December 3, 2021

expert reaction to fourth and final government report on understanding and tackling COVID-19 disparities

The final report by the Race Disparity Unit on progress to address COVID-19 health inequalities has been posted online.

This Roundup accompanied an SMC Briefing.

Prof Sir Stephen O’Rahilly, Professor of Clinical Biochemistry and Medicine, University of Cambridge, said:

“It is good to see the report recognise that the previous dismissal of genetic factors as likely unimportant in influencing susceptibility to poor outcomes in specific ethnic groups turned out to be both  premature and incorrect. Only a truly integrated approach, rigorously examining both socio-cultural issues and intrinsic biological factors related to genetic ancestry, will allow optimal progress to be made. There are likely to be other genetic factors that influence outcomes in people of different ethnicities and the discovery of the precise nature of these may facilitate better targeting of treatments to particular mechanisms of disease and  result in improved outcomes.”

Dr Ben Kasstan, a medical anthropologist at the University of Bristol, said:

“The report acknowledges COVID-19 has disproportionately affected ethnic minorities – and in different ways. It is good that central government have understood the homogenizing BAME category is not helpful, and how this descriptor glosses over the diverse needs and experiences of different minority groups. The apparent commitment to addressing government and public health communications and issues of representation in data collection can help to inform delivery strategies and how statutory services operate more broadly. These will only be effective with broader structural change committed to mitigating health and social inequalities that have been allowed to fester.  

“Unfortunately, the report continues to emphasise individual, lifestyle or cultural ‘behaviours’ and genetic susceptibility rather than the obvious question we should be asking – in what ways has structural racism caused the disparities and excess deaths we have seen? How has racism consistently put people in harm’s way during the pandemic? Structural racism causes a cascade of social and health inequalities that affects how people live and how they are forced to work in public-facing roles, and the health conditions they develop.  

“The report notes how the UK government invested considerably in COVID-19 vaccine programmes to promote vaccination coverage among minorities. Vaccines are a crucial way to protect people, especially those at higher risk of death due to pre-existing conditions. Yet, vaccines are not a solution for the underlying structural issues that led to the disproportionate burden of morbidity and mortality among ethnic minorities. As it is looking like COVID-19 booster vaccines will need to become routine, so must the efforts and funding directed to increasing vaccination coverage among minorities be continued. 

“The COVID-19 pandemic has revealed the human cost of social inequality, and public health preparedness cannot operate on technological solutions alone.”  

Prof Neena Modi, Professor of Neonatal Medicine, Imperial College London, said:

“It is disappointing that this report does not highlight the high burden of Covid-19 infection on pregnant women (more deaths of pregnant women in the third wave compared with the previous waves;  pregnant women make up a third of all women aged 16-49 years, on ECMO in intensive care), nor the importance of the intersection of sex, cultural background, genetic predisposition and socioeconomic status in driving susceptibility, nor in their recommendations, the need to ensure in the future that pregnant women are included at the outset in vaccine trials unless there is clear reason from developmental toxicity studies for their exclusion.”

‘Final report on progress to address COVID-19 health inequalities’ by the Race Disparity Unit, Cabinet Office was posted online at 00:01 UK time on Friday 3 December 2021.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Neena Modi: “President, British Medical Association; Immediate Past-President, the Medical Women’s Federation.”

None others received.