COVID-19 vaccines in high-risk ethnic groups
Authors: Rashmi S D'Souza, Ingrid Wolfe
Journal: The Lancet (2021)

Black, Asian, and minority ethnic communities worldwide have a disproportionate risk of severe COVID-19. In the UK, as of May 19, 2020, 36% of critically ill patients with COVID-19 requiring intensive care were from Black, Asian, or minority ethnic groups.1Public Health EnglandDisparities in the risk and outcomes of COVID-19.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdfDate: August, 2020Date accessed: February 24, 2021Google Scholar According to Public Health England, the mortality risk from COVID-19, after accounting for sex, age, deprivation score, and geographical region, is double in Bangladeshi people and up to 50% higher in Black and south Asian people compared with White British people.1Public Health EnglandDisparities in the risk and outcomes of COVID-19.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdfDate: August, 2020Date accessed: February 24, 2021Google Scholar This finding contrasts with age-adjusted all-cause mortality from previous years, which was lower in Asian and Black people than in White British people.1Public Health EnglandDisparities in the risk and outcomes of COVID-19.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdfDate: August, 2020Date accessed: February 24, 2021Google Scholar These data imply that COVID-19 has more serious effects in Black and Asian people. The ethnic groups most affected by COVID-19 are under-represented in the COVID-19 vaccine trial data published so far. Despite efforts to encourage participation from Black, Asian, and minority ethnic groups, of the 552 participants in the phase 2/3 Oxford–AstraZeneca trial (based in Southampton and Oxford, UK), only one participant was Black and 19 were Asian.2Ramasamy MN Minassian AM Ewer KJ et al.Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial.Lancet. 2020; 396: 1979-1993Summary Full Text Full Text PDF PubMed Scopus (1058) Google Scholar Large-scale trials also have a smaller proportion of minority groups compared with the populations sampled (appendix).3Voysey M Clemens SAC Madhi SA et al.Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.Lancet. 2021; 397: 99-111Summary Full Text Full Text PDF PubMed Scopus (3266) Google Scholar, 4Polack FP Thomas SJ Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.N Engl J Med. 2020; 383: 2603-2615Crossref PubMed Scopus (9520) Google Scholar, 5Baden LR El Sahly HM Essink B et al.Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2020; 384: 403-416Crossref PubMed Scopus (6568) Google Scholar Black, Asian, and minority ethnic individuals are under-represented in research. However, the ongoing pandemic necessitates that access to trials and vaccinations shifts from being equal to being equitable. Study recruitment and participation designs should improve diversity in ethnic groups to maximise the validity of results to the populations concerned. Age and sex are routinely considered in recruitment design—the same should now apply to ethnicity. In the context of a pandemic that has higher infection and mortality risks in certain ethnic groups, it is important that these specific groups are adequately represented in vaccine trials to evaluate both immunogenicity and efficacy. We declare no competing interests. Both authors contributed equally. Download .pdf (.12 MB) Help with pdf files Supplementary appendix