RCGP chair Professor Martin Marshall has called on health and social care secretary Matt Hancock to provide ‘a more detailed rationale’ of the government's vaccination plans following the publication of a priority list last week.
The college has suggested that a risk score that accounts for ethnicity, geographical socio-economic indicators and other related factors should be used to decide which groups receive the vaccine first.
Members of the British International Doctors Association (BIDA) are also ‘extremely concerned’ that BAME communities have been ‘ignored as a vulnerable group’ - despite the disproportionate impact of the virus on this part of the population.
COVID-19 vaccine priority
Last week the Joint Committee on Vaccination and Immunisation (JCVI) published a final list of priority groups for the COVID-19 vaccination, which confirmed that staff and residents at care homes for older people would be first in line; a setting where the virus ran riot during the early stages of the pandemic.
Patients aged over 80 and health and social care workers are second on the list. Vaccination for care home staff will begin in 50 'hospital hubs' across England this week, with some patients in the over-80 category also offered jabs if they are receiving outpatient treatment or being discharged. GP-led sites will begin to roll out vaccination from next week.
But the JCVI list makes no specific reference to BAME communities. This is despite a report published in June finding that deaths from COVID-19 were highest among patients from BAME backgrounds.
In a letter to Matt Hancock the chair of the RCGP Professor Martin Marshall asked the government to provide more information on its decision to omit BAME communities from its priority list. He said: 'Throughout the pandemic the RCGP has raised significant concerns about the extent to which GPs, their practice staff, and patients from BAME communities are disproportionately affected by COVID-19…yet we note that they are not included on the initial JCVI prioritisation list ahead of roll-out of the vaccines.
BAME deaths
‘It is important that GPs and their patients are aware of the rationale for the decisions made, particularly as data clearly indicates that patients from ethnic minority backgrounds are more susceptible to contracting and dying from the virus.
‘While some of this may be due to the higher prevalence of pre-existing conditions within the BAME communities, a recent study by the Office of National Statistics (ONS) suggested that is not sufficient to explain the disparity in mortality rates from COVID-19, and emphasises the importance of demographic and socio-economic factors, such as place of residence and occupational exposure.’
He added: ‘We would therefore like to ask for clarification of the rationale for people from BAME communities not being included on the initial JCVI prioritisation list and to be able to communicate this clearly to our members. We would additionally like to know whether using a risk score that accounts for ethnicity, geographical socio-economic indicators, and other related factors has been considered.’
Immediate action
BIDA leaders also wrote to the health secretary to express their concern at the exclusion of BAME communities from the priority list. They said: ‘BIDA would like to call upon the Department of Health and Social Care (DHSC), the JCVI and all the Public Health units of all four nations to question how they justify the exclusion of the vulnerable BAME community from the priority list.
'We strongly feel that the JCVI takes notes of our concerns and takes immediate action for the inclusion of the BAME community in the priority list for the vaccination programme.’
There were approximatley 3,900 deaths of BAME individuals in hospitals in England up to 9 June, according to a study - representing 15.5% of all deaths at the time of publication. But the 2011 census shows that 14.5% of the English population were from BAME backgrounds.
A government document on the COVID-19 vaccine priority list published on 2 December argues that ‘there is no strong evidence that ethnicity by itself (or genetics) is the sole explanation for observed differences in rates of severe illness and deaths’ from COVID-19.
It also states that the government is ‘highly confident’ that social factors, such as poverty and occupation, make a large contribution to the greater burden of COVID-19 in ethnic minorities.
The government has said it expects 800,000 doses of the Pfizer/BioNTech vaccine to become available this week, with as many as 10m potentially available by the end of 2020. NHS England has confirmed that some GP practice sites will begin to administer COVID-19 vaccination to patients aged over 80 from 14 December.
