy. And it pregnancy itself is the universal factor, I think, for women having, you know, being hesitant in sort of, in having a vaccine. Currently, the vaccine is discussed or, you know, they are vaccinating women, or looking to vaccinate women who have particular risk factors that are similar to the high risk factors in the general population. But as a whole, because of the lack of evidence there is not really in the pregnant population. It's not necessarily advocated for women during their pregnancy. And this is universal for all races. It's just under the umbrella of pregnancy.


Vivienne Parry  11:22

Yes. And, of course, that one message that every pregnant woman has got, is don't take any medicines. And yet, with flu vaccine, what are the things that we found out in the last pandemic, remember that one? was that pregnant women, particularly the last trimester were particularly at risk from the flu virus, and some of them became extremely unwell. And flu vaccine then was given to pregnant women. And it was an important part of keeping them safe. So here, we've got two things going on. We've got pregnant women's natural and absolutely understandable concerns about taking anything during pregnancy. Plus, you've got a suspicion of the health services because of demonstrable inequitable treatment. So now, let's add another layer. Chris, what other kinds of barriers are preventing black people who actually want the vaccine from getting vaccinated?


Chris Brew-Graves  12:21

That's a very, very important question to ask. Because there are several layers here, one needs to think about. I think the most obvious usually are the physical barriers, where with most people pick up and drop off might be done by a member of the family. In in black communities, you'll find that most of us tend to do frontline jobs. So we either drive trains or work for the NHS, or on the gig industry. And we don't have the flexibility of working from home. And if we don't work, we don't get paid. So taking an older parent to have a vaccination a long way from home where we have to travel to this hub, take time off work is quite onerous. And I would have thought with populations that are difficult to reach. If for example, a GP surgeon was going into a home to vaccinate an older person, they would capitalise on add on sales and vaccinate the entire household because these populations are difficult to reach. So one one barrier is making the time and to have it done twice. In addition to that there are some language barriers, but a lot of trusts have an active NHS have provided leaflets and several languages, and YouTube quick, short YouTube videos to explain, you know, sort of the questions individuals will ask when it comes to vaccination. So that's tackled, and but sometimes I asked myself the question, the fact that I probably speak Yoruba, does that mean, I read it, as well as I speak it, so I think the leaflets need to bear that in mind. So just saying, Oh, we've got it in 22 languages might not be enough, because we might not be using the right sort of language. And it might be easier to use YouTube clips for people listening. But for me, the most important are the issues around mistrust. So like Lola has, has sort of explained a black woman is probably four times more likely to die in childbirth, and a black man is four times more likely to be sectioned than a white contemporary. We have lots of issues around mistrust. And some people might ask the question to go into be vaccinated. You asked for my NHS number. Why do you do that? And by giving you that information, am I revealing myself to certain authorities that I might not want to know where I am? And this could bring up all the issues around Windrush and issues around fear of authority, police, and so on, but I think these to me are the layers you know, the physical the language, and of course, or paramount importance is mistrust.


Vivienne Parry  15:02

And actually, there's one more that I've certainly come across, which is that there's a lot of talk. And in fact, I know from doctors who've had vaccines in the early stages, that some of them actually have been quite ill with side effects, you know, they've spent a day in bed after the vaccine. And if you're on a zero hours contract, the idea that you might have to take time off for which you're not paid, is actually a real deterrent to having a vaccine.


Chris Brew-Graves  15:31

Yeah you're absolutely right. But statistically, I'm not sure how many people will be so ill, they wouldn't be able to attend work. But that is definitely an issue as well, I think definitely, like, for me, you'll, you'll have to take painkillers The next day, but you should still be able to work. But you're right, there will be a small number of outliers who would be quite ill and unable to work. And certainly they'll lose income.


Vivienne Parry  15:56

And of course, their tales get disproportionately told. So we shouldn't forget that the way that these things work is always the personal stories of people that you know, are always the most salient and have the, you know, the greatest impact on people. So just having had one person say, I felt so ill I had to take a day off work is enough to spook a lot of people. I want not to go to Taj, because on top of all of these layers, and multiple layers, there's also a lot of misinformation about the safety of vaccine, which is really scaring people. Taj, do you think that fake news stories have an appeal in some black communities, particularly if it seems to support a negative experience of health care in the UK? In other words, it kind of reinforces initial beliefs.


Taj Fregene  16:50

I think absolutely fake news stories do have a negative and deleterious effects on all communities, not just black communities. I think there's lots of evidence out there that says, when we are asked to undertake an action of either vaccination or anything else, the one of the key things is the messenger, the person who was telling us to do this, or not to do things. And you mentioned it just now that's actually the personal stories that people that we have within our own sphere, there's hold much more weight than say somebody on the telly, especially somebody on telly, who doesn't you feel doesn't represent your interests or your values. Just a very quick story for my own personal experience about my mother. So my mother is a care home worker, she, you know, was very fearful of Coronavirus itself and getting associated very pro vaccinations. However, some of our colleagues were not. One of them, a black man, was also a pastor of a church who was very, very hesitant about vaccines. However, what other workplace did was they put together an inflammation module elearning that they made all the workforce to. And after doing this elearning this person had a complete 180 - a got it. He understood like the rest of Coronavirus, and it causes cancer vaccines, and therefore he is now going around and 10 people in his congregation to get vaccinated. So I think actually getting the information out there in a way that's accessible to people. And from people that they trust and respect. I think it's very important


Vivienne Parry  18:11

Taj one of the barriers I see of being a journalist is that we tend to put out a lot of the correcting information in mainstream media, but it's not the media that actually ethnic minorities choose to use themselves.


Taj Fregene  18:29

Yes, that is very true as well. And this goes back to what I was saying before about if a message comes from someone that you know, you trust and respect, especially powerful fellas recent thing or a newspaper of seen on television, and therefore they were key things in trying to encourage black people to obtain vaccine is getting the message coming from those people that are respected in those communities. How to do that is is you know, it's going to be difficult because I think it's certainly worthwhile trying I think actually is necessary that we do try to cut costs. If we do not get enough black people vaccinated, we could wipe them disproportionately these health inequalities that are existing already.


Vivienne Parry  19:07

So we've talked about those multiple layers of barrier and challenge. And I want to turn to actually something that's even more tricky, which is solutions. So I'm gonna come to each view in turn. Leye, what do you think


Leye Ajayi  19:24

we're in a challenging time, are we a lot of this is through education and communication. And we are in a challenging situation where our interaction is limited during this current surge where everyone is at home. People are heavily influenced with what they read on the internet and on various social media platforms. So I think efforts need to be made to engage in and educate individuals on this you can give a perfect example where a lot of our black people take religion very seriously and educating individuals via their church pastor or their preacher is a way to increase Mass uptake of this if the preacher is educated and informed about the vaccine, all it takes is a word from the preacher or their pastor on a Sunday service to say, look, by the way, this vaccine, I've had the vaccine, it's very safe. I recommend the congregation to have the vaccine, you find increased uptake. So a lot of it is education.



Yeah. Yes.


Vivienne Parry  20:21

Yes, vaccines centre.


Leye Ajayi  20:24

Exactly. So that kind of dialogue or narrative, I think will go a long way into increasing the uptake of the vaccine in the black population.


Vivienne Parry  20:33

And I get to give you free sandwiches and food at the end,


Leye Ajayi  20:37

that always goes down very well.


Vivienne Parry  20:38

Yeah. Well, all those kinds of things that make people feel but it's a whole community thing. So Lola, what about you? What would you do?


Lola Emanuel-Kole  20:48

I think I would agree with what Leah says it's it is going into places where you are more likely to find the black community and places of trust. So you know, the church has definitely won one of the optimal ways to do that. And like he said, it is about, I think, also continuing to give our stories, finding more black leaders out there who will be willing to put their heads above the parapet and say I've had the vaccine. I've thought about it, possibly even with photos of them having the vaccine, the same thing you see in social media at the moment, and trying to help to influence that way. So you are looking at people I hate say it's almost feels very stereotypical to say it, but people that ain't no the sports industry, entertainment industry, I mean, they're very visible, obviously. But also, I think it's worth trying to get the voices of other people who are in other different professions, you know, people that you might trust that you know, us as doctors, when we were hopefully we are hopefully going to make a difference. But looking at other professions, looking at MPs, looking at generally black people who you may not necessarily see as very visible, perhaps some lawyers in just in different walks of life. And I think ultimately, that's one way that will help to to spread the message and perhaps give some more confidence.


Vivienne Parry  22:06

Or perhaps the lovely Kevin Fenton, Kevin Fenton, of course professor at UCL, but also director of the London region for public health. And I saw in a poll of the most influential black people in Britain, he was only one behind Lewis Hamilton and above Marcus Rashford, a UCL professor, there you go.


Lola Emanuel-Kole  22:28

We have unfortunately, have a very recently, a close family friend of ours passed away recently, and he was somebody who's very, very prominent in in looking at World Health and vaccinations, and I think, had he been alive today. And you know, in, he was quite, he's quite elderly at the time, but better able to be visible and speak, he would have been someone who would have been an excellent person and advocate for vaccine, he's worked tirelessly over his life to do things like help eradicate smallpox, he was very prominent in the School of Hygiene and Public Health, he was a professor at Harvard, and also quite significantly, he's worked pretty much in his retirement and as far as as much as he was able to with the Bill Gates Foundation to try to look at ways of treating and essentially eradicating malaria in the world. So it's people like these, I think, that are quite important, who would be, you know, really useful in the public eye to speak up?


Vivienne Parry  23:24

Thank you. Chris, ehat would your solution be? And do you think that this also could mark a turning point in the way that black people's health is considered in the UK, and I was just thinking, for instance, about pulse oximeters, which give not too accurate readings, as accurate readings in in black people. So we're, we become much more aware of these systemic issues.


Chris Brew-Graves  23:51

You're right, Vivienne. And I must admit, despite all the negatives that COVID has brought upon us, it's also shown to us that the gaping inequalities in health affect us disproportionately. And I think it's brought this to the forefront of a lot of policy makers, minds and influential people. If I was asked for solution, one of the most important the fastest thing I'd say to everybody is when you have your vaccination, stick that "I had my vaccination" on your phone, everybody always has their phone in their hand. And for me having that label on my phone, you know, you go to pay or you bring a phone out. It's always a point for starting a conversation. People go, Oh, you've had it, and you can talk about it. So I think when we vaccinated, we should all put that label on the backs of our mobile phones. One thing, it starts that conversation and for us as black people, we then get the opportunity to influence for me as a researcher, I would say that again COVID has exposed these health inequalities and in everything we do now, we should always think when we write our protocols like Leye alluded to, we make sure that we recruit a representation that reflects our society, or, or probably reflects the disease area specifically. So if it's a disease that is predominant amongst black people into recruit that level of incidence, don't go for the low hanging fruit and just loaded up with easy to recruit patients who may not necessarily reflect the demographic we need to look at. And I think we all need to listen, particularly because mistrust comes about because black people feel they're not listened to. So they go in, speak to a health professional and feel they're not listened to, I think we need to listen and show that we are listening, rather than just make decisions that individuals feel they were not central to because we're not listened to. And yeah, we need to go into churches, we need to go into barber shops, we need to go into hairdressing salons, we need to re educate but there's a lot of work to do. And I for one, together with my colleagues would be looking at doing some research, trying to understand why black people are hesitant to take the COVID vaccine, but they're hesitant for other things. And we'd like to use this opportunity to look deeper and come up with some solutions that will be published and will probably assist to make change more structural.


Vivienne Parry  26:18

And speaking, you know, for research funders, I think research that's funded, you know, clinical trials, I don't think that they should be funded unless they are representative. I mean, that's what we had to do in order to get women into clinical trials. We certainly ought to be doing it for ethnic minorities. I come now to Taj. And I know you're very keen on barber shops, aren't you? I'm not mean, barber shops a lot. But they play a key role, don't



they? Yes, they


Taj Fregene  26:48

do yesterday, I'm glad this is a podcast that people can't actually see the state of my hair at the moment in lockdown. But yes, I think what Chris was saying about starting those conversations, wherever they pop up, I think is really going to be very key and very important in this drive to get more people and more black people vaccinated. And actually, the more conversations we have around this with the correct information, I think this can only be a positive thing you were mentioning about trials and recruitments. Personally, I know one of my friends who was mixed race was part of the Imperial COVID trial. And I'm speaking to her the other weekend. She said the only reason that she went into the trial because she saw a direct request a direct call out for people of colour on Twitter. So it's thinking about how do we reach people. It's not that people don't want to be part of this. But actually, the mechanisms by which we are reaching people are perhaps not the same methods that people use to gain their information.


Vivienne Parry  27:39

And that's great stuff. Thank you so much. So we've come to the end of our time. I think that this is such an important area for research in the future, as Chris has indicated, and let's try and make sure that that research gets done. You've been listening to Coronavirus the whole story This episode was presented by myself Vivienne Parry produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the splendid Cerys Bradley, I was joined today and thank you so much all of you by Mr. Leye Ajayi, Dr. Lola Emanuel-Kole, Dr. Taj Fregene and Chris Brews-Graves. If you'd like to hear more of these podcasts UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds bringing together UCL knowledge, insights and expertise, sort of events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.