Health Secretary Matt Hancock has said that Black, Asian and minority ethnic people could be among the first to get a coronavirus vaccine. Speaking at No 10 briefing, the minister confirmed that two groups have been recommended for priority vaccinations when it is discovered and manufactured.
The joint committee on vaccination and immunisation has said that the frontline health and social care workers and those who are at greater risk of death or serious illness from Covid-19 will be on the list. But Mr Hancock added that BAME people could also be included in those to get the treatment first.
The Health Secretary reportedly added, “As we learn more about the virus we will continue to take into account which groups may be particularly vulnerable – including, for example, those from ethnic minority backgrounds – so that we can protect the most at risk first, should a vaccine become available, and get this country back on our feet as soon as we possibly can.”
This came after a report published in two phases by Public Health England (PHE) has said that BAME population is at higher risk of coronavirus deaths, because of their pre-existing health conditions as well as structural racism and social inequalities- that are the key reasons behind higher BAME deaths, exposure and disease progression risk.
The report said, “Racial discrimination affects people’s life chances and the stress associated with being discriminated against based on race/ethnicity affects mental and physical health. Issues of stigma with Covid-19 were identified as negatively impacting health seeking behaviours.
“Once infected, many of the pre-existing health conditions that increase the risk of having severe infection are more common in death from Covid-19 was identified as negatively impacting how BAME groups took up opportunities to get tested and their likelihood of presenting early for treatment and care. For many BAME groups lack of trust of NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease.”
Mr Hancock also said that human trials of a potential vaccine were taking place at Imperial College London and that Astra Zeneca had struck a deal to manufacture a second possible vaccine being developed by Oxford University.
On Tuesday, the first healthy volunteer, who asked to be anonymous, received the coronavirus vaccine developed by Imperial researchers. The clinical team, who delivered a small dose of the vaccine to the participant at a West London facility, were closely monitoring the participant and reported they were in good health, with no safety concerns, as we went to press.
Imperial College London’s vaccine candidate is being developed and trialled as a result of more than £41 million in funding from the UK Government and a further £5 million in philanthropic donations.
One person has now received a first dose vaccine, with a second booster dose to follow within four weeks. Several others are expected to receive a first dose over the coming days. The clinical team will continue to monitor all participants closely for safety, as well as looking to see if they produce antibodies against the SARS-CoV-2 virus.
In the initial stage of the trial, 15 healthy volunteers are receiving the vaccine – starting with a low dose and escalating to increasingly higher doses for subsequent volunteers – to assess safety and to find the optimal dosage.
Over the coming weeks, 300 healthy participants are expected to receive two doses of the vaccine. If the vaccine is safe and shows a promising immune response in humans, then larger trials would be planned for later in the year.
Professor Robin Shattock, from the Department of Infectious Disease at Imperial and who is leading the work, said: "The first participant marks an important step for our saRNA vaccine platform, which has never before been trialled in humans.
"We now eagerly await rapid recruitment to the trial so that we can assess both the safety of the vaccine and its ability to produce neutralising antibodies which would indicate an effective response against Covid-19. I look forward to our progress in the coming months."
ONS study
Office for National Statistics looked at total number of deaths involving Covid-19 and found that 88.6% were of people from a White Ethnic group, 6.2 % from an Asian Ethnic group, 4.0% from a Black Ethnic group and 0.5 % from and Other Ethnic group.
According to a research based on linking deaths to the 2011 census, the most timely data available, including people aged 9 years and over, ONS for the period 2 March to 15 May 2020, taking into account size and age structure of the population, found that the mortality rate for deaths involving Covid-19 was highest among males of Black ethnic background at 255.7 deaths per 100,000 population and lowest among males of White ethnic background at 87.0 deaths per 100,000.
For females, the pattern was similar with the highest rates among those of Black ethnic background (119.8) and lowest among those of White ethnic background (52.0).
However males of Bangladeshi, Pakistani and Indian ethnic background also had a significantly higher risk of death involving ovid-19 (1.5 and 1.6 times, respectively) than White males once region, population density, socio-demographic and household characteristics were accounted for; whilst for females in Bangladeshi or Pakistani, Indian, Chinese and Mixed ethnic groups the risk of death involving Covid-19 was equivalent to White females.
Nick Stripe, Head of Life Events, Office for National Statistics said, “ONS analysis continues to show that people from a Black ethnic background are at a greater risk of death involving COVID-19 than all other ethnic groups. The risk for black males has been more than three times higher than white males and nearly two and a half times higher for black females than white. Adjusting for socio-economic factors and geographical location partly explains the increased risk, but there remains twice the risk for Black males and around one and a half times for black females. Significant differences also remain for Bangladeshi, Pakistani and Indian men. The ONS will continue to research this unexplained increased risk of death, examining the impact of other health conditions.”
Diabetes a slow killer?
It has also been revealed that South Asians’ death and increased rate of hospitalisation due to Covid-19 have been related to high level of diabetes. Prof Ewen Harrison, professor of surgery and data science and honorary consultant surgeon at the University of Edinburgh, the lead author of the study pointed out that people from South Asian background had 20% more chances of dying, than white population. The study analysed data from 40% of all people admitted in hospitals with Covid-19 between 6 February and 8 May in England, Scotland and Wales.
The paper which is not yet peer reviewed said that some ethnicities are at greater risks than other. It also said that increased prevalence of diabetes in the British South Asian population accounted for 18% of their increased risk of death.
According to Diabetes.co.uk, People from South Asian communities are known to be up to 6 times more likely to have type 2 diabetes than the general population. In addition, South Asians tend to have poorer diabetes management, putting them at higher risk of serious health complications.
South Asians without diabetes are also 3 times more likely to develop cardiovascular disease, but combined with type 2 diabetes, this risk rises even further, particularly for adults with type 2 diabetes aged 20 to 60.
The Study
27 institutions across the UK, including universities and public health bodies, as well as 260 hospitals, were involved in the study.
It is hugely significant as it evaluated data from four-in-ten of all hospital patients with Covid-19. The findings have been made public online ahead of being formally published in a medical journal. However, it has been revealed that the results were passed onto the UK Government's scientific advisory group - Sage - more than a month ago.
The study tells us only what happens when somebody is admitted in a hospital, not whether they were more likely to catch the virus. The study showed all ethnic minorities were more likely to need intensive care, partly due to the disease becoming more severe. However, it found that all ethnicities under study were admitted to hospital roughly around the same stage of Covid-19, which means there was no delay in getting help between ethnicities or access to health care.
The study highlighted, “Ethnic Minorities in hospital with Covid-19 were more likely to be admitted to critical care and receive IMV than Whites, despite similar disease severity on admission, similar duration of symptoms, and being younger with fewer comorbidities. South Asians are at greater risk of dying, due at least in part to a higher prevalence of pre-existing diabetes.”
The paper has been written by Prof Harrison along with 43 other authors including Srinivasa Vittal Katikireddi, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Manish Pareek of University of Leicester - Department of Respiratory Sciences, Naveed Sattar, University of Glasgow - Institute of Cardiovascular and Medical Sciences, Aziz Sheikh, University of Edinburgh - Asthma UK Centre for Applied Research and Ian P Sinha,
University of Liverpool - Women’s and Children’s Health.
34,986 patients were enrolled in the study, 30,693 (88%) had ethnicity recorded: South Asian (1,388, 5%), East Asian (266, 1%), Black (1,094, 4%), Other Ethnic Minority (2,398, 8%) (collectively Ethnic Minorities), and White groups (25,547, 83%).
It also found that Ethnic Minorities were younger and more likely to have diabetes (type 1/type 2) but had fewer other comorbidities such as chronic heart disease or dementia than the White group. No difference was seen between ethnic groups in the time from symptom onset to hospital admission, nor in illness severity at admission. Critical care admission was more common in South Asian (odds ratio 1.28, 95% confidence interval 1.09 to 1.52), Black (1.36, 1.14 to 1.62), and Other Ethnic Minority (1.29, 1.13 to 1.47) groups compared to the White group, after adjusting for age, sex and location. This was broadly unchanged after adjustment for deprivation and comorbidities. Patterns were similar for IMV. Higher adjusted mortality was seen in the South Asian (hazard ratio 1.19, 1.05 to 1.36), but not East Asian (1.00, 0.74 to 1.35), Black (1.05, 0.91 to 1.26) or Other Ethnic Minority (0.99, 0.89 to 1.10) groups, compared to the White group. 18% (95% CI, 9% to 56%) of the excess mortality in South Asians was mediated by pre-existing diabetes.
Prof Calum Semple, professor in child health and outbreak medicine at the University of Liverpool, and chief investigator on the report, told The Guardian that he believed occupation, which numerous studies on ethnicity and Covid-19 risk have been unable to take into account, was likely to be a significant factor.
Commenting on the above mentioned study, Dr Faye Riley, Senior Research Communications Officer at Diabetes UK, told Asian Voice: “We know that if you are South Asian you are more at risk of developing type 2 diabetes, as you are more likely to develop insulin resistance at a younger age. This research shows us that the higher prevalence of diabetes in the South Asian population is an important factor in explaining why people in this group have increased risk of poorer outcomes with Covid-19. But it also shows diabetes doesn’t fully account for this additional risk.
“The research also adds further weight to the evidence that people from South Asian backgrounds – and other BAME communities – are at greater risk of dying from Covid-19. This cannot be allowed to continue unchallenged.
“Governments across the UK must prioritise the rapid development of the tools and systems needed to provide a more personalised approach to risk assessment for individuals, alongside the development of more robust safeguards and support to better protect those who are identified as high risk from Covid-19.”
Genetic building?
According to diabetes.co.uk particularly cases of type 2 diabetes, is a growing health problem for people of South Asian descent. The likelihood of developing type 2 diabetes is reported to be as much as 6 times higher in South Asians than in Europeans, with a number of factors, mostly linked to lifestyle, believed to be behind this increased risk.
It is not entirely known why this is the case, but many experts believe diet, lifestyle and different ways of storing fat in the body all play a major part in upping the risk for this ethnic group. In terms of diet, traditional foods high in sugar and fat combined with western “fast foods” are thought to be a major factor behind the high rates of obesity amongst South Asian communities in western countries and could therefore also play a role in the development of diabetes.
Obesity, particularly central or abdominal obesity, is strongly associated with type 2 diabetes and people of South Asian origin are known to be more likely to have excess fat stored around the abdomen. Genes are thought to play a big too.
Inactivity, abdominal fat and Vitamin D
Dr Sreedhar Krishna, who is a Consultant Dermatologist in Croydon University Hospital, has a MPhil degree in Public Health in University of Cambridge and researched on the effects of physical inactivity on the risk of heart attacks. He has also published on the relationship between obesity and high blood pressure in Gujaratis.
Speaking to Asian Voice exclusively, Dr Krishna said, “BMI is an index of how much you weigh, divided by how tall you are. It is not a great index of if you are really obese. Rugby players are covered in muscles and according to BMI they could be classified as obese.”
For research BMI is an easily calculable index, that’s what all the data is based on. However, there are other ways of characterising this, which is a lot better. But they are not easily available or scalable. Hence the government or any such official sources use BMI as a reliable measurement.
“If you are Asian and obese- you will clearly be at more at risk. But there hasn’t been a national strategy by NHS England as to what to do with very high-risk people, and it is left to the individual hospitals to decide.”
Members of minority ethnic groups in the UK often have lower socioeconomic status, which is in turn associated with a greater risk of obesity in women and children.
Stressing on the nature of work and physical inactivity also leading up to these disproportionate deaths, Dr Krishna added, “Physical inactivity increases risk of heart attack and stroke. The nature of your work makes a huge difference. If you are at a desk job and don’t exercise, then you are in serious trouble. The way fat is deposited in Asian person is different from a Caucasian person. Although Asians get a bad reputation, when we look at the national data, we are not more obese than the general population. In fact, for Asians it is actually lower.”
Research says waist size is usually a better and easier thing to measure when it comes to excess fat.
“But underlying heart issues is actually more of a risk factor than obesity. Food habits and genetics contribute to that,” he added.
In the UK we get most of our Vitamin D from sunlight exposure from around late March and early April to the end of September. We need vitamin D to help the body absorb calcium and phosphate from our diet. These minerals are important for healthy bones, teeth and muscles.
“All Asian people should be taking Vitamin D.” said Dr Krishna. “Low Vitamin D is associated with everything from heart disease to suicide risks. Asians with low Vitamin D are at high risk of Coronavirus too. That’s one of the most important factors to look into.
“Poverty and socio-economic factors like living in crowded houses also add up to these deficits. Nature of your work – whether NHS, retail or transport, if you are not given PPEs, people from ethnic minorities are less likely to flag it, some of which is cultural- that can lead to risking your health further.
“I feel obesity and Vitamin D deficiency are part of the reasons for these disproportionate deaths. But not the only reasons.”
