COVID-19 and the new variant strain in England - What are the implications for those from ethnic minority groups?

Two new variants of Severe Acute Respiratory Distress Syndrome-Coronavirus-2 (SARS-CoV-2) have been reported over a matter of days in the United Kingdom (UK). The first variant, named VUI-202,012/01, originally detected in Kent and London, has an unusually large number of mutations that increase the virus’ affinity for human hosts [1]. The second, named 501Y.V2 was first detected in Nelson Mandela Bay in South Africa [2]. Epidemiological evidence of a sharp rise in Coronavirus disease-2019 (COVID-19) admissions to both UK and South African hospitals along with a rising attributable proportion of cases due to these two variants, suggests that both are significantly more transmissible than previous variants.

Ethnic minority groups in the UK have been disproportionately affected by COVID-19 since the start of the pandemic [3]. A key driver in this association is the increased risk of infection [4]. The UK Office for National Statistics reported that Black and Asian men were more likely to work in occupations associated with higher COVID-19 death rates, such as taxi drivers, care home workers, and nurses. Ethnic minority groups are also more likely to live in deprived areas and in multi-generational households [5]. Without urgent action, the rapid spread of new, more transmissible variants will have even more disproportionate effects on these communities.

Meanwhile, Black and Asian groups continue to be under-represented in COVID-19 research and vaccine uptake. A report by the National Institute for Health Research found that ethnic minority groups only comprise 9.3% of participants in COVID-19 studies, and 5.7% in vaccine studies in particular, well below their representation in the national population (13.8%) [6]. This may be due to both structural and individual-level barriers to recruitment and participation. A qualitative survey exploring the views of ethnic minority communities towards participation in COVID-19 vaccine trials found that although there was broad agreement that clinical research was necessary, many were extremely uncomfortable with the idea of attending hospital, due to legitimate fears of contracting COVID-19, side effects of vaccines, and lack of support for language or cultural needs [7]. These barriers may be compounded by additional barriers such as fear, mistrust, privacy concerns, and inadequate provision of information.

In light of the worrying news about these more transmissible variants, we call for a focused effort to conduct more research on their transmission and outcomes in ethnic minority populations. This should be supported by meaningful engagement with these groups to inform research, policy, and practice [8]. We also call for protection of those from ethnic minority groups in the months to come. First, regularly updated public health messaging should be clear, accessible, and tailored to ethnic minority groups, to support the effectiveness of public health measures, alleviate anxiety, and increase trust in medical services. Culturally relevant documentation on vaccine ingredients, for example with proven halal certification, and consideration of religious and cultural engagements in research and vaccine schedules should be taken into account.

Second, a targeted, robust testing approach must be taken for groups who are at high risk of becoming infected. SARS-CoV-2 infection is associated with is poorly ventilated spaces, and with multiple household contacts [9]. Now is the time for the government to proactively provide the resources for public health teams to implement focused testing of districts where clusters of infection arise (which will inevitably disproportionately affect ethnic minority communities) rather than reconsider any plans for mass testing.

Third, ethnic minorities should be included as part of the decision making process for priority vaccination groups. Currently the UK's vaccination priority list focuses mainly on those who are at risk of severe disease, and apart from healthcare workers, give no mention to those at high risk of exposure to SARS-CoV-2 infection, such as ethnic minorities who make up the bulk of key worker roles. Through a balanced consideration of the risk of infection and the risk of death in the distribution of vaccines, a more equitable approach should be presented in the coming months. The first wave of COVID-19 has disproportionately affected ethnic minority groups resulting in poorer clinical outcomes in these communities; the new variant has the potential to worsen this further. We must learn from our experiences in 2020 and proactively include ethnic minority groups into public health policy.

Declaration of Competing Interest

KRA has served as a paid consultant, providing unrelated methodological advice, to; Abbvie, Amaris, Allergan, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol-Meyers Squibb, Creativ-Ceutical, GSK, ICON/Oxford Outcomes, Ipsen, Janssen, Eli Lilly, Merck, NICE, Novartis, NovoNordisk, Pfizer, PRMA, Roche and Takeda, and has received research funding from Association of the British Pharmaceutical Industry (ABPI), European Federation of Pharmaceutical Industries & Associations (EFPIA), Pfizer, Sanofi and Swiss Precision Diagnostics. He is a Partner and Director of Visible Analytics Limited, a healthcare consultancy company. KK has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Takeda, Servier and Pfizer, and research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Pfizer. KK is Director for the University of Leicester Centre for BME Health, Trustee of the South Asian Health Foundation, national NIHR ARC lead for Ethnicity and Diversity, Chair of the SAGE subgroup on Ethnicity and COVD and a member of Independent SAGE. MP reports grants and personal fees from Gilead Sciences and personal fees from QIAGEN, outside the submitted work. All other authors report no conflict of interest.